H&N Cancer Flashcards
Laryngeal cancer
Symptoms [5]
Indicate which symptoms should prompt ENT referral in age 45 and over [2]
Which subtype if most common [1]
Hoarseness for more than 3w* Irritation in throat Cough Referred otalgia Neck lump* Most common: squamous cell laryngeal cancer
Laryngeal cancer Squamous cell laryngeal cancer Describe the classical patient's symptoms [6] Typical younger patient history? [1] Diagnosis [2]
Old male smoker Progressive hoarseness Stridor Dysphagia Haemoptysis Ear pain Typical young patient: HPV +ve Dx: laryngoscopy + biopsy
Laryngeal cancer Squamous cell laryngeal cancer Management options [2] Treatment for HPV positive [1] Post-op care [4]
Radical radiotherapy
Total laryngectomy + block dissection of neck glands
HPV: respond better to chemo
Post-op care:
- Permanent tracheostomy
- Must learn esophageal speech
- Fit voice prosthesis
- Recover speech within weekS
- Laryngectomy support group
Care of tracheostomy
[3]
Excess secretions and crusting around stoma
- humidified stomal covers
Avoid fishing, deep water
H&N Ca
Nasopharyngeal cancer
Symptoms [8]
Symptoms:
- Neck pain, sore tongue, ear ache
- Hoarse voice >6w
- Sore throat >6w
- Mouth bleeding, numbness, epistaxis
- Sinus congestion, ear effusion
- Painless ulcers
- Lumps
- Speech change
- Dysphagia
H&N Ca
Nasopharyngeal cancer management [3]
Radiotherapy is mainstay
Chemotherapy
Surgery- radical neck dissection
H&N Ca Oropharyngeal cancer Describe typical older patient history [4] Risk factor [1] Imaging [2]
Typical older patient: Smoker with sore throat Sensation of lump Referred otalgia Local irritation by hot/cold foods
Risk factors
- Chewing/smoking tobacco
Imaging
- MRI
- Contrast enhanced C
Nasopharyngeal cancer associations [5]
Associations:
- HLA A2 allele
- HPV, EBV
- Tobacco, formaldehyde
- Wood dust exposure, weaning onto salted fish
- 25% in China, 1% in UK
Staging of nasopharyngeal cancer. Describe:
T1-4
N1-3
T1 Nasopharynx, oropharynx, or nasal cavity
T2 Parapharyngeal extension
T3 Bony structures of skull-base/paranasal sinuses
T4 Intracranial, cranial nerves, hypopharynx, orbit,
infratemporal fossa/masticator space
N1 Unilateral cervical, unilateral or bilateral retroph-
aryngeal nodes, above supraclavicular fossa,
≤6cm in the greatest dimension.
N2 Bilateral cervical above supraclavicular fossa ≤6cm
N3 >6cm. N3b Supraclavicular fossa.
What does Stage 2 and Stage 3 Nasopharyngeal cancer include in terms of T and N staging?
Stage II=T1N1 to T2N0–1. Stage III=T12N2 to T3 N0–2.
Oropharyngeal cancer
Surgery [6]
When would RT be first line?
- Jejunal flaps
- tubed skin flaps (eg radial forearm or anterolateral thigh flaps)
- gastric pull-ups
- transoral laser
- robotic surgery
- partial laryngeal surgery
RT first line if T1 or T2
Hypopharyngeal tumours
Premalignant lesions [2]
Associations [4]
premalignant conditions: leukoplakia and Patterson–Kelly–Brown syndrome (Plummer–Vin- son)
They are as- sociated with previous irradiation, smoking and alcohol, but not as clearly as laryngeal carcinoma.
Squamous cell laryngeal cancer
Describe typical older patient [5]
Risk factors [2]
Older patient: Male smoker with progressive hoarseness > stridor > difficulty/painful swallow
Regular cannabis users
Younger patient: HPV positive
Squamous cell laryngeal cancer
Ix [3]
Mx [2]
If recurrence after radiotherapy what is a surgical option?
Ix: laryngoscopy + biopsy, MRI imaging
Mx:
- Radical radiotherapy
- Or Total laryngectomy +/- block dissection of neck glands
- Recurrence after radiotherapy: Partial ‘salvage’ laryngectomy, gives reasonable preservation of laryngeal function
After total laryngectomy [4]
- Permanent tracheostomy
- Must learn esophageal speech
- Voice prosthesis can be fitted at surgery so reasonable speech possible within weeks
- Give pre-op counseling
- Excess secretions are common and need meticulous attention
- Avoid fishing and deep water
Sinus squamous cell cancer presentation
Suspect when chronic sinusitis presents for the first time in later life.
- Early signs: Blood-stained nasal discharge and nasal obstruction.
- Later: Cheek swelling, swelling or ulcers of the buccoalveolar plate or palate, epiphora due to a blocked nasolacrimal duct (fig 2, p419), ptosis and diplopia as the floor of the orbit is involved, and pain in maxillary division of the trigeminal nerve.
Malignant salivary gland tumours
Prognosis
Most common type
Investigations [4]
Prognosis poor
Mucoepidermoid carcinoma
X-ray to exclude stones
Sialography to delineate ductal anatomy
FNAC
CT/MRI for staging
Mucoepidermoid ca
Treatment for high grade lesions
High grade lesions - radical resection + radiotherapy
Adenoid cystic carcinoma [2]
Tendency for perineurial spread
More common distant mets
Parotid gland
Benign neoplasms
Name 4
Indicate which is most common
Benign pleomorphic adenoma*
Warthin tumour
Monomorphic adenoma
Hemangioma
Parotid gland Benign neoplasms Describe Benign pleomorphic adenoma [2] Risk of becoming malignant [1] Management approach [1]
Proliferation of epithelial and myoepithelial cells of the ducts [1]
Slow growing [1]
Malignant degeneration in 2-10%
Careful not to burst it when excising as it can lead to recurrences
Parotid gland
Benign neoplasms
Describe Warthin tumour [2]
Risk of becoming malignant [1]
Bilateral benign neoplasm of parotid (usually at tail)
Presents as lymphocytic infiltrate and cystic epithelial proliferation
Malignant transformation rare
Parotid gland
Benign neoplasms
Describe Monomorphic adenoma [2]
Called mono because it only consists of one morphological cell type
Slow growing
Parotid gland Benign neoplasms Hemangioma Epidemiology [1] How do we know its a hemangioma? [1] Risk of becoming malignant [1]
90% of parotid tumors in children <1yo
Hypervascular on imaging
Spontaneous regression may occur
Malignant transformation rare
What feature in examination would be pathognomic of malignant salivary gland tumours?
Facial nerve palsy
