Head and Neck CA Flashcards
Non-healing ulcer/ sore
Loosening of teeth or ill-fitting dentures
Dysphagia/ Odynophagia
Wt loss
Bleeding
Referred otalgia
Neck mass
Are all ssx of what cancer
Oral Cavity Cancer
Neck mass
Chronic serous otitis media
Pain
Are all ssx of what cancer
Nasopharynx Cancer
Chronic sore throat
Referred otalgia
Late sx - change in voice/ hoarseness, dysphagia, trismus (locked jaw)
Are all ssx of what cancer
oropharynx cancer
Patients often remain asymptomatic for a long period
presenting complaints - pain, bleeding, neck mass
are all ssx of what cancer
posterior pharyngeal wall cancer
70-80% of pts have clinically involved cervical nodes at the same time of diagnosis - ssx of what cancer
hypopharynx cancer
usually dx late stage can present with airway obstruction and neck mass due to lymphadenopathy =
supraglottic cancer
often causes sx early:
persistent hoarseness
dysphagia
referred otalgia
chronic cough
hemoptysis
stridor =
glottic laryngeal
Over 60% of pts with head and neck cancer present with
cervical lymphadenopathy
Head and Neck CA is dx by
bx
Refer immediately to ____ if Head/Neck CA suspected
EENT
Testing for Head/Neck CA can include:
Panendoscopy (laryngoscopy, Bronchoscopy, Esophagoscopy)
CT or MRI
PET scan
CBC, LFTs, CMP
Neck Mass DDX
congenital - Branchial cleft cyst, thyroglossal duct cyst, vascular abnormalities
Infectious/ inflammatory
Malignant
Branchial Cleft Cysts are
by the 5th week of pregnancy these “gills” should go away but when they don’t they form this
located right below the ear or anterior to the sternocleidomastoid muscle
Thyroglossal duct cyst is located
superior of cricoid cartilage, inferior of hyoid bone
if infection is unlikely, mass doesn’t resolve, or mass recurs ___________ is required
further workup
first imaging study =
CT
staging for head/neck cancer
TNM staging
Tumor
nodes
mets
Early stage treatment (stage 1 & 2)
small localized disease without nodal involvement
treat with either surgery or radiation
Locally advanced (high risk for local recurrence)
chemo is gold standard
surgery reserved to preserve organ function
Early stage head and neck CA prognosis
70-90% survival
Late stage head and neck CA prognosis
30-60% survival
Late stage head and neck CA prognosis
30-60% survival
Cancers due to HPV appear to have a better
prognosis
Head and Neck CA prevention vaccines
HPV (Gardisil, Gardisil 9, Cervarix)
Leukoplakia =
Premalignant lesion
white patch on oral mucosa that cannot be scraped off
bx is needed - 20% develop into invasive cancer in
Leukoplakia =
Premalignant lesion
white patch on oral mucosa that cannot be scraped off
bx - precancerous
20% develop into invasive cancer in 10 years
Erythroplakia =
red patch on the oral mucosa
dx - precancerous
more likely than leukoplakia to become malignant or have an invasive component (30-50%)
Hairy Leukoplakia =
EBV induced lesion
always HIV infected or immunocompromised pts
NOT a premalignant lesion
painless white patch - often tx is not needed
Nasal/ Paranasal CA is _____ and is more common in _____
rare
men ~ 60-65 yo
Most common site of Nasal/ Paranasal CA
maxillary sinus
second - ethmoid sinus
Nasal/ Paranasal CA ssx
pain
nasal obstruction
epistaxis
chronic sinus congestion
hyposmia/ microsmia*
Nasal/ Paranasal CA dx you need a
bx
workup - CT, endoscopy, MRI
Nasal/ Paranasal CA dx you need a
bx
workup includes - CT, endoscopy, MRI
Nasal/ Paranasal CA are usually related to
occupational exposures
Nasal/ Paranasal CA staging
TNM staging
most do NOT have lymph node involvement
most Nasal/ Paranasal CA do NOT have ________
lymph node involvement
80+% of Nasal/ Paranasal CA have ______ invasion
bony
Nasal/ Paranasal CA treatment
surgery and radiation
Salivary gland tumors are most common in
80-85% = parotid gland, 80% = benign
tumors in other salivary glands more likely to be malignant
Nasal/ Paranasal CA prognosis
overall poor
T1 = 50% and the further you go the further it drops
