Head and neck cancer

Question 1

What are the common symptoms seen?

Answer 1

• persistent pain in the throat
• pain on swallowing (odynophagia)
• difficulty swallowing (dysphagia)
• persistent hoarseness or a change in voice
• referred pain to the ear
• bleeding in the mouth or throat
• enlarging neck node
• persistent ulceration, leukoplakia (white patch) or erythroplakia (red patch)

Question 2

What is the pathology of head and neck cancers?

Answer 2

SCC
Lymphoma (most often diffuse non-Hodgkins lymphoma)
Salivary gland tumours (including adenoid cystic, mucoepidermoid, acinic cell) Thyroid (papillary, follicular, medullary and anaplastic carcinomas), sarcomas and undifferentiated carcinomas.

Question 3

What are the investigations for head and neck cancers?

Answer 3

CT/MRI of neck from skull base to thoracic inlet
CXR or CT chest
blood tests (U&E, FBC, LFT, Glucose, Albumin, TFT)
ECG
Assessment of nutritional status
FNAC

Question 4

What are the risk factors for tumours of the oropharynx?

Answer 4

6-8 million per year
50-70yrs or 30-40yrs (more in males)
Smoking, alcohol, betel-nut chewing, radiation, iron deficiency anaemia, HPV infection

Question 5

What is the histology of oropharynx cancer?

Answer 5

SCC (90%), Non-Hodgkin Lymphomas (8%), minor salivary gland tumours (2%)

Question 6

How does oropharynx cancer present?

Answer 6

Sore throat, odynophagia, dysphagia, otalgia, bleeding, change of voice, trismus, weight loss or a mass in the neck

Question 7

What are the risk factors for hypopharyngeal tumours?

Answer 7

10-20 million per year
Incidence increasing with age
Postcricoid cancer only one more common in women
Smoking, alcohol abuse, betel-nut chewing, radiation, iron deficiency anaemia, HPV infection
Almost exclusively SCC

Question 8

What are the presenting symptoms of hypo pharyngeal tumours?

Answer 8

sore throat, odynophagia, dysphagia, otalgia, haemoptysis, hoarseness, stridor and occasionally weight loss in advanced cases, neck mass (45 % have metastatic neck disease at presentation)

Question 9

What are the risk factors for laryngeal cancer?

Answer 9

40 million per year
Incidence increasing with age (rare <45yrs)
M:F 4:1
smoking and alcohol abuse, previous neck radiation

Question 10

What is the histology of laryngeal cancer?

Answer 10

95% of all primary laryngeal cancers are squamous cell carcinomas, with the remainder being minor salivary gland tumours, neuroendocrine tumours and sarcomas

Question 11

What are the presenting symptoms of laryngeal cancer?

Answer 11

change of voice/hoarseness, dyspnoea/stridor, pain/odynophagia, dysphagia, neck mass

Question 12

What are the sub sites for laryngeal cancer?

Answer 12

the glottis or true vocal cords (50%)
the supraglottis, consisting of the false vocal cords, the epiglottis and the aryepiglottic folds (40%)
the subglottis, consisting of the below the true vocal cords the lower edge of the cricoid cartilage (5%)

Question 13

What are the common causes of xerostomia (dry mouth)

Answer 13

Depression, anxiety, drugs 
Antimuscarinic activity:
Atropine, hyoscine, ipratropium
Tricyclic antidepressants
Monoamine oxidase inhibitors
Phenothiazines
Orphenadrine, benzhexol, and related antiparkinson drugs
Antihistamines
With sympathomimetic activity 
‘cold cures’ and decongestants e.g. ephedrine, phenylpropylamine
bronchodilators e.g. isoprenaline
appetite suppressants
Sjogren's syndrome 
Radiotherapy to head and neck region