Head and neck cancer Flashcards
H&N cancer
Malignancies of the oral cavity, pharynx, larynx, paranasal sinuses, nasal cavity/salivary glands
Over 90% derive from squamous cell epithelium
H&N risk factors
Alcohol and tobacco use
HPV
Betel quid
Occupational wood dust
EBV infection
Premalignant conditions - leukoplakia, erythroplakia, erythroleukoplakia, oral lichen planus or actinic cheilitis
Oral cavity cancer clinical features
Painless mass
Bleeding
Localised pain within the oral cavity
Jaw swelling
Pharyngeal cancer clinical features
Odynophagia
Dysphagia
Stertor
Referred otalgia
Trotters syndrome - triad of clinical features suggestive of nasopharyngeal malignancy comprised of: unilateral conductive deafness, trigeminal neuralgia & defective mobility of the soft palate
Laryngeal cancer CFs
Hoarse voice
Stridor
Dysphagia
Persistent cough
Referred otalgia
H&N cancer Ix
Biopsy of the lesion
For patients presenting solely with lymphadenopathy → undergo ultrasound-guided fine needle aspiration
Staging - CT scan of neck and chest, MRI neck
Laryngeal cancer referrals
Persistent unexplained hoarseness (urgent)
Unexplained lump in the neck (urgent)
Oral cancer referrals
Lump on the lip or in the oral cavity (urgent)
Erythroplakia or erythroleukoplakia (urgent)
Unexplained ulceration in the oral cavity for > 3 weeks (consider)
Persistent and unexplained lump in the neck (consider)
H&N cancer management
Varies greatly depending on the location, size, stage, and grade of the cancer, as well as patient preference & co-morbidities
Surgical resection +/- adjuvant radiotherapy/chemotherapy or primary radiotherapy +/- adjuvant chemotherapy
Discussed in a a dedicated head and neck MDT meeting
H&N cancer complications
Secondary primary malignancies
Dysphagia
Pharyngocutaneous fistula
Injury to the accessory, vagus, hypoglossal or marginal mandibular nerves
Mucositis
Chronic pain, persistent hoarse voice or hearing loss
