Head and Neck Cancer

Question 1

Presenting symptoms

Answer 1

• non healing ulcer or mass
• pain, bleeding at primary site
• hoarseness, sore throat, odynophagia, dysphagia, hempotysis, neck mass, weight loss
• anosmia, nasal obstruction, hearing loss, diplopia, otalgia/fullness

Question 2

Risk factors

Answer 2

• tobacco
• alcohol
• viral (HPV and EBV)
• immune suppression
• nutritional deficiencies
• occupational exposures
• GERD
• trauma

Question 3

Examination signs

Answer 3

• ulcer, mass at primary site
• asymmetry, fullness
• stridor, hoarseness, muffled voice, trismus
• lymphadenopathy
• serous otitis media, cranial neuropathies, loss of laryngeal crepitus, vocal cord paralysis

Question 4

Potentially premalignant lesions

Answer 4

• leukoplakia of mucous membranes
• erythroplakia of mucous membranes
• actinic keratosis
• squamous carcinoma in situ
• dysplasia
• verrucous hyperplasia

Question 5

Tx options for H&N cancer

Answer 5

• surgical excision
• radiation
• chemo/immunotherapy
• various combinations of above

Question 6

Radical neck dissection

Answer 6

• surgical removal of lymph nodes I-V

- w/wo removal of jugular vein, sternocleidomastoid muscle, spinal accessory nerve (CN-XI) - most morbid

Question 7

Reconstructive options of head and neck cancer

Answer 7

• primary closure or secondary healing
• local flap
• skin grafting
• axial pattern flaps
• myocutaeous flaps
• free flaps
• bone grafting

Question 8

Radiation therapy

Answer 8

• external beam radiation

- complications: dry mouth (xerostomia), increased dental/periodontal disease, loss of manibular bone, serous otitis

Question 9

Chemotherapy

Answer 9

• 5FU
• compliations: MUCOSITIS, n/v, hearing loss, decreased immunity
• Immunotherapy

Question 10

Salivary Gland Malignancies

Answer 10

• gradually enlarging, painless mass
• facial nerve weakness
• risk factors: radiation
• mucoepidermoid carcinoma
• adenoid cystic carcinoma
• malignant mixed tumors
• lymphoma
• acinic cell carcinoma
• adenocarcinoma
• squamous cell carcinoma

Question 11

Thyroid gland malignancies

Answer 11

• painless enlarging mass
• compressive symptoms
• hoarseness
• Types: well differentiated tumors (papillary and follicular carcinoma), medullary carcinoma, undifferentiated carcinoma

Question 12

Thyroid gland malignancies risk factors

Answer 12

• radiation
• family hx
• iodine deficiency

Question 13

Well differentiated thyroid CA tx

Answer 13

• surgery: lobectomy, total thyroidectomy
• radioactive iodide
• follow w/ bloodwork (TG level)

Question 14

Medullary carcinoma thyroid CA tx

Answer 14

• does not respond to I-131

- occasionally radiated

Question 15

Undifferentiated carcinoma thyroid CA tx

Answer 15

-carries poor prognosis regardless of tx