Head And Neck Cancers

Question 1

Most common histological classification of head and neck cancers

Answer 1

90% are squamous cell carcinomas

Question 2

Risk factors for head and neck cancer

Answer 2

Alcohol
Tobacco
Beetle nut chewing for oral cavity malignancies
Chinese ethnicity for nasopharyngeal malignancy
Men affected twice as much as women

Question 3

What staging system is used for head and neck cancers?

Answer 3

TNM
T = tumour size 1-4
N = Nodal metastasis 0-N3
M = distant metastasis 0-1
Higher number gives worse prognosis. Patients with fiat the metastasis are not curable and treated palliatively

Question 4

Investigations of the primary tumour site

Answer 4

Examination under anaesthetic to biopsy for histological diagnosis, assess size and look for second primary

CT neck to assess size and neck nose metastasis

Question 5

Investigation of neck metastasis

Answer 5

Examine any palpable cervical lymphadenopathy
CT neck
Ultrasound guided fine needle aspiration

Question 6

Investigation of distant metastasis

Answer 6

CT chest (most common site of metastasis)

Question 7

Management of head and neck cancers

Answer 7

Palliation - aimed at reducing suffering, may involve chemo and radio

Curative - aimed at primary site and neck metastasis:
Radiotherapy +/- chemo
Surgery - endoscopic eg laser resection/ open surgery eg laryngectomy

Question 8

General clinical features in head and neck cancers

Answer 8

Dysphonia (especially laryngeal malignancy)
Dysphagia
Dyspnoea - stridor from narrowing of airway
Neck masses
Pain from site of pathology or referred
Bleeding from nose or mouth
Nasal blockage - unilateral progressive in nasopharyngeal pathology