Diseases of the head and neck Flashcards
What kind of carcinoma accounts for 90-90% of malignancies of the oral cavity?
squamous cell carcinoma
Is the incidence and mortality related to oral squamous cell carcinoma increasing or decreasing?
Increasing
What are the survival rates of oral squamous cell carcinoma?
Less than 50%
What are the 6 most common sites of oral squamous cell carcinoma?
1) Floor of mouth
2) Ventrolateral tongue
3) Retromolar region
4) Lower lip
5) Soft palate
6) Gingiva
What are the 2 dominant risk factors for oral carcinoma?
Tobacco and alcohol abuse (account for 75% of the disease burden or oral carcinoma)
What is a major cause of oral carcinoma in parts of SE Asia, China and Taiwan?
Oral smokeless tobacco
Which virus is found in some cases of oral carcinoma?
HPV - types 16 and 18
How common is HPV infection in oral carcinoma?
- In a small proportion of oral carcinoma
- Up to 50% of oropharyngeal SCC - particularly involving the tonsils and tongue base
How does the finding of HPV infection in oral carcinoma alter survival?
Interestingly tend to have better survival rates than HPV negative patients
In addition to tobacco, alcohol and HPV infection, name the 2 other risk factors for oral carcinoma?
1) Dietary factors - fruits and veg = protective, meat and chilli powder = risk factor
2) Genetic factors
Give 5 pre cancerous conditions in carcinoma of the oral cavity?
1) Submucous fibrosis
2) Actinic keratosis
3) Lichen planus
4) Leukoplakia and erythroplakia
5) Chronic hyperplastic candidosis
What is the mechanism of spread of carcinoma of the oral cavity?
Almost always tumour embolism
Local metastasis of oral carcinoma goes to where?
Cervical lymph nodes
Distant metastasis of oral carcinoma commonly goes to which 4 places?
1) Mediastinal lymph nodes
2) Lung
3) Liver
4) Bone
What is the most common type of cancer of the larynx?
Squamous cell carcinoma
What is laryngeal carcinoma historically treated with?
Total laryngectomy
What are the 2 major risk factors for laryngeal carcinoma?
1) Tobacco
2) Alcohol
Infection with what 2 types of HPV is a risk factor for laryngeal carcinoma?
Types 6 and 11
In addition to HPV infection, tobacco and alcohol, what are the 6 other risk factors for laryngeal carcinoma?
1) Diets low in veg, high in meat, fat and salt
2) Metal/ plastic workers
3) Exposure to paint, diesel and gasoline fumes and asbestos
4) Exposure to radiation
5) Laryngopharyngeal reflux
6) Genetic susceptibility
What is Lichen Planus?
A non malignant inflammatory condition which is a muco cutaneous condition - involves cutaneous lesions and oral lesions
Is there a risk of malignant transformation in Lichen Planus?
A small risk
How do the cutaneous lesions appear in Lichen Planus?
Itchy, purple papules forming plaques with Wickam’s striae
How do the oral lesions appear in Lichen Planus?
Reticular striations, plaque-like, erosive, ulcerative, desquamative gingivitis
What is the suggested pathogenesis of Lichen Planus?
T cell mediated autoimmune response
What is the pathogenesis of vocal cord nodules and polyps?
Reactive lesions which are most often seen in heavy smokers and individuals who impose great strain on their vocal cords - adults and males mostly
What is the main symptom associated with vocal cord nodules and polyps?
Voice change eg. hoarseness, change in quality and increased effort in producing the voice
What part of the larynx are vocal cord nodule and polyps usually located in?
True vocal cords
What is the pathogenesis of nasal polyps?
Related to recurrent attacks of rhinitis which lead to focal protrusions of the mucosa, which may reach 4cm in size - features point to an allergic aetiology but most patients aren’t atopic
When do symptoms of nasal polyps tend to occur?
When polyps are large and multiple they can start to encroach the airway and impede sinus drainage
What is the histology of nasal polyps? 5
Oedematous muscosa Loose stroma Hyperplastic mucous glands Inflammatory infiltrate Eosinophils
Acute sinusitis is usually preceded by what condition?
Acute or chronic rhinitis
When may acute sinusitis progress into chronic sinusitis?
When there is impairment of sinus drainage
Obstruction in sinusitis most commonly affects which sinuses?
Ethmoid
Where can maxillary sinusitis commonly arise from?
Extension of infection from an upper tooth through antral floor
The causative organisms of sinusitis are commonly inhabitants of which flora?
Oral flora
In which patients is sinusitis sometimes caused by fungi?
Diabetics
What is the major complication of sinusitis?
Spread to osteomyelitis, meningitis, cerebral abscess
Chronic otitis media commonly results from what?
Recurrent and persistent episodes and failure of resolution of acute bacterial infections
What are the 3 most common causative organisms in chronic otitis media?
Pseudomonas aeruginosa
S aureus
Fungi
What are the 4 major complication of otitis media?
1) Perforation of eardrum
2) Aural polyps, cholesteatoma
3) Mastoiditis - spreading to cerebral abscess
4) Malignant otitis media
What is cholesteatoma and what is it associated with?
Associated with chronic otitis media
Get cystic lesions lined by keratinising squamous epithelium and filled with debris and cholesterol
Why may a foreign body giant cell reaction occur in cholesteatoma?
Lesion precipitates surrounding inflammatory reaction which is enhanced if the cyst ruptures and then results in foreign body giant cell reaction
What are the 3 potential complications of cholesteatoma?
1) Enlargement leading to erosion of ossicles , labyrinth and adjacent bone and surrounding tissue
2) Hearing loss
3) Very rarely CNS complication (abscess)
What is otosclerosis?
Abnormal bone deposition in the middle ear due to uncoupling of normal bone resorption and bone formation
Is otosclerosis usually unilateral or bilateral?
Bilateral
How does otosclerosis progress?
1) Fibrous ankyloses
2) Bony overgrowth
3) Anchorage of middle ear bones to oval window
What determines the severity of hearing loss in otosclerosis?
Degress of immobilisation of the ossicles, in most cases eventually get marked hearing loss
What is the cause of otosclerosis?
Most cases are familial
What is labyrinthitis?
Inflammatory disorder of the inner ear or labyrinth - produces disturbances of balance and hearing
By what 2 processes is labyrinthitis caused?
1) Acute inflammation of the labyrinth in conjunction with either local or systemic bacterial or viral infections
2) Autoimmune processes eg. Wegener granulomatosis or polyarteritis nodosa
What 2 carcinomas are most common in the external ear (pinna)?
1) Squamous cell carcinoma
2) Basal cell carcinoma
Carcinoma of the external ear tend to occur in which group and are associated with what exposure?
Elderly men
Associated with actinic radiation
What carcinoma occurs in the ear canal?
Squamous cell carcinoma
In which group is carcinoma of the ear canal most common?
Middle aged elderly women
Is carcinoma of the ear canal associated with sun expsosure?
No
What is the most common tumour of the middle ear?
Paragangliomas
Where do paragangliomas arise?
Originating in the paraganglia
What are the 6 presenting symptoms of paraganglioma?
1) Pulsatile tinnitus
2) Hearing loss
3) Aural pressure/ fullness
4) Dizziness
5) Otalgia
6) Bloody otorrhea
