cancer- head/neck Flashcards
1
Q
what is cancer
A
- Disease that results when cells undergo cellular change causing proliferation and uncontrolled growth of abnormal cells
- Cells within the body, naturally go through a cellular life expectancy and death and undergo a natural process of apoptosis
- Cancer cells grow uncontrollably and at different rates and do not die a natural, normal death within their life cycle
2
Q
aetiology of head/neck cancer
A
- the sixth most common cancers worldwide and an important cause of ill health
- usually refer to neoplasms of the soft tissue origin that develop in the oral cavity
- The majority of head and neck cancers are squamous cell carcinomas
- Tobacco and alcohol consumption are considered to be risk factors and it was previously estimated that these risk factors accounted for about 75% of cases
- A study in the UK in 2016 highlights that the incidence of laryngeal cancer, possibly correlating with a downturn in the number of people smoking
- More recently human papillomavirus (HPV) has emerged as a likely cause of oropharyngeal cancer. This is undergoing consistent research
3
Q
risk factors for head/neck cancer
A
- Tobacco Smoking
- Alcohol Consumption
- Poor oral & dental hygiene
- Environmental conditions
- Age (>40)
- Gender (men are 2-3 times more likely to develop HNSCC than women)
- HPV, EBV
- Radiation
4
Q
epidemiology
A
- HNSCC is the sixth leading cancer by incidence worldwide (WHO)
- Cancer of the oral cavity and pharynx is more common in males than females
- However there is correlation with HPV Incidence increases with age: <7/100000 in the <40 yrs of age compared to 40.1/100000 in the 70-74 yrs of age
5
Q
signs/symptoms of oral cancer
A
- mouth pain or pain when swallowing
- a persistent sore or swelling in the mouth
- unusual bleeding or numbness in the mouth
- red or white patches on the gums, tongue or mouth
- changes in speech or difficulty pronouncing words
- difficulty chewing or swallowing food, difficulty moving the tongue or limited chewing
- weight loss
- a lump in the neck
- loose teeth, or dentures that no longer fit
- earache, or ringing in the ears
6
Q
signs/symptoms of laryngeal cancer
A
- swelling or a lump in the neck or throat
- a persistent sore throat
- a persistent change in the sound of your voice, including hoarseness
- difficulty swallowing or pain when swallowing
- constant coughing
- difficulty breathing
- weight loss
7
Q
signs/symptoms of pharyngeal cancer
A
- throat pain or difficulty swallowing
- a persistent sore throat or cough
- coughing up bloody phlegm
- bad breath
- weight loss
- voice changes or hoarseness
- dull pain around the breastbone
- a lump in the neck
- pain in the ear or frequent ear infections
- feeling that your air supply is blocked
- numbness of the face
- nasal congestion
- hearing loss
- headache
8
Q
signs/symptoms of nasal/ paranasal sinus cancer
A
- decreased sense of smell
- a persistent blocked nose, particularly in one nostril
- frequent nosebleeds
- excess mucous in the throat or back of nose
- frequent headaches or sinus pressure
- difficulty swallowing
- loose or painful upper teeth
- a lump on/in the face, nose or mouth
- numbness of the face, upper lip, or within the mouth or upper teeth
- pressure or pain in the ears
- a bulging or watery eye
- double vision
- complete or partial loss of eyesight
9
Q
clinical examination of HNSCC
A
- Thorough examination of head and neck area through palpation, checking for any lumps or abnormalities
- Looking inside mouth and throat with lights to assess for any changes or abnormal findings
- Endoscopy procedure: nasopharyngoscopy, pharyngoscopy, or laryngoscopy. Allows for visualisation beyond the human eye
- Biopsy- of suspicious cells
- Preserving organ function and reducing toxic effects are increasingly the focus of clinical trials
- During the past 5–10 years, chemo-radiotherapy was shown to markedly improve survival and organ preservation
10
Q
what imaging modalities are used for imaging head and neck cancers
A
head mri CT scan of the paranasal sinuses/neck OPG PET scan US Fluoroscopy
11
Q
how is CT used for head/neck cancer imaging
A
- Mainstay for primary disease
- Disadvantages (radiation, often administer iodine vascularity of tumour, can be nephrotoxic/ cause an allergic reaction, limited soft tissue resolution)
- Advantages (good spatial resolution, delineates between tumour extent and nodal disease, quick acute diagnosis, good bone detail of surrounding structures, due to rapidity of scan, unliked for patient motion)
12
Q
how is MRI used for head/neck cancer imaging
A
Versatile technique that has the advantage of providing not only anatomical information but also molecular, metabolic, and physiological information
- Disadvantages of MRI (not easily accessible, motion artefact, detection of subtle osseous abnormalities, long scan time)
- Advantages of MRI (improved soft tissue contrast, non-ionising radiation, various sequences demonstrate various aspects
13
Q
how is PET used for head/neck cancer imaging
A
- Labelled tracers fuse CT images with a functional map
- Royal College of Radiologists published evidence based guidelines for PET–CT use in head and neck cancer
- Multi-modality approach
- FDG PET/CT imaging is particularly useful to detect residual disease in neck lymph nodes
- In patients with suspected recurrence, PET/CT has the highest sensitivity and specificity regardless of the primary treatment modality. However, post therapy inflammation remains a potential source for false positive interpretation
14
Q
how is US used for head/neck cancer imaging
A
- Useful tool for cervical lymph node staging & investigating thyroid and salivary gland tumours
- Great resolution in superficial structures
- Limitations in assessment of deep lesions, however, it is a useful tool for biopsy guiding masses within the neck
15
Q
Treatment options for HNSCC
A
Surgery
RT
Chemotherapy
