Head And Neck Cancers Flashcards
Epidemiology of head and neck cancer?
What is most common cell type of H+N cancer?
Where do they begin?
12,000 cases per year in the UK
* 4th most common in men
* 13th most common in women
Most common type = SCC
Begins in the mucosal surfaces lining the cavities of the H+N, and also in the salivary glands
Describe the tumour subtypes you see in H+N cancer
Lip/Oral cavity
Pharynx = oropharynx, nasopharynx, laryngopharynx
Larynx = supraglottis, glottis, subglottis
Thyroid
What are risk factors for H+N cancer?
Lifestyle
* smoking
* alcohol
* betal nut chewing
* dental hygiene
Occupational
* wood dust
* asbestos
* formaldehyde
Viruses
* HPV for oropharynx
* EBV for nasopharynx
Premalignant conditions:
* leucoplakia
* erythroplakia
What are RF for thyroid cancer?
- irradiation exposure = includes iodine and radiation leaks
- family history and inherited conditions (FAP, MEN2A and MEN2B conditions)
- young lumps < 20 years old and old lumps > 70 years old = more likely to be malignant
How are H+N cancers staged?
TNM staging
What are the types of thyroid cancer?
Papillary
Follicular
Medullary
Anaplastic
Thyroid lymphoma
How does lip/oral cavity H+N cancer present?
- lump - on lip or oral cavity
- pain - includes referred pain to the ear
- fixation of tongue
- dysphagia
- odynophagia
What investigations and management would you do for lip/oral cavity H+N cancer?
Inv
* biopsy
* may need imaging with CT +/- MRI
* may need PET
Management:
* Consider an urgent referral (for an appointment within 2 weeks) for assessment by a dentist
* Consider suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) in people when assessed by a dentist as having a lump on the lip or in the oral cavity consistent with oral cancer
* small tumours = excise and repair the defect
* radiotherapy
* larger tumours that don’t respond to radiotherapy = extensive surgery
How does pharynx H+N cancer present?
- Lump - mainly nodal mets are first thing patient notices
- Pain - referred otalgia
- dysphagia
- odynophagia
- weight loss
Investigations and treatment for pharynx H+N cancer?
Investigations:
* Imaging with CT +/- MRI
* may need PET
* biopsy
Treatment:
* excise small tumour
* radiotherapy
* extensive surgery if no benefit from radiotherapy
How does larynx H+N cancer present?
- dysphonia
- dysphagia
- referred otalgia
- globus
- neck lump
- weight loss
- cacexia
What would be your inv and treatment for larynx H+N cancer?
Inv:
* biopsy
* imaging with CT and MRI
* may need PET
Treatment:
* surgery or radiotherapy
* see pic for larynx
Distinguish between papillary, follicular, medullary and aplastic thyroid cancer
* which is more common?
* ages for each?
* which are aggressive?
* where are mets?
For H+N cancers, what are general investigations to do?
H+N induction slides
Why is there a huge psychological impact with advanced H+N cancers?
H+N cancers affect:
* breathing
* eating
* communication
* carotid
Who is in MDT when managing H+N cancers?
- ENT
- Maxillofacial
- Dental
- dietician
- SALT
- CNS - clincial nurse specialist
How does cancer of the thyroid present?
- lump in the thyroid or neck nodal metastasis
- compressive symptoms - problems swallowing (odynophagia), feel like they are being strangled
- voice changes
What is triple assessmen of thyroid in H+N cancers?
- Full Hx and Ex
- Imaging - USS
- Needle testing of any suspicious lumps via cytology by FNAC (fine needle aspiration cytology)
What are treatment options for Thyroid cancer?
Hemi-thyroidectomy or total thyroidectomy
Neck dissection for nodal disease
Radioactive iodine
Radiotherapy or chemo
What are side effects of radiotheapy in H+N cancers?
What follow up would you do for H+N cancers?
What are causes of recurrent laryngeal nerve palsy?
- idiopathic
- laryngeal cancer
- thyroid disease - benign or malignant
- trauma - iatrogenic (thyroidectomy)
- cervical lymphadenopathy
- oesophageal cancer
- apical lung cancer
- aortic aneurysm
- neuropathic - diabetes
What are red flags in Hx or Ex that may suggest H+N cancer?
- Lump in the mouth or on the lip
- Unexplained ulceration in the mouth lasting more than 3 weeks
- Erythroplakia or erythroleukoplakia
- Persistent neck lump
- Unexplained hoarseness of voice
- Unexplained thyroid lump
What is name of monoclonal antibody used in treating H+N cancers?
Dr Tom z2f
Cetuximab is an example of a monoclonal antibody used in treating squamous cell carcinomas of the head and neck.
* It may also be used to treat bowel cancer.
* It targets epidermal growth factor receptor, blocking the activation of this receptor and inhibiting the growth and metastasis of the tumour.
