Head and Neck Cancer Flashcards
Risk factors head and neck cancer
Smoking
Alcohol
HPV (HPV-16 in particular)
EBV
Typically what is the cell type in head and neck cancer?
Squamous cell carcinomas
Presentation head and neck cancer
Hoarseness- persistent and progressive Dysphagia/odynophagia Sore throat Sensation of lump/neck lumps (LN spread or masses- primary) Cough Referred otalgia Stridor Weight loss Neck pain
Note the smaller the gland the more likely it is to be malignant
Typical patient/risk factors in pharyngeal cancer
Typical patient: elderly smoker with sore throat, lump sensation, referred otalgia
Risk factors: smoking + alcohol, HPV-16
Hypo-pharyngeal cancer typically presents with..
Dysphagia, voice alteration, otalgia, stridor + throat pain, lump
Typical presentations of nasopharyngeal cancers..
Unilateral ear effusions
Epistaxis, diplopia, conductive hearing loss/deafness, referred pain, nasal obstruction, CN palsy (I, VII, VIII)
Typical patient in sinus (squamous) cell cancer
Typical patient: middle-aged or elderly. Suspect when chronic sinusitis present for first time in later life
Whats special about supraclavicular lymph nodes?
Especially on left - often mets from distant site due to thoracic duct draining into lower IJV, carrying malignant cells from chest/abdo pelvis
If someone presents with hoarseness what else might you ask about?
- GORD, dysphagia, SMOKING, stress, singing+ shouting
* Voice overuse is a common cause (e.g. teachers)
Aetiology hoarseness (dysphonia)
- Laryngeal cancer
- Vocal cord palsy
- Vocal cord nodules
- Voice overuse/shouting
- Neurological causes
- Functional dysphonia- dissociated with stress
What;s rink’s oedema?
A gelatinous fusiform enlargement of vocal cords, also associated with hypothyroidism
Typical presentation laryngeal cancer
- Male smoker
- Progressive hoarseness
- Stridor- after hoarseness
- Dysphagia/Odynophagia
- +/- Haemoptysis
- Ear pain- if pharynx involved
Imaging laryngeal cancer
• Flexible Laryngoscopy + Biopsy • Indirect Laryngoscopy • CT/MRI- staging • CXR- rule out lung cancer o Pancoast tumour can cause hoarseness
Management laryngeal cancer
Medical:
• Radiotherapy- 1st line
Surgical:
• Open Partial Laryngectomy +/- LN dissection
• Total Laryngectomy +/- LN dissection 1st line
o After laryngectomy, permanent tracheostomy required
Aetiology laryngeal nerve palsy
30% cancers - larynx, thyroid, oesophages, bronchis
25% iatrogenic - after parathyroidectomy, pharyngeal pouch repair, oesophageal surgery
15% idiopathic
Some cases - CNS disorders, TB, Aortic aneurysm
(Dips under aortic arch!!)
