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
