Head and Neck Cancer Flashcards
risk factors for head and neck cancer
tobacco alcohol viruses (HPV and EBV) betel nut hardwood (sinus cancer)
presentation
dysphonia (vocal cord cancer= smokers) lump/mass in neck, often painless and progressive enlargement is a worry dysphagia odynophagia lymphadenopathy airway obstruction e.g. stridor
what investigation is required if dysphonia has been present for more than 3 weeks?
urgent laryngoscopy
what does soft palpation of a tongue mass on the lateral border indicate?
probably just candida
what does a mass in the parapharyngeal space present with?
one sided pain on swallowing (can present as referred otalgia)
diagnosis
examination CT for lymph nodes, larynx and chest MRI for nasopharynx and tongue FNA endoscopy biopsy
other causes of a lump in the neck
Virchow’s node= gastric cancer
lymphoma
(always consider PMH for metastasis)
what does laryngeal cancer management depend on?
TNM staging
management of early (T1 and T2) laryngeal cancer
transoral laser surgery and radiotherapy
management of advanced (T3 and T4) laryngeal cancer
partial or total laryngectomy, chemo and radiotherapy
management of neck nodes
chemoradiotherapy or surgery
what does oropharyngeal cancer management depend on?
TNM staging
HPV status
management of early (T1 and T2) oropharyngeal cancer
chemo-radiotherapy and transoral surgery
management of advanced (T3 and T4) oropharyngeal cancer
chemo-radiotherapy
how is nasopharyngeal cancer managed?
chemo-radiotherapy
nasopharyngeal carcinoma associations
south China
EBV
laryngeal carcinoma associations
typically cigarettes and alcohol
oropharyngeal carcinoma associations
west commonly associated with HPV (younger, multiple sex partners)
oral cavity carcinoma associations
Southern Asia
chewing tobacco
which salivary gland is most commonly affected?
parotid gland
what does a large salivary gland indicate?
benign, small glands usually malignant
most common salivary gland cancer
pleomorphic adenoma in parotid- risk of malignant transformation if young
management of parotid gland cancer
parotidectomy
remember facial nerve, retromandibular vein and ECA
red flags for head and neck cancer
if any of the following have been present for longer than 3 weeks:
- sore throat
- hoarseness
- stridor
- dysphagia
- lump in neck
- unilateral ear pain
adjuvant analgesic categories
anticonvulsants
antidepressants
examples of anticonvulsants
gabapentin (given via PEG tube)
pregabalin
examples of antidepressants
amitriptyline (side effects of dry mouth and dizziness)
management of morphine at home
transdermal fentanyl patch
