Head and Neck Cancer

Question 1

risk factors for head and neck cancer

Answer 1

tobacco
alcohol
viruses (HPV and EBV)
betel nut
hardwood (sinus cancer)

Question 2

presentation

Answer 2

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

Question 3

what investigation is required if dysphonia has been present for more than 3 weeks?

Answer 3

urgent laryngoscopy

Question 4

what does soft palpation of a tongue mass on the lateral border indicate?

Answer 4

probably just candida

Question 5

what does a mass in the parapharyngeal space present with?

Answer 5

one sided pain on swallowing (can present as referred otalgia)

Question 6

diagnosis

Answer 6

examination
CT for lymph nodes, larynx and chest
MRI for nasopharynx and tongue
FNA
endoscopy
biopsy

Question 7

other causes of a lump in the neck

Answer 7

Virchow’s node= gastric cancer
lymphoma
(always consider PMH for metastasis)

Question 8

what does laryngeal cancer management depend on?

Answer 8

TNM staging

Question 9

management of early (T1 and T2) laryngeal cancer

Answer 9

transoral laser surgery and radiotherapy

Question 10

management of advanced (T3 and T4) laryngeal cancer

Answer 10

partial or total laryngectomy, chemo and radiotherapy

Question 11

management of neck nodes

Answer 11

chemoradiotherapy or surgery

Question 12

what does oropharyngeal cancer management depend on?

Answer 12

TNM staging

HPV status

Question 13

management of early (T1 and T2) oropharyngeal cancer

Answer 13

chemo-radiotherapy and transoral surgery

Question 14

management of advanced (T3 and T4) oropharyngeal cancer

Answer 14

chemo-radiotherapy

Question 15

how is nasopharyngeal cancer managed?

Answer 15

chemo-radiotherapy

Question 16

nasopharyngeal carcinoma associations

Answer 16

south China

EBV

Question 17

laryngeal carcinoma associations

Answer 17

typically cigarettes and alcohol

Question 18

oropharyngeal carcinoma associations

Answer 18

west commonly associated with HPV (younger, multiple sex partners)

Question 19

oral cavity carcinoma associations

Answer 19

Southern Asia

chewing tobacco

Question 20

which salivary gland is most commonly affected?

Answer 20

parotid gland

Question 21

what does a large salivary gland indicate?

Answer 21

benign, small glands usually malignant

Question 22

most common salivary gland cancer

Answer 22

pleomorphic adenoma in parotid- risk of malignant transformation if young

Question 23

management of parotid gland cancer

Answer 23

parotidectomy

remember facial nerve, retromandibular vein and ECA

Question 24

red flags for head and neck cancer

Answer 24

if any of the following have been present for longer than 3 weeks:

• sore throat
• hoarseness
• stridor
• dysphagia
• lump in neck
• unilateral ear pain

Question 25

adjuvant analgesic categories

Answer 25

anticonvulsants

antidepressants

Question 26

examples of anticonvulsants

Answer 26

gabapentin (given via PEG tube)

pregabalin

Question 27

examples of antidepressants

Answer 27

amitriptyline (side effects of dry mouth and dizziness)

Question 28

management of morphine at home

Answer 28

transdermal fentanyl patch