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Cancer care (Y4) > 5- Head and neck cancers > Flashcards

5- Head and neck cancers Flashcards

1
Q

epidiemology of H and N cancer

A
  • 12,000 cases per year
    o 4th most common in men
    o 13th in women
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2
Q

key types of H and N cancer

A

o Oral cancer
o Nasal cancer
o Laryngeal cancer
o Thyroid cancer

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3
Q

pathophysiology of most H and N cancer

A
  • Begin in the mucosal surfaces lining the cavities of the head and neck -> mostly squamous cell carcinoma
  • Also of the salivary glands
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4
Q

Huge psychological impact of advanced H+N tumours

A
  • Breathing
  • Eating
  • Communication
  • Carotid
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5
Q

P16- tumour suppressor in H&N cancer

A

p16 is a tumor suppressor gene, over expression of which is considered as a surrogate marker of oncogenic human papillomavirus (HPV) infection. Moreover, p16 over expression correlates with good prognosis in head and neck squamous cell carcinoma (HNSCC).

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6
Q

Metastasis of H+N cancer

A
  • Local invasion
  • Lymph nodes
  • Lungs
  • Also bone, liver, brain
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7
Q

Risk factors of H+N cancer

A
  • Smoking
  • Alcohol
  • Betel nut chewing
  • HPV- oropharynx
  • EBV- nasopharynx
  • Wood dust
  • Asbestos
  • Ethnicity
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8
Q

presentation of H+N cancer

A
  • Depends on location
  • Often lymphadenopathy first noticed by patient
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9
Q

referral for H+N cancer

A

Referral
2- week wait referral if persistent and unexplained
- Lumps in the
o Neck
o Lip
o Oral cavity
- Ulceration in the oral cavity lasting more than 3 weeks
- Hoarseness

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10
Q

Investigation for H+N cancer

A
  • US and final needle aspiration
  • CT/MRI scan
  • Panendoscopy (upper airway camera) and biopsy EUA
  • PET scan
  • P16 – blood test for tumour suppressor gene
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11
Q

general management of H+N cancer

A
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12
Q

red flag symptoms

A
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13
Q

staging of H+N cancers

A
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14
Q

Oral cancer
Background

A
  • Lip/tongue/ oral cavity
  • Premalignant conditions- white plaques on tongue
    o Leucoplakia
    o Erythroplakia
  • SCC
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15
Q

presentation of oral cancer

A

Presentation
- Lump
- Pain (but typically painless)
- Fixation of tongue
- Problems swallowing (dysphagia)
- Pain on swallowing (odynophagia)

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16
Q

investigations of oral cancer

A

Investigations
- Biopsy
- May need imaging with CT +/- MRI (including chest)- not needed for superficial lip lesion
- May need PET

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17
Q

Management of oral cancer

A

- Early tumour T1/T2 trans oral resection (laser or robotic + neck dissection)
- Large tumour- surgical resection +- flap reconstruction + neck dissection +- radio and chemo

18
Q

laryngeal cancer background

A

Mainly SCC
Types
- Supraglottic
- Glottis (better prognosis due to becoming hoarse earlier)
- Subglottic

19
Q

Presentation of laryngeal cancer

A
  • Dysphonia (hoarse) - problems speaking
  • Dysphagia
  • Referred otalgia
  • Globus- abnormal sensation of lump in throat
  • Neck lump
  • Weight loss
  • Cachexia
  • Stridor if advanced
20
Q

Presentation of laryngeal cancer

A
  • Dysphonia (hoarse) - problems speaking
  • Dysphagia
  • Referred otalgia
  • Glovbus- abnormal sensation of lump in throat
  • Neck lump
  • Weight loss
  • Cachexia
  • Stridor if advanced
21
Q

investigations for laryngeal cancer

A

Investigations
- Imaging with CT +/- MRI
- May need PET
- Biopsy during flexible nasal endoscopy (FNE)
- Fine needle aspiration of cervical lymphaendompathy

22
Q

prognosis of laryngeal cancer

A

Prognosis
- Poor
- Often have long term voice issues and/or swallowing problems

23
Q

management of laryngeal cancer

A
  • Small tumours(T1/T2)may have laser resection or Radiotherapy (RT)
  • Medium sized tumours do well with RT and chemo
  • Larger tumours (T4a) that do not respond to RT mat need extensive surgery (laryngectomy- remove voicebox and disconnected oral cavity from the airway)
    o May need an electrical larynx
    o Recurrent cancer: Salvage Laryngectomy
24
Q

pharynx cancer background

A
  • Location
    o Oropharynx
    o Nasopharynx
    o Hypopharynx (majority)
  • Usually SCC
  • Frequently at advanced stage and metastasise early
25
Q

Presentation of pharynx cancer

A

often presents late – 25% untreatable at presentation

  • Lump (mainly nodal mets or unknown primary)
  • Pain- glossopharyngeal nerve (Referred otalgia )
  • Dysphagia
  • Pain on swallowing- odynophagia
  • Weight loss
  • Stertor (snoring noise)
  • Trotters syndrome (nasopharyngeal malignancy)

1) Unilateral conductive hearing loss
2) Trigeminal neuralgia
3) Defective mobility of the soft palate

26
Q

investigations for pharynx cancer

A

Investigation
- Imaging with CT +/- MRI
- May need PET
- Biopsy

27
Q

management of pharynx cancer

A
  • Small tumours undergo surgical resection using laser or transoral robotic surgery +- neck dissection or primary radiotherapy or both
  • Large tumours undergo solely primary radiotherapy +/- adjuvant chemo
  • Larger tumours that do not respond to RT may need extensive surgery (mandibular split or other type of pharngectomy or robotic procedure)
28
Q

patients who have extensive surgery due to pharynx cancer will often need

A

need feeding assistance with gastrostomy tubes

29
Q

types of thyroid cancer

A

Papillary adneocaricnoma (80%)
Follicular adenocarcinoma (10%)
Medullary carcinoma
Lymphoma
Anaplastic carcinoma

30
Q

Papillary adenocarcinoma (80%)

A
  • 40-50 yo females
  • Multiple lesions rarely encapsulated
  • Histologically cells are a mixture between papillary and colloid-filled follicles, with papillary projections and pale empty nuclei
  • Spread via lymphatics
31
Q

Follicular adenocarcinoma (10%)

A
  • 40-60 females
  • Focal encapsulated lesion with microscopic capsular invasion
  • Haematogenous spread to bones and lungs
32
Q

Medullary carcinoma

A
  • Arise in parafollicular cells
  • Produce raised calcitonin levels
  • Associated with MEN 2 syndrome
  • Spread via lymphatic and medullary routes
  • Nodal disease associated with very poor prognosis
33
Q

Anaplastic carcinoma

A
  • Rare tumours
  • Elderly
  • Very aggressive
  • Grow rapidly with earl local invasion
  • Prognosis is poor
34
Q

Lymphoma

A

 Very rare
 >60 yo
 Grow rapidly
 B-cell symptoms

35
Q

Risk factors (specific to thyroid)

A
  • Irradiation exposure (including radioactive iodine and radiation leaks)
  • Family history e.g. FAP, MEN2
  • Hashimoto’s disease
  • Lumps in those <20 or >70 more likely to be malignant
36
Q

presentation of thyroid cancer

A

Presentation
- Tend to present with a lump (in the thyroid or neck nodal metastasis)
- moves on swallow
- Rarely have problems with the thyroid status

Compressive symptoms
- Problems swallowing or feeling like being strangled
- Voice can change

Red flags
- Rapid growth
- Pain
- Cough, hoarse voice, stridor
- Multiple enlarged cervical lymph nodes
- Tethering of lump

37
Q

examination for thryoid cancer

A

Swallow and stick out tongue
- Any lump related to thyroid will move on swallowing
- If the lump moves when tongue being stuck out- thyroglossal cysts

38
Q

Investigations for thyroid cancer

A

Bloods
- TFTs
- Serum calcitonin may be useful for diagnosis and monitoring in medullary carcinoma

US imaging
- Microcalcification
- Hypoechogenicity
- Irregular margin

FNA if suspicious lump via cytology

39
Q

Management of thyroid cancer

A
  • Hemi-thyroidectomy or total thyroidectomy depending on type of carcinoma
  • Neck dissection for N+ disease (locally advanced)
  • Radioactive iodine
    o Iodine is only used by thyroid gland- very useful target
  • Radiotherapy/ chemotherapy
40
Q

Complications of thryoid surgery

A
  • Haematoma forming under the skin which can cause airway obstruction- emergency
    –> Wound must be re-opened and drained
  • Hypocalcaemia
    –>If parathyroid gland removed
  • Vocal cord paralysis due to damage to the recurrent laryngeal nerve
41
Q

prognosis of thyroid cancer

A

Prognosis

  • For papillary cancer, prognosis is quite good with 10 year survival of 90% (this drops considerably if the tumour has spread beyond the gland)
  • Follicular cancer has a high 10 year survival at around 85% (haematogenous spread is a marker of poorer prognosis)
  • Medullary cancer also has a good prognosis, with 10 year survival dropping only below 90% when nodal or metastatic spread is seen.
  • For anaplastic cancer, there is a very poor prognosis with a 1 year survival of 10-20%
42
Q

neck lump differentials

A

Cancer care (Y4) (30 decks)

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