Head and Neck Cancer

Question 1

List risk factors for head and neck cancer

Answer 1

Tobacco - chewing or smoking
Alcohol (especially combined with tobacco)
Viruses - HPV or EBV
Betel nuts - common in south Asians

Question 2

Which diagnostic tests can be used for head and neck cancers

Answer 2

Full head and neck exam
Endoscopy with biopsy
Biopsy - FNA where possible, core or open if FNA unavailable or lymphoma
US
CT - good for undetectable lesions and staging
MRI - good for oropharynx and salivary glands
PET scan

Question 3

What is the most common type of cancer that affects the head and neck

Answer 3

Squamous cell cancer

Question 4

List some symptoms of throat cancer

Answer 4

Stridor
Hoarse voice
Dysphagia
Pain - on swallowing or referred to the ear

Question 5

List malignant cancers that can affect the salivary glands

Answer 5

Muco-epidermoid 
Adenoid cystic 
Acinic cell cancer 
SCC 
Adenocarcinoma

Question 6

List symptoms of a parotid cancer

Answer 6

Facial weakness 
Dry mouth 
Lymph node involvement 
Pain 
Skin fixing 
Mass

Question 7

Describe the pain ladder

Answer 7

Non-opioid with adjuvant
Opioid for mild pain with the non-opioid and adjuvant
Then change to a strong opioid

Question 8

Which drugs can be used as adjuvant analgesics

Answer 8

Anticonvulsants - gabapentin, pregabalin

Antidepressants –amitriptyline

Question 9

List symptoms of head and neck cancer

Answer 9

Any of the following lasting more than 3 weeks: 
Sore throat
Hoarseness or other voice changes
Stridor
Difficulty swallowing
Lump in neck
Unilateral ear pain

Combine with other cancer red flags, weight loss, fatigue etc

Question 10

List potential treatments for head and neck cancer

Answer 10

Surgery
Chemotherapy
Radiotherapy
Nutritional support
Symptom management

Question 11

What is stridor

Answer 11

Inspiratory sound

Signifies airway compromise

Question 12

Which benign tumours can affect the salivary glands

Answer 12

Pleomorphic adenomas

Warthin’s tumour

Question 13

Any cervical lymphadenopathy in the over 35s must get a full head and neck exam to look for cancer - true or false

Answer 13

True

Is malignancy until proven otherwise

Question 14

Children with lymphoma may present with a neck lump - true or false

Answer 14

True

Question 15

What are red flags for thyroid malignancy

Answer 15

FH of thyroid cancer
History of irradiation to that are 
Child under 10 with a new midline neck swelling
Unexplained hoarseness with goitre  
Age over 45

Question 16

What are the 4 main types of thyroid cancer

Answer 16

Papilliary
Medullary
Follicular
Anaplastic

Question 17

How does thyroid cancer present

Answer 17

Presents with hypo or hyperthyroidism and a neck lump

Midline mass which moves on swallowing

Question 18

80% of cervical lymphadenopathy in adults is neoplastic - true or false

Answer 18

True
80% are mets from elsewhere (not lymphoid)
80% of that proportion are from head and neck

Question 19

List risk factors for laryngeal cancer

Answer 19

Smoking

Alcohol consumption

Question 20

How does laryngeal cancer present

Answer 20

Constant hoarseness
Associated dysphagia or odynophagia
All usual cancer red flags
Enlarged cervical nodes

Question 21

How do you treat laryngeal cancer

Answer 21

Can be treated with curative intent
Small tumours - radiotherapy or endoscopic laser surgery
Larger tumours get more extensive surgery or chemoradiotherapy
In most severe cases you can do a laryngectomy (total removal of the larynx)

Question 22

How is a laryngectomy performed

Answer 22

Remove the entire larynx
Create an end stoma where the trachea is brought out on the anterior midline of the neck
Pharynx is closed so that oesophagus connects only to the mouth/nose

Question 23

Which head and neck malignancies commonly affect children

Answer 23

Lymphomas - can present which neck lumps
Rhabdomyosarcoma = 40% present in HandN
Neuroblastoma - tumour of the sympathetic chain, adrenal gland is most common site but can cause neck swelling if in cervical chain