Head and Neck Cancer Flashcards
What are the risk factors for head and neck cancer?
tobacco, alcohol, viruses, betel nut and hardwood
If someone chews tobacco where will they get cancer?
Buccal mucosa
What virus is associated with nasopharyngeal cancer?
Epstein-Barr
What strains of HPV causes cancer?
Papillomas caused by 6 and 11
Carcinomas caused by 16 and 18
What causes cancers in young people?
Viral infections e.g. HPV
What is the commonest cause of oral cancer in india?
Chewing of betel nut
What type of cancer does hardwood cause?
Sinus cancer
What clinical skills do you need to know?
Thorough oral examination and feel any abnormalities with a gloved hand
Feel hard = cancer
Thorough neck examination (expose down to clavicles) do examination from behind. If lump on thyroid then check if it moves on swallowing
Where does cancer usually occur in the mouth?
on the buccal mucosa and the lateral borders of the tongue
What practical procedures can be carried out?
endoscopy and fine needles aspiration (for neck lumps)
Radiology - USS for neck masses then CT or MRI
Describe fine needles aspiration?
A fine boar needle inserted into a lump and cytology, cells, aspirated for further examination by pathology
When is CT most useful?
If mass up against bone then go CT as greatest contrast between bone and soft tissue
When is MRI most useful?
-
Why do you image the chest as well as ENT region?
As there might be dual pathology (especially if cause is smoking then may have lung cancer)
Do head and neck cancers tend to metastasise?
No
What is the head and neck team made up of?
Surgeons - max fax, plastics
Palliative care
What do you want when breaking bad news to a patient?
To give them time to mull things over, get them back to the clinic in a week with their families to go through things again
What is essential when breaking bad news to a patient?
Emotional and empathetic support
What is the most common cancer in the head and neck?
Squamous cancer
What non-ENT problem can cause hoarseness?
Compression of the recurrent laryngeal nerve - normally left sided pathologies - lung and aortic problems
What is a common presentation to ENT with non-ENT problem
Lump felt in left superior clavicular fossa - as the lymphatics drain to thoracic duct and present cancer mets
Why might a patient become hypocalcaemic after treatment?
Removal of the parathyroid gland from radiation
What is the difference between wheeze and stridor?
W - expiratory
S - inspiratory
What is a concern with breathing?
Loud noisy breathing but O2sats can be normal with O2 and increased breathing rate
