H and N cancer Flashcards
What is leukoplakia?
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
Take a detailed history from a patient with dysphagia
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
Ix for HN C
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.
What is the most common type of HN cancer ? What are the common symptoms?
Mouth cancer: affects the tongue, inner lip, gingivia, hard palate.
Persistent ulcers or lumps in the mouth
How are mouth cancers treated?
Surgery, usually with skin graft
- maxillectomy
- mandibulectomy
- glossectomy
- radical neck disection
- mohs procedure
Symptoms and risk factors for Nasopharyngeal cancer?
- epistaxis
- blocked nose
- lump in the neck
- hearing loss (unilateral)
nickel, wood-dust
Where does oropharyngeal cancer tend to affect? Risk factors?
hard palate, tonsils, pharyngeal wall (lateral and posterior), base of tongue
smoking, alcohol, hpv, betal-nut chewing, iron deficiency anaemia, radiation
Histology of OP cancers?
SCC, but also NHL, minor salivary gland tumours
What is the hypopharynx?
connects oropharynx with the trachea: pyriform sinus, posterior pharyngeal wall and the post-cricoid area
Cancer of the hypopharynx has a good prognosis, true or false? Why?
false, terrible prognosis. late presentation. extensive lymph node network around the larynx
Laryngeal cancer presents how?
- difficulty swallowing
- pain on swallowing
- voice change
- breathing changes: short of breath, noisy breathing
- persistent cough
- lumps in neck
affects vocal cords too!
Treatment of layngeal cancer?
- laser removal
- partial laryngectomy
- total laryngectomy with tracheostomy
Presentation of nose and sinus caner?
- anosmia
- mucous streaming down throat or face
- epistaxis
- blocked throat
Name the laryngeal cartilages
cricoid thyroid (C3/4) epiglottis arytenoids corniculate cuneiforms
Management of leukoplakia
lifestyle changes
retinoids
surgery
What is hairy leukoplakia?
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
What is erythroplakia?
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
How does nasopharyngeal carcinoma tend to present?
painless lymphadenopathy- because of its early spread
also presents with epistaxis, unilateral hearing loss, headaches,
Drainage into the posterior triangle node is from?
the nasopharynx
Drainage into the anterior triangle nodes is from?
larynx, buccal mucosa, and tonsillar fossa
