Head and Neck Cancer Flashcards
Epidemiology of H&N cancer
-6th most common
-Highest rates= France, India, Brazil, Eastern Europe
-Increases with age but getting younger
-M:F= 2:1
Aetiology of H&N cancer
-Tobacco
-Smokeless tobacco= betel nut chewing
-Alcohol= synergistic interaction
-Poor oral hygiene
-Occupational factors
=Wood dust (sinus)
=Exposure to coal products
=Nickel and asbestos (laryngeal)
-Viruses
=HPV (16/18)
=EBV
-Family risk
Spread of H&N cancer
-Local= direct to local structures
-Regional lymphatics= neck nodes
-Distant= lung (synchronous as well)
Staging of HNSCC
TNM
T= size and extent of invasion
N= size and number of metastatic cervical lymph nodes
M= presence of absence of distant metastases
Symptoms in history
-Mouth ulcer (persistent)
-Sore throat (persistent)
-Hoarseness
-Dysphagia
-Globus
-Odynophagia
-Otalgia
-Neck lump
Investigation of H&N cancer
-Biopsy (FNA of neck mass/ biopsy of primary tumour)
-Endoscopy under GA (direct laryngoscopy/ esophagoscopy)
-Radiology
=CT/MRI (assess primary and spread to regional lymph nodes)
=PET
=USS
Management of H&N cancer
-Surgery
-Surgery and adjuvant treatment (chemo/ radio)
-Non surgical= radio/ chemo/ combination
-NO TREATMENT
Describe lip cancer
-Aetiology= UV light, tobacco-pipe smokers
-Ulcer on lower lip
Describe oral cavity cancer
-Tongue
=Lateral border most common
=Common in India
=Painless ulcer presentation
=Tongue fixation and invasion of mandible-difficulty in swallowing, speech
=Persistent unexplained sore throat/ ear pain
-Floor of mouth
=Presents late with invasion of mandible
=Dysphagia and pain
-Alveolar ridge
=Presents late with direct invasion of mandible, inferior alveolar nerve
-Hard palate rare
-Buccal mucosa
=Indian sub-continent, tobacco and betel nut chewing
Symptoms of laryngeal cancer
-Dysphagia= supraglottic NG
-Dysphonia= glottic NG
-Respiratory problems= subglottic NG
-Neck lump most common in supraglottic carcinoma
HOARSENESS
Overview of glottic carcinoma
-Early symptoms lead to early diagnosis
-Poor lymphatic drainage
-Lymph node metastases uncommon
-Treatment= laser resection/ radio/ partial or total laryngectomy
Overview of supraglottic cancer
-Early symptoms subtle, often ignored
-Few barriers to tumour spread
-Rich lymphatic drainage, often bilateral
-Lymph node metastases common
-Early treatment
=Laser/ radio/ supraglottic laryngectomy
-Advanced treatment
=chemoradiotherapy +/- neo adjuvant, total laryngectomy +/- pharyngectomy
Overview of subglottic cancer
-Rarest laryngeal subsite
-Presents late, invasion of surrounding structures
-Total laryngectomy
Hypopharyngeal cancer aetiology
-Tobacco and alcohol
-Paterson-Brown Kelly syndrome (Plummer Vinson)
=Post cricoid web
=Fe deficiency anaemia
=Glossitis
=Koilonychia
=Splenomegaly
-Post cricoid web can progress to carcinoma
Clinical presentation of hypopharyngeal cancer
-Odynophagia
-Dysphagia
-Referred otalgia common
-Hoarseness due to invasion of larynx or recurrent laryngeal nerves
-Neck node
=Rich lymphatic supply
=Occult nodes very common
