head and neck cancer and palliative care Flashcards
what can cause cancer in the oropharynx?
HPV
what are the symptoms of nasopharyngeal cancer?
Unilateral epistaxis
Unilateral nasal blockage
Mass in nasopharynx
Unilateral conductive hearing loss
Neck lump
what are some examples of midline swellings?
thyroid
thyroglossal cyst-attached to tongue base (moves when tongue sticks out)
dermoid cyst- (moves when tongue sticks out)
what are the features of a thyroglossal cyst?
can arise in any part of the thyroglossal tract.
contains lymphatics which may become infected
moves with the tongue
usually presents in teenage years
how are thyroid nodules categorised?
U1, U2- Benign
U3- Equivocal
U4, U5- Malignancy
classified using an USS and FNA
what are some examples of anterior triangle swellings
Lymph Nodes
Branchial Cyst
Salivary glands
Carotid Body Tumour
at what size is a lymphnode considered abnormal?
(>1 cm or >1.5 cm at level 2
what should be done for cervical lymphadenopathy?
Always-
Look for other nodes( neck, axilla, groin)
Look for primary sites( skin, tonsil, nasopharynx)
Look for hepatosplenomegaly
Investigations
Chest Xray
ENT opinion
Fine Needle Aspiration
what are the features of a brachial cyst?
Persisting second branchial arch
Arises in upper part of ant. Triangle
Usually presents in teenage years
what are some possible issues with the salivary glands?
Submandibular
Stone
Pleomorphic adenoma
Parotid
Infective
Pleomorphic adenoma
Stone
where is the most common site for head and neck cancer?
the larynx (voice box)
what type of cancer is the most common head and neck cancer?
squamous cell carcinoma
what groups of people are most likely to present with head and neck cancer in the UK
traditional patient- male >55 with long exposure to cigarettes and alcohol
or
non-smoker, middle class, multiple sexual partners (HPV related)
what are key symptoms in patients with a neck lump?
Dysphonia – >3 weeks warrants urgent referral for laryngoscopy
Dysphagia – particularly if progressive
Odynophagia
(Unilateral) otalgia – if no other cause (remember referred pain)
Neck lump
Can present with airway obstruction - Stridor
where do supra-glottic tumours spread to?
Drain to superior deep cervical nodes
where do glottic tumours drain to?
Present on the cords
95% stay on the cords
Minimal lymphatic drainage
Presents with voice changes/airway obstruction
where do subglottic tumours drain to?
only make up 1% of laryngeal tumours
Spread to paratracheal nodes
Present with voice/airway obstruction
how is a head and neck caner diagnosis confirmed?
biopsy from primary site +/- biopsy of suspected metastases
what are the 5 commonly used investigations in the head and neck clinic?
US- lymphnode and thyroid, guided FNAC
FNA- sensitvity 80%, specificity 95%
CT- shows the extent of cancer, neck and chest
MRI- look at deep lobe of parotid and nasal pharynx
PET- metastatic nodes
what is the management of laryngeal cancer?
Early (T1 & T2)
-Transoral laser surgery
-Radiotherapy
> 90% 5 year survival
Advanced (T3 and T4)
-Partial or Total laryngectomy
-Chemo & Radiotherapy
what is the management of oropharyngeal cancer?
Early (T1 & T2)
-Chemo-radiotherapy
-Transoral robotic surgery
>90% 5 year survival
Advanced (T3 and T4)
-Chemo-radiotherapy
what are the signs of nasopharyngeal cancer?
30-40% have unilateral ear symptoms
Up to 50% have nasal symptoms
Up to 70% have palpable neck lymphadenopathy
CN III, IV, V2, V3, VI involvement
uncommon in UK, unless of south china origin
how is nasopharyngeal cancer treated?
Treatment is with (Chemo) Radiotherapy
5 year survival is excellent:
Stage1 - 100%
Stage 4a – 67%
which salivary gland is most likely to have a cancerous mass?
sublingual and submandibular
where are pleomorphic tumours likely to occur?
parotid gland
what is the definition of palliative care?
Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
which salivary gland is most likely to have a tumour (benign)
parotid
