5: Head and neck cancer Flashcards
What are the big risk factors for head and neck cancers?
Smoking
Alcohol
Viruses (HPV)
Which strains of HPV cause papillomas and carcinomas?
Papillomas - HPV 6 and 11
Carcinomas - HPV 16 and 18
Young people tend to develop head and neck cancers due to ___.
viral infection
HPV - oral sex
What virus is linked to nasopharyngeal carcinoma?
Epstein Barr virus (EBV)
Where do oral cancers tend to arise?
Buccal mucosa
Lateral borders of tongue
What should you do if you find a dodgy lesion on oral examination?
Feel it
How do
a) benign
b) malignant
oral lesions feel?
a) Soft
b) Firm
What would you find on neck examination of someone with ENT cancer?
Enlarged lymph nodes
Thyroid lumps (which move up and down)
What is used to look into the pharynx and larynx?
Endoscope
How are biopsies taken from ENT tumours?
FNA
Apart from endoscopy and biopsies, what other investigations are done for head and neck cancers?
Ultrasound
X-ray
MRI
CT
Are blood tests done for head and neck cancers?
No
not many markers for these cancers
Which scan is used for bony cancers?
Which scan is used for soft tissue cancers?
CT (hard)
MRI (soft)
Why are CXRs commonly done in addition to investigations for head and neck cancers?
Risk factors for ENT / lung cancers are the same
So chances are they have primary / secondary lung cancers as well
How are head and neck cancers managed?
MDT
What is the most common form of ENT cancer?
Squamous cell carcinoma
because the cavities are lined by squamous epithelium
Does hoarseness automatically mean a glottic tumour?
No
Which cranial nerve is disrupted to cause hoarseness?
What are some possible causes?
CN X
Disruption to recurrent laryngeal nerve, so lung problems and aortic aneurysm
Apart from CN X, which other cranial nerve can be damaged by ENT cancers?
CN VII
Which lymph node becomes enlarged in a variety of different, diffuse cancers?
Virchow’s node
Left supraclavicular node
Why might a patient become hypocalaemic following ENT surgery?
Removal of parathyroid glands
i.e glands can be gammied by cancer surgery
What is the difference between wheeze and stridor?
Wheeze is EXPIRATORY, deep, best heard over the lung bases
STRIDOR is INSPIRATORY, high pitched, comes from the upper airways
(Stertor is the preceding sound)
What may be compromised in ENT cancers?
Airway
Why may a patient with ENT cancer experience dysphagia?
Compression of oesophagus
Why is it important for cancer patients to see the same doctor on each visit?
Continuity of care - trust
Confidentiality
If a relative asks to discuss a patient’s condition, what do you need?
Patient’s consent
