Head and Neck Cancer

Question 1

Histologically, what is the most common type of head and neck cancer?

Answer 1

They are usually squamous cell carcinomas arising from the squamous cells of the mucosa.

Question 2

Where can head and neck cancers occur?

Answer 2

The potential areas of head and neck cancers are:

• Nasal cavity
• Paranasal sinuses
• Mouth
• Salivary glands
• Pharynx (throat)
• Larynx (epiglottis, supraglottis, vocal cords, glottis and subglottis)

Question 3

Where do the majority of head and neck cancers spread to first?

Answer 3

Head and neck cancers usually spread to the lymph nodes first.

Question 4

What are the risk factors for head and neck cancer?

Answer 4

• Smoking
• Chewing tobacco
• Chewing betel quid (a habit in south-east Asia)
• Alcohol
• Human papillomavirus (HPV)
  
  • Particularly strain 16
• Epstein–Barr virus (EBV) infection

Question 5

What strains of HPV does the HPV vaccine protect against?

Answer 5

The HPV vaccine (Gardasil) protects against strains 6, 11, 16 and 18.

Question 6

What are the red fags for head and neck cancers?

Answer 6

Presenting symptoms and signs that may indicate head and neck cancer are:

• Lump in the mouth or on the lip
• Unexplained ulceration in the mouth lasting more than 3 weeks
• Erythroplakia or erythroleukoplakia
• Persistent neck lump
• Unexplained hoarseness of voice
• Unexplained thyroid lump

Question 7

How are head and neck cancers staged?

Answer 7

Staging usually involves the TNM staging system, grading the tumour, node involvement and metastases.

Question 8

What are the treatment options for head and neck cancers?

Answer 8

Treatment may involve any combination of:

• Chemotherapy
• Radiotherapy
• Surgery
• Targeted cancer drugs (i.e., monoclonal antibodies)
• Palliative care

Question 9

Briefly describe the role of Cetuximab is treating head and neck cancers

Answer 9

Cetuximab is an example of a monoclonal antibody used in treating squamous cell carcinomas of the head and neck. It may also be used to treat bowel cancer. It targets epidermal growth factor receptor, blocking the activation of this receptor and inhibiting the growth and metastasis of the tumour.