Head and Neck Cancer

Question 1

what aspects of health promotion can be used as cancer prevention

Answer 1

tobacco, alcohol, viruses(eg HPV), Betel nut, Hardwood

Question 2

what types of head cancer are related to HPV virus

Answer 2

tonsil cancer and cancer at the back of the tongue in the pharynx

Question 3

what types of head/neck cancer are related to EBV virus

Answer 3

nasopharyngeal cancer

Question 4

how do nasopharyngeal cancers tend to present

Answer 4

unilateral hearing problem, as eustachian tube is blocked by cancer and leads to effusion in middle ear, also nasal symptoms and neck lymphadenopathy

Question 5

what type of cancers are linked to Betel nuts and hardwood

Answer 5

Betel nut = mouth cancer

hardwood = cancer of sinuses

Question 6

what type of pain is felt in cancer in the neck

Answer 6

painless

Question 7

what is involved in the clinical presentation of neck cancers

Answer 7

changes in voice, swallowing, growth of mass

Question 8

where in the mouth are cancers most commonly formed

Answer 8

on the tongue, specifically the lateral borders of the tongue

Question 9

what clinical presentation is often seen with pharynx cancer

Answer 9

unilateral pain on swallowing, with referred ear pain

Question 10

what investigations are used for head and neck cancers

Answer 10

radiology(CT, MRI, USS), FNA, endoscopy/biopsy

blood of little use

Question 11

what type of cancer are the vast majority of head and neck cancers

Answer 11

squamous cancer

Question 12

give some examples of a metastases that may present with a neck tumour

Answer 12

squamous cell carcinoma of the skin, cervical/chest/gastric cancers presenting mets above clavicle

Question 13

give an example of a complication of neck cancer chemo/radiotherapy

Answer 13

hypothyroidism or hypoparathyroidism

Question 14

where are malignant and benign salivary cancers usually seen

Answer 14

malignant = small/minor salivary glands, eg submandibular and sublingual glands
benign = parotid/large glands

Question 15

what presenting symptoms are associated with head and neck cancer

Answer 15

dysphonia, dysphagia, odynophagia, otalgia, neck lump, airway obstruction/stridor

Question 16

what is the ‘typical’ presentation of a head and neck cancer

Answer 16

male, >55y/o, long exposure to alcohol and cigarettes

Question 17

describe the spread of supra-glottic tumours

Answer 17

drain to superior deep cervical nodes

Question 18

describe the spread of glottic tumours

Answer 18

present on the cords, 95% stay on cords, minimal lymphatic drainage

Question 19

describe the presentation of glottic and sub-glottic tumours

Answer 19

present with voice changes/airway obstruction

Question 20

describe the spread of sub-glottic tumours

Answer 20

spread to paratracheal nodes

Question 21

what are USS, CT and MRI best used for in investigation of head and neck cancer

Answer 21

USS = lymph nodes and thyroid, also guiding FNA
MRI = deep lobe of parotid, nasopharynx, base of tongue
CT = lymph nodes and larynx