Head and Neck Cancer

Question 1

What are some red flag symptoms for head and neck?

Answer 1

Question 2

What is the most common presentation for a tongue based cancer?

Answer 2

asymptomatic nodal mass

Question 3

How many people present with a neck mass in HPV +

Answer 3

About two-thirds of HPV(+) patients present with an asymptomatic neck mass and often require multiple biopsy procedures to establish the diagnosis.

Question 4

What are some sympotms of NPC

Answer 4

• Unilateral epistaxis
• Unilateral nasal blockage
• Mass in nasopharynx
• Unilateral conductive hearing loss

Neck lump

Question 5

provide some facts about a thyroglossal cyst

does it move with tongue?

when does it present?

Answer 5

• 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

Question 6

How many women will develop a solitary thyroid nodule?

Answer 6

5% of all woman will develop a STN

Question 7

Investigation of a Solitary Thyroid Nodule (STN)

Answer 7

Is the patient hoarse (RLN invasion)

? Presence of lymphadenopathy

• TSH
• USS- FNA

Question 8

Detail the staging of a lump when you ultrasound

Answer 8

• USS- FNA
• U1, U2- Benign
• U3- Equivocal
• U4, U5- Malignancy

Question 9

Detail some causes of neck swellings

Answer 9

• Lymph Nodes - 85%
• Thyroid - 8%
• Others - 7%

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Question 10

If there is cervical lymphadenopathy then what is likely to arise from it?

Answer 10

Infective

Malignant

Haematological - leukaemia/lymphoma

Question 11

What do you look for when looking at neck lumps?

why are round lymph nodes bad?

Answer 11

• Position
• Size (>1 cm or >1.5 cm at level 2- abnormal)
• Shape
• Consistency
• Associated other Lymphadenopathy

becuase they are usually oval in shape

Question 12

What should you always do in cervical lymphadenopathy?

Answer 12

• Always
• Look for other nodes( neck, axilla, groin)
• Look for primary sites( skin, tonsil, nasopharynx)
• Look for hepatosplenomegaly

Question 13

• Branchial Cyst
• when does it usually present?

where does it arise?

Answer 13

• Persisting second branchial arch
• Arises in upper part of ant. Triangle
• Usually presents in teenage years

Question 14

• Submandibular - what are the pathologies
• Parotid - what are the pathologies?

Answer 14

Stone

• Pleomorphic adenoma

Infective

• Pleomorphic adenoma
• Stone

Question 15

What is a big worry in paraganliomas?

Answer 15

they are genetic

Question 16

Where is a commons site for H and N cancer?

Answer 16

Larynx is commonest site

Question 17

Describe a typical patient of OP SCC

what type of OP SCC is increasing rapidly? and whys that?

Answer 17

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

Question 18

What are the presenting sympotms of someone with head and neck cancer?

Answer 18

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

Question 19

Where are the smokers cancer found?

Answer 19

in the vocal cords

Question 20

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?

Answer 20

• 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

Question 21

when is a CT used and when is an MRI used?

Answer 21

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

Question 22

how is T1/2 laryngeal cancer treated?

What about T3/4?

Answer 22

Early (T1 & T2)

Transoral laser surgery

Radiotherapy

>90% 5 year survival

Advanced (T3 and T4)

Partial or Total laryngectomy

Chemo & Radiotherapy

Question 23

What is first bite sydnrome?

Answer 23

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