Head and Neck Cancer

Question 1

What are the risk factors for head and neck cancer?

Answer 1

tobacco, alcohol, viruses, betel nut and hardwood

Question 2

If someone chews tobacco where will they get cancer?

Answer 2

Buccal mucosa

Question 3

What virus is associated with nasopharyngeal cancer?

Answer 3

Epstein-Barr

Question 4

What strains of HPV causes cancer?

Answer 4

Papillomas caused by 6 and 11

Carcinomas caused by 16 and 18

Question 5

What causes cancers in young people?

Answer 5

Viral infections e.g. HPV

Question 6

What is the commonest cause of oral cancer in india?

Answer 6

Chewing of betel nut

Question 7

What type of cancer does hardwood cause?

Answer 7

Sinus cancer

Question 8

What clinical skills do you need to know?

Answer 8

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

Question 9

Where does cancer usually occur in the mouth?

Answer 9

on the buccal mucosa and the lateral borders of the tongue

Question 10

What practical procedures can be carried out?

Answer 10

endoscopy and fine needles aspiration (for neck lumps)

Radiology - USS for neck masses then CT or MRI

Question 11

Describe fine needles aspiration?

Answer 11

A fine boar needle inserted into a lump and cytology, cells, aspirated for further examination by pathology

Question 12

When is CT most useful?

Answer 12

If mass up against bone then go CT as greatest contrast between bone and soft tissue

Question 13

When is MRI most useful?

Answer 13

-

Question 14

Why do you image the chest as well as ENT region?

Answer 14

As there might be dual pathology (especially if cause is smoking then may have lung cancer)

Question 15

Do head and neck cancers tend to metastasise?

Answer 15

No

Question 16

What is the head and neck team made up of?

Answer 16

Surgeons - max fax, plastics

Palliative care

Question 17

What do you want when breaking bad news to a patient?

Answer 17

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

Question 18

What is essential when breaking bad news to a patient?

Answer 18

Emotional and empathetic support

Question 19

What is the most common cancer in the head and neck?

Answer 19

Squamous cancer

Question 20

What non-ENT problem can cause hoarseness?

Answer 20

Compression of the recurrent laryngeal nerve - normally left sided pathologies - lung and aortic problems

Question 21

What is a common presentation to ENT with non-ENT problem

Answer 21

Lump felt in left superior clavicular fossa - as the lymphatics drain to thoracic duct and present cancer mets

Question 22

Why might a patient become hypocalcaemic after treatment?

Answer 22

Removal of the parathyroid gland from radiation

Question 23

What is the difference between wheeze and stridor?

Answer 23

W - expiratory

S - inspiratory

Question 24

What is a concern with breathing?

Answer 24

Loud noisy breathing but O2sats can be normal with O2 and increased breathing rate

Question 25

Should you avoid the word ‘cancer’ when breaking bad news?

Answer 25

Yes - be honest but also be sympathetic and deal appropriately with their reaction

Question 26

Should you tell a relative information about your patients?

Answer 26

No - need patients consent and respect confidentiality

if want to have a ‘quick’ chat about it not always good motivation - get patient and all talk about it, be honest

Question 27

What are the main causes of death from ENT cancer?

Answer 27

Asphyxia
Catastrophic bleed from the cancer interfereing in carotid artery
can be managed in a side room, given lots of pain med and make death dignified and less scary