head and neck cancer Flashcards
most common site for squamous cell carcinoma
tonsil - present at an advanced stage
risk factors for tonsil SCC
smoking, high levels of alcohol intake and poor oral hygiene.
which organism is linked to tonsilar carcinoma
HPV
which organism is linked to nasopharyngeal or lymphoma
EBV
HIV individuals are at increased risk of developing which type of head and neck cancer
kaposi sarcoma
Non-hodgkin lymphoma
HTLV is associated with which virus
adult T cell leukaemia
features of head and neck cancer
neck lump
hoarseness
persistent sore throat
persistent mouth ulcer
criteria for laryngeal cancer 2 week referral
people aged 45 and over with:
persistent unexplained hoarseness or
an unexplained lump in the neck
criteria for oral cancer 2 week referral
unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck.
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:
a lump on the lip or in the oral cavity or
a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.
criteria for thyroid cancer 2 week referral
for thyroid cancer in people with an unexplained thyroid lump.
Gold standard Ix for parapharyngeal abscess
CT scan with IV contrast
what is nasopharyngeal carcinoma
type of cell
ass w
Squamous cell carcinoma of the nasopharynx
Rare in most parts of the world, apart from individuals from Southern China
Associated with Epstein Barr virus infection
systemic and local features of nasopharyngeal carcinoma
1) painless Cervical lymphadenopathy AS IT CAN SPREAD EASILY
2) Epistaxis
3) headaches
4) lymph node metastasis
5) unilateral hearing loss
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI
Ix for nasopharyngeal carcinoma
combined CT and MRI
treatment for nasopharyngeal carcinoma
radiotherapy
red flags in chronic rhinosinusitis
unilateral symptoms, epistaxis, blood-stained discharge, crusting, orbital symptoms (such as diplopia or reduced visual acuity), or neurological symptoms or signs.
premalignant lesions of the oral cavity
leukoplakia and erythroplakia
risk factors of oral cavity cancer
Smoking alcohol Chronic dental infection, e.g. caries, may result in malignant change tertiary syphilis. Betel nut
risk factors for carcinoma of the lip
outdoor workers
near the equator
tobacco smokers
clinical features
lower lip
Dyskeratosis - white patch - ‘actinic chelitis’
ulcer look alike
DD for lip ulcer
keratoacanthoma, syphilis and tuberculosis
Ix for lip cancer
biopsy
management for lip cancer
lip shave
radical neck dissection - metastatic nodal disease
clinical features of tongue cancer
persistent ulcer, painless
if the lesion grows - tongue fixation and invade the mandible
inflamed gland on the contralateral side
clinical features of head and neck cancer
neck lump
hoarseness
persistent sore throat
persistent mouth ulcer
dysphonia
- dysphagia/odynaphagia
- dyspnoea - stridor from narrowing of airway, esp laryngeal tumors
- neck mass
- pain from site of pathology or referred eg. to ear
- bleeding from nose or mouth depending on site of primary (rare presentation)
- nasal blockage - normally unilateral progressive for nasal/nasopharyngeal pathology
histopathology of head and neck cancer
SCC
risk factors of Head and neck cancer
alcohol
tobacco
beetle nut
chinese ethnic origin for nasopharyngeal malignancy
Ix for primary tumor site in H&N cancer
1) examination under anaesthetic
- panendoscopy or laryngopharyngo-oesophagoscopy in H&N
- purpose - biopsy for histo diagnosis, assess size of tumour, look for secondary primary
2) CT neck
- purpose - assess size of tumour and neck node metastasis
Ix of neck metastasis for H&N cancer
CT
not possible then do FNA
if primary unknown then do FNA
Ix for distant metastasis in H&N cancer
CT chest
management of H&N cancer
Radiotherapy
surgery
- endoscopic
- open surgery
important cause if oropharyngeal cancer
HPV infection
what is paterson-brown kelly syndrome / Plummer-vision syndrome
hypochromic microcytic anaemia, glossitis, koilonychia, splenomegaly and a postcricoid web with dysphagia
low iron
clinical features of hypopharyngeal neoplasia
otalgia enlarged neck node dysphonia resp difficulties dysphagia weight loss
Ix for hypopharyngeal neoplasia
barium swallow
name of the benign nose tumor
angiofibroma
names of the malignant nose tumor
carcinoma
non-hodgkins lymphoma
chrodroma
what is saguineous discharge
bloody discharge indicating SCC
features of post-cricoid tumors
sensation of lump
local pain
otalgia
anameia signs - chelitis
pulsatile tinnitus
hearing normal
promotory in th emiddle ear behind TM
glomus tumor
what are glomus tumor
benign tumors in the carotid arteries
what is cricoarytenoid
rotate with the vocal chords
