H and N cancer

Question 1

What is leukoplakia?

Answer 1

Leukoplakia is a condition in which thick, white or grayish patches form usually inside your mouth. It is a hyperkeratosis. Smoking is the most common cause. But other irritants can cause this condition as well. More common in men

It is a risk factor for H and N cancer. 3% do undergo malignant change in 5 years
Ulceration or erosions are a sign

Question 2

Take a detailed history from a patient with dysphagia

Answer 2

Think swallowing:
pain or difficulty swallowing
Think sensation:
otalgia
sore throat
globus

Think chewing and speaking:
difficulty chewing
difficulty moving tongue
numbness of the tongue
voice changes
swelling of the jaw

Lumps:
thickened mouth tissue
lumps that have enlarged

Mouth ulcers that haven’t disappeared. Half of HN cancer originates from the mouth

Extra stuff:
SOB?
Bowel habits?
Weight loss usually secondary to dysphagia, thus if present be more suspicious of spread

Risk factors
FMH

Question 3

Ix for HN C

Answer 3

FNAC under Uss
CT/MRI H and N
CXR or CT chest
FBC, U&E, LFT, glucose, albumin, TFT
ECG
Nutritonal status 

Consider panendoscopy to look at upper aerodigestive tract.

Question 4

What is the most common type of HN cancer ? What are the common symptoms?

Answer 4

Mouth cancer: affects the tongue, inner lip, gingivia, hard palate.
Persistent ulcers or lumps in the mouth

Question 5

How are mouth cancers treated?

Answer 5

Surgery, usually with skin graft

• maxillectomy
• mandibulectomy
• glossectomy
• radical neck disection
• mohs procedure

Question 6

Symptoms and risk factors for Nasopharyngeal cancer?

Answer 6

• epistaxis
• blocked nose
• lump in the neck
• hearing loss (unilateral)

nickel, wood-dust

Question 7

Where does oropharyngeal cancer tend to affect? Risk factors?

Answer 7

hard palate, tonsils, pharyngeal wall (lateral and posterior), base of tongue

smoking, alcohol, hpv, betal-nut chewing, iron deficiency anaemia, radiation

Question 8

Histology of OP cancers?

Answer 8

SCC, but also NHL, minor salivary gland tumours

Question 9

What is the hypopharynx?

Answer 9

connects oropharynx with the trachea: pyriform sinus, posterior pharyngeal wall and the post-cricoid area

Question 10

Cancer of the hypopharynx has a good prognosis, true or false? Why?

Answer 10

false, terrible prognosis. late presentation. extensive lymph node network around the larynx

Question 11

Laryngeal cancer presents how?

Answer 11

• difficulty swallowing
• pain on swallowing
• voice change
• breathing changes: short of breath, noisy breathing
• persistent cough
• lumps in neck

affects vocal cords too!

Question 12

Treatment of layngeal cancer?

Answer 12

• laser removal
• partial laryngectomy
• total laryngectomy with tracheostomy

Question 13

Presentation of nose and sinus caner?

Answer 13

• anosmia
• mucous streaming down throat or face
• epistaxis
• blocked throat

Question 14

Name the laryngeal cartilages

Answer 14

cricoid
thyroid (C3/4)
epiglottis
arytenoids
corniculate
cuneiforms

Question 15

Management of leukoplakia

Answer 15

lifestyle changes
retinoids
surgery

Question 16

What is hairy leukoplakia?

Answer 16

related to EBV, HIV. Often asymptomatic but can show pain, dysaesthesia, alteration of taste and cosmetic impact.
Antiviral therapy, topical retinoid , surgery, even vigorous brushing

Question 17

What is erythroplakia?

Answer 17

red velvety presentation of red patches. Macular/Papular with well defined borders. Often associated with dysplasia- premalignant
Often affects floor of the mouth, the tongue and soft palate.

Biopsy and surgical excision

Question 18

How does nasopharyngeal carcinoma tend to present?

Answer 18

painless lymphadenopathy- because of its early spread

also presents with epistaxis, unilateral hearing loss, headaches,

Question 19

Drainage into the posterior triangle node is from?

Answer 19

the nasopharynx

Question 20

Drainage into the anterior triangle nodes is from?

Answer 20

larynx, buccal mucosa, and tonsillar fossa