Head and neck cancer Flashcards
Risk factors for head and neck cancer
Chronic exposure to any of the following carcinogens: Tobacco Smoking Alcohol Consumption Poor oral & dental hygiene Environmental conditions Age (>40) Gender (men are 2-3 times more likely to develop HNSCC than women) HPV, EBV Radiation
Signs and symptoms for mouth (oral) cancer
Mouth pain or pain when swallowing
A persistent sore or swelling in the mouth
Unusual bleeding or numbness in the mouth
Red or white patches on the gums, tongue or mouth
changes in speech or difficulty pronouncing words
Difficulty chewing or swallowing food, difficulty moving the tongue or limited chewing
Weight loss
A lump in the neck
Loose teeth, or dentures that no longer fit
Earache, or ringing in the ears
Signs and symptoms for laryngeal cancer
Swelling or a lump in the neck or throat
A persistent sore throat
A persistent change in the sound of your voice, including hoarseness
Difficulty swallowing or pain when swallowing
Constant coughing
Difficulty breathing
Weight loss
Signs and symptoms for pharyngeal cancer
- THROAT PAIN OR DIFFICULTY SWALLOWING
- A PERSISTENT SORE THROAT OR COUGH
- COUGHING UP BLOODY PHLEGM
- BAD BREATH
- WEIGHT LOSS
- VOICE CHANGES OR HOARSENESS
- DULL PAIN AROUND THE BREASTBONE
- A LUMP IN THE NECK
- PAIN IN THE EAR OR FREQUENT EAR INFECTIONS
- FEELING THAT YOUR AIR SUPPLY IS BLOCKED
- NUMBNESS OF THE FACE
- NASAL CONGESTION
- HEARING LOSS
- HEADACHE
Signs and symptoms for nasal or paranasal sinus cancer
NASAL OR PARANASAL SINUS CANCER • DECREASED SENSE OF SMELL • A PERSISTENT BLOCKED NOSE, PARTICULARLY IN ONE NOSTRIL • FREQUENT NOSEBLEEDS • EXCESS MUCUS IN THE THROAT OR BACK OF THE NOSE • FREQUENT HEADACHES OR SINUS PRESSURE • DIFFICULTY SWALLOWING • LOOSE OR PAINFUL UPPER TEETH • A LUMP ON/IN THE FACE, NOSE OR MOUTH • NUMBNESS OF THE FACE, UPPER LIP, OR WITHIN THE MOUTH OR UPPER TEETH • PRESSURE OR PAIN IN THE EARS • A BULGING OR WATERY EYE • DOUBLE VISION • COMPLETE OR PARTIAL LOSS OF EYESIGHT
Clinical examinations
Thorough examination of head and neck area through palpation, checking for any lumps or abnormalities.
Looking inside mouth and throat with lights to assess for any changes or abnormal findings.
Endoscopy procedure: nasopharyngoscopy, pharyngoscopy, or laryngoscopy. Allows for visualisation beyond the human eye.
Biopsy- of suspicious cells.
Medical imaging for head and neck cancers
HEAD MRI: sensitive tool when looking at tumours of the head and neck
CT SCAN OF THE PARANASAL SINUSES/NECK – allows for quick acute diagnosis
OPG: Panoramic view of the jaw and teeth, can allow for visualisation of oral cancers.
PET SCAN: allows for a pinpoint the anatomic location of abnormal metabolic activity with the uptake of radioactive tracers
Ultrasound – allows for quick acute clinical diagnosis
Fluroscopy – barium swallows and meals
CT for head and neck cancers
Mainstay for primary disease
Disadvantages
◦ Radiation
◦ Often administer IODINE TO VIEW VASCULAIRTY OF TUMOUR, CAN BE NEPHROTOXIC/CAUSAE AN ALLERGIC REACTION
◦ LIMITED SOFT TISSUE RESOLUTION
Advantages
◦ Good spatial resolution, delineates between tumour extent and nodal disease. ◦ QUICK ACUTE DIAGNOSIS
◦ GOOD BONE DETAIL OF SURROUNDING STRUCTURES
◦ DUE TO RAPIDITY OF SCAN, UNLIKED FOR PATIENT MOTION
MRI for head and neck cancers
Versatile technique that has the advantage of providing not only anatomical information but also molecular, metabolic, and physiological information
Disadvantages of MRI
◦ NOT EASILY ACCESSIBLE
◦ MOTION ARTEFACT
◦ DETECTION OF SUBTLE OSSEOUS ABNORMALITIES ◦ Long scan times
ADVANTAGES OF MRI
◦ IMPROVED SOFT TISSUE CONTRAST
◦ NON-IONISING RADIATION
◦ Various sequences demonstrate various aspects
PET for head and neck cancers
Labelled tracers fuse CT images with a functional map
Royal College of Radiologists published evidence- based guidelines for PET–CT use in head and neck cancer.
MULTI MODALITY APPROACH
FDG PET/CT imaging is particularly useful to detect residual disease in neck lymph nodes.
In patients with suspected recurrence, PET/CT has the highest sensitivity and specificity regardless of the primary treatment modality. However, post therapy inflammation remains a potential source for false positive interpretation.
Ultrasound for head and neck cancers
Useful tool for cervical lymph node staging & investigating thyroid and salivary gland tumours.
Great resolution in superficial structures
Limitations in assessment of deep lesions, however, it is a useful tool for biopsy guiding masses within the neck.
Treatment for head and neck cancers
Early stage head & neck treatment often involves a single modality approach with either surgery or radiation therapy
Multi modality treatment is the preferred means of treating head & neck cancer that is locally advanced (Stage III or IV)
With locally advanced – surgery occurs, followed by radiation therapy +/- chemo to reduce the likelihood of secondary tumour growth.
The aim of multimodality treatment is to optimize cure rates and preserve as much normal function.
Surgery
Radiation Therapy
Chemotherapy
Targeted therapy
Surgery for head and neck cancers
Primary curative surgery for HNSCC is reserved for resectable tumours in which clear margins can be achieved and function is preserved
Surgical resection, usually gold standard for HNSCC
Keeping the individuals’ quality of life and improving the overall survival rate at the same time
Radiation therapy for head and neck cancers
The preferred technique is intensity modulated RT (IMRT), due to its ability to deliver non- uniform and optimized radiation beam intensities to conform highly complex shape of the target.
Allows confinement of the higher radiation doses to the target volumes.
Damages DNA –> cells stop dividing –> eliminated by the body
Chemotherapy and targeted therapy for head and neck cancers
- Chemotherapy generally is delivered at the same time as radiation therapy.
- May be given before and during treatment. Before, as an attempt to shrink the tumour. After, to kill off any remaining cancer cells.
- Targeted therapy treatment refers to treatment with pharmaceuticals that are specifically designed to target cancer cells, to avoid harm to normal, healthy cells.
