Head and neck cancer

Question 1

Head and neck cancer primarily refers to carcinomas of where?

Answer 1

larynx; naso-, oro-, and hypopharynges; paranasal sinuses; salivary glands; and oral cavity.

Question 2

majority of these cancers occurred in patients with a history of what?
What kind of cancer is most common in the upper aerodigestive tract of these pts?

Answer 2

smoking and alcohol use

SCC

Question 3

Why is the incidence of oropharyngeal cancers increasing?

Answer 3

HPV-mediated cancers

Question 4

___% of head and neck cancer is squamous cell carcinoma.

Answer 4

95

Question 5

SCC originates from ___ cells along the BM of the mucosa

Answer 5

cuboidal cells (under microscope they look flat)

Question 6

An adult patient with a persistent lump in the neck is very likely to have a (benign/malignant) process, with its origins in the upper aerodigestive tract.

Answer 6

malignant

Question 7

What is the modern approach for neck lumps?

Answer 7

FNA biopsy follwing complete head and neck exam.

CT and possible PET for complete staging and tx plan

Question 8

When should a pt with hoarseness be referred to oto?

Answer 8

Hoarsness >2 weeks

Question 9

What’s the most common cause of hoarseness?

6 wks of hoarseness in adult is suspicious for what?

Answer 9

URI with edema of the true vocal cords
Precancerous (dysplasia) or cancerous lesion of the larynx
If not cancerous may be GERD, allergic rhinitis postnasal drip, polyps, etc

Question 10

Which CN innervate the oropharynx and hypopharynx and send a branch to where?

Answer 10

9 and 10
Ear
This is how a cancer in the throat could cause ear pain

Question 11

The oral tongue is innervated by which CN?

Answer 11

5 (lingual portion). May cause jaw pain and otalgia

Question 12

What is the most common cause of ear pain with a normal ear exam ?
How do you dx?

Answer 12

TMJ

Pain on palpation of the joint in front of the tragus when the pt opens and closes the jaw

Question 13

How can a unilateral serous otitis media (fluid in middle ear) in an adult be a sign of cancer?

Answer 13

Cancer in the nasopharynx can obstruct one of the eustachian tubes. URI is more common but must rule cancer out.

Question 14

T/F Dysphagia or odynophagia may be due to cancer.

Answer 14

T

Question 15

Pts w/ superficial LN in posterior triangle behind SCM may be due to?
What nerve is close to this area?

Answer 15

1. secondary to skin infection/inflam on scalp
2. Lymphoma
3. Rarely Upper aerodigestive tract SCC

Spinal accessory nerve

Question 16

Most common parotid neoplasia?

Answer 16

Pleomorphic adenoma (benign mixed tumor)

Question 17

T/f it’s easy to distinguish bw somethign subcutaneous and something in the parotid gland

Answer 17

F. ascending ramus of the mandible is deep to the parotid gland; thus, a mass may be well within the substance of the gland and still feel very superficial, because there is a solid background immediately behind it.

Question 18

When to refer a patient to a specialist in diseases of the head and neck for any symptoms that suggest the possibility of cancer:

Answer 18

1. Mass in the neck
2. hoarseness for 2+ weeks
3. Otalgia, odynophagia, dysphagia
4. lump below or in front of the ear
5. persistent oral ulcer
6. unilateral serous otitis media

Question 19

Carcinogens like smoke and etoh acts in a ____ manner

Answer 19

synergistc. each promotes the occurrence of the cancer, but the combined effect is greater than the sum of the 2.

Question 20

3 reasons for endoscopy for a suspicious lump

Answer 20

1. size and extent of primary tumor/locate it
2. look for second primaries
3. biopsy

Today imaging, in-office endoscopy and FNAB reduces need for endoscopy under anesthesia

Question 21

How big are T1-4 cancers and how well do they respond to surgery or radiation?

Answer 21

T1: less than 2cm (75-85% 5yr survival)
T2: 2-4cm (75-85% 5yr survival)
T3: More than 4 cm
T4:: large and invasive (15-35%)

Question 22

Cancer of the larynx, particularly ___ cancer is usually smaller at presentation bc of quick onset of symptoms.

Answer 22

Glottic.

Bc of quick onset different staging is used.

Question 23

T/F small/early tumors without mets do well and large or metastatic tumors do poorly

Answer 23

T

Question 24

Normal radiation for tumor with microscopic disease is ___ rads centigray.
Dose goes up to ___ for big bulky tumor

Answer 24

1. 5600

2. 7000-8000

Question 25

T/F SCC tends to metastasize early from LN of the neck –> lung, liver, bone and brain

Answer 25

T

Question 26

T/F • If the tumor has metastasized to the lungs or liver, the role of surgery is limited to palliation.

Answer 26

T

Question 27

If the metastases are confined to the lymph nodes of the neck (rare), then a neck dissection—removing lymph nodes from the neck—is performed at the time of surgery.

Answer 27

F - this is common not rare

Question 28

A radical neck dissection is performed when bulky metastasis demands radical surgery and includes removal of what 3 things?

Answer 28

the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve