Head and Neck Cancer Flashcards
1. List the risk factors of head and neck cancer (MKS 1b) 2. Apply the knowledge of clinical features and anatomy to diagnose head and neck cancer in a patient (MKS 1d) 3. Describe the basic principles of head and neck cancer treatment (MKS 1e) 4. Describe the functions of the head and neck that must be preserved during treatment (MKS 1e)
1
Q
What is the most common type of head and neck cancer, and what is the pathophysiology?
A
- Squamous Cell Carcinoma
- Represents >90% of all head and neck cancer
- Arises from squamous epithelium
- May be various grades of dysplasia, before basal layer is violated
- Distinguishes carcinoma-in-situ from ‘invasive’ carcinoma
2
Q
Aside from squamous cell carcinoma, what are some other types of head and neck cancers?
A
-
Glandular Origin
- Adenocarcinoma
- Adenoid cystic carcinoma
- Acinic Cell carcinoma
- Mucoepidermoid carcinoma
- Undifferentiated carcinoma
- Sarcoma
- Lymphoma
- Mucosal Melanoma
3
Q
What are the risk factors for head and neck cancers?
A
-
Risk Factors:
- Tobacco
- Alcohol
- Epstein Barr Virus: nasopharynx
- Human Papilloma Virus: oropharynx
- Associated with HPV16: 14x increase in risk of scca
- Younger patients
- Latency of 15-20 years
- Sexual activity
- Potential impact of vaccination
- Family History: relatively small risk factor
4
Q
What is the clinical presentation of head and neck cancer?
A
-
Symptoms
- Pain
- Bleeding
- Dysphagia, Odynophagia
- Hoarseness, Hemoptysis
- Neck mass
- Otalgia
-
Findings
- Ulcerative or exophytic lesion
- Cervical adenopathy
5
Q
Describe the diagnostic workup for head and neck cancer.
A
- Biopsy of primary site, FNA cervical node
- CT Neck with Contrast
- CT Chest: r/o synchronous primary lung ca vs metastatic dx
- LFT’s
- PET/CT is widely utilized in common practice, though it is not formally required (NCCN Guidelines)
- Staging, according to AJCC staging criteria
- Discussion at multi-disciplinary Tumor Conference
6
Q
What are the basic guidelines for treatment of head and neck cancers?
A
- Stage I/II disease (T1/T2 N0M0) generally well-treated with single modality treatment: surgery vs radiation therapy
- May require treatment of the cervical nodes, neck dissection yields diagnostic and therapeutic benefit
- Advanced stage disease (Stage III, IV) generally treated with multi-modality therapy
- Organ-preservation regimens: larynx, oropharynx
- 5-year survival rates similar to standard of surgery/xrt; surgery for primary was reserved for salvage
