Head and Neck Cancer Flashcards
What are some red flag symptoms for head and neck?
What is the most common presentation for a tongue based cancer?
asymptomatic nodal mass
How many people present with a neck mass in HPV +
About two-thirds of HPV(+) patients present with an asymptomatic neck mass and often require multiple biopsy procedures to establish the diagnosis.
What are some sympotms of NPC
- Unilateral epistaxis
- Unilateral nasal blockage
- Mass in nasopharynx
- Unilateral conductive hearing loss
Neck lump
provide some facts about a thyroglossal cyst
does it move with tongue?
when does it present?
- Thyroglossal Cyst
- can arise in any part of the thyroglossal tract.
- contains lymphatics which may become infected
- moves with the tongue
- usually presents in teenage years
How many women will develop a solitary thyroid nodule?
5% of all woman will develop a STN
Investigation of a Solitary Thyroid Nodule (STN)
Is the patient hoarse (RLN invasion)
? Presence of lymphadenopathy
- TSH
- USS- FNA
Detail the staging of a lump when you ultrasound
- USS- FNA
- U1, U2- Benign
- U3- Equivocal
- U4, U5- Malignancy
Detail some causes of neck swellings
- Lymph Nodes - 85%
- Thyroid - 8%
- Others - 7%
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If there is cervical lymphadenopathy then what is likely to arise from it?
Infective
Malignant
Haematological - leukaemia/lymphoma
What do you look for when looking at neck lumps?
why are round lymph nodes bad?
- Position
- Size (>1 cm or >1.5 cm at level 2- abnormal)
- Shape
- Consistency
- Associated other Lymphadenopathy
becuase they are usually oval in shape
What should you always do in cervical lymphadenopathy?
- Always
- Look for other nodes( neck, axilla, groin)
- Look for primary sites( skin, tonsil, nasopharynx)
- Look for hepatosplenomegaly
- Branchial Cyst
- when does it usually present?
where does it arise?
- Persisting second branchial arch
- Arises in upper part of ant. Triangle
- Usually presents in teenage years
- Submandibular - what are the pathologies
- Parotid - what are the pathologies?
Stone
• Pleomorphic adenoma
Infective
- Pleomorphic adenoma
- Stone
What is a big worry in paraganliomas?
they are genetic
Where is a commons site for H and N cancer?
Larynx is commonest site
Describe a typical patient of OP SCC
what type of OP SCC is increasing rapidly? and whys that?
Typical ‘traditional patient’ is male aged>55 years with long exposure to cigarettes & alcohol.
HPV related OP SCC is increasing dramatically – typical patient is non-smoker, higher socio-economic class, multiple sexual partners
What are the presenting sympotms of someone with head and neck cancer?
Dysphonia – >3 weeks warrants urgent referral for laryngoscopy
Dysphagia – particularly if progressive
Odynophagia
(Unilateral) otalgia – if no other cause (remember referred pain)
Neck lump
Can present with airway obstruction - Stridor
Where are the smokers cancer found?
in the vocal cords
Supra-glottic Tumours - where do they drain?
How do glottic tumours present? why do they tend to not mets
Sub-glottic Tumours- where do they present and where do they spread?
- Drain to superior deep cervical nodes
Glottic Tumours
- Present on the cords
- 95% stay on the cords
- Minimal lymphatic drainage - so they will not mets
- Presents with voice changes/airway obstruction
Spread to paratracheal nodes
-Present with voice/airway obstruction
when is a CT used and when is an MRI used?
CT - Great for looking at lymph nodes, larynx,
CT chest for staging - ie looking for a metastasis or a second primary tumour in 5-10%
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MRI - Great for looking at nasopharynx & tongue base
how is T1/2 laryngeal cancer treated?
What about T3/4?
Early (T1 & T2)
Transoral laser surgery
Radiotherapy
>90% 5 year survival
Advanced (T3 and T4)
Partial or Total laryngectomy
Chemo & Radiotherapy
What is first bite sydnrome?
First bite syndrome – when you take a bite is the first indication or production of saliva, if its sore then its an indication the a gland could be blocked
Parotid lump – facial plasy or paresis
Bi manuel palpation of lump
