Dysphagia and head and neck cancers Flashcards
What is the main investigation for dysphagia?
Endoscopy
What are the crutial questions in a dysphagia history?
Can fluid be drunk as fast as usual?
-Yes - suspect stricture
-No -motility disorder (achalasia, neurological cause)
Is it difficult to make the swallowing movement?
-Yes - Suspect bulbar palsy esp. if cough on swallowing
Is the dysphagia constant and painful?
-yes - suspect malignancy
Does the neck bulge or gurgle on drinking?
-Yes - suspect pharyngeal pouch
What tests should be done for dysphagia?
FBC, ESR, U and E, Barium swallow, endoscopy, oesophageal motility studies
What are the clinical features and treatment of oesophageal cancer?
CLinical features: -Dysphagia -Hoarseness -cough -weight loss Treatment: -surgery with chemo/radiotherapy
What are the causes and treatment of benign oesophageal stricture?
Causes: -reflux -Swallowing corrosives -trauma -foreign body Treatment: -Endoscopic
What is the pathophysiology, investigation and treatment of dysphagia?
This is when a hearniation of the pharangeal mucosa occurs possibly due to an incoordination of swallowing
The investigations are barium swallow and endoscopy to exclude malignancy
Treatment if symptomatic is endoscopic stapling of the entrance to the pouch
What is globus pharungeus and how is it treated?
The sensation of a lump in the throat, most noticed when swallowing saliva
It is treated with reassurance as the condition is worsened by anxiety
Endoscopy may be required to exclude malignancy
What are the majority of head and neck cancers?
They are squamous cell carcinomas of the aerodigestive tract
What are the associations with head and neck cancers?
Smoking
HPV
Alcohol consumption
What are the suspicious symptoms for head and neck cancers?
Neck lump Hoarse voice >6weeks Sore throat >6weeks Mouth bleeding Mouth numbness Sore tongue Painless ulcers Speech change dysphagia
What are the investigations for head and neck cancers?
Fibre optic endoscopy to look for any abnormalities
Fine needle aspiration or biopsy of any masses
CT or MRI to look for nodal metastatic disease
What are the signs and symptoms of oral cavity or tongue cancers?
Perisitent painful ulcers
Red or white patches on the tongue
Otalgia
Lymphadenopathy
What is the treatment for most head and neck cancers?
Surgery and radiotherapy
How does oropharyngeal cancer typically present?
This often presents late with sore throat, sensation of lump and referred otalgia
MRI is the best form of imaging
How does laryngeal cancer present?
This is typically an older smoking patient, progressive hoarseness, the stridor, difficulty swallowing
Younger patients tend to be HPV positive
