head and neck cancer and palliative care

Question 1

what can cause cancer in the oropharynx?

Answer 1

HPV

Question 2

what are the symptoms of nasopharyngeal cancer?

Answer 2

Unilateral epistaxis
Unilateral nasal blockage
Mass in nasopharynx
Unilateral conductive hearing loss
Neck lump

Question 3

what are some examples of midline swellings?

Answer 3

thyroid
thyroglossal cyst-attached to tongue base (moves when tongue sticks out)
dermoid cyst- (moves when tongue sticks out)

Question 4

what are the features of a thyroglossal cyst?

Answer 4

can arise in any part of the thyroglossal tract.
contains lymphatics which may become infected
moves with the tongue
usually presents in teenage years

Question 5

how are thyroid nodules categorised?

Answer 5

U1, U2- Benign
U3- Equivocal
U4, U5- Malignancy

classified using an USS and FNA

Question 6

what are some examples of anterior triangle swellings

Answer 6

Lymph Nodes
Branchial Cyst
Salivary glands
Carotid Body Tumour

Question 7

at what size is a lymphnode considered abnormal?

Answer 7

(>1 cm or >1.5 cm at level 2

Question 8

what should be done for cervical lymphadenopathy?

Answer 8

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

Question 9

what are the features of a brachial cyst?

Answer 9

Persisting second branchial arch
Arises in upper part of ant. Triangle
Usually presents in teenage years

Question 10

what are some possible issues with the salivary glands?

Answer 10

Submandibular
Stone
Pleomorphic adenoma
Parotid
Infective
Pleomorphic adenoma
Stone

Question 11

where is the most common site for head and neck cancer?

Answer 11

the larynx (voice box)

Question 12

what type of cancer is the most common head and neck cancer?

Answer 12

squamous cell carcinoma

Question 13

what groups of people are most likely to present with head and neck cancer in the UK

Answer 13

traditional patient- male >55 with long exposure to cigarettes and alcohol
or
non-smoker, middle class, multiple sexual partners (HPV related)

Question 14

what are key symptoms in patients with a neck lump?

Answer 14

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

Question 15

where do supra-glottic tumours spread to?

Answer 15

Drain to superior deep cervical nodes

Question 16

where do glottic tumours drain to?

Answer 16

Present on the cords
95% stay on the cords
Minimal lymphatic drainage
Presents with voice changes/airway obstruction

Question 17

where do subglottic tumours drain to?

Answer 17

only make up 1% of laryngeal tumours

Spread to paratracheal nodes
Present with voice/airway obstruction

Question 18

how is a head and neck caner diagnosis confirmed?

Answer 18

biopsy from primary site +/- biopsy of suspected metastases

Question 19

what are the 5 commonly used investigations in the head and neck clinic?

Answer 19

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

Question 20

what is the management of laryngeal cancer?

Answer 20

Early (T1 & T2)
-Transoral laser surgery
-Radiotherapy

> 90% 5 year survival

Advanced (T3 and T4)
-Partial or Total laryngectomy
-Chemo & Radiotherapy

Question 21

what is the management of oropharyngeal cancer?

Answer 21

Early (T1 & T2)
-Chemo-radiotherapy
-Transoral robotic surgery
>90% 5 year survival

Advanced (T3 and T4)
-Chemo-radiotherapy

Question 22

what are the signs of nasopharyngeal cancer?

Answer 22

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

Question 23

how is nasopharyngeal cancer treated?

Answer 23

Treatment is with (Chemo) Radiotherapy
5 year survival is excellent:
Stage1 - 100%
Stage 4a – 67%

Question 24

which salivary gland is most likely to have a cancerous mass?

Answer 24

sublingual and submandibular

Question 25

where are pleomorphic tumours likely to occur?

Answer 25

parotid gland

Question 26

what is the definition of palliative care?

Answer 26

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.

Question 27

which salivary gland is most likely to have a tumour (benign)

Answer 27

parotid