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RB Y2 ENT > Head and Neck Cancers > Flashcards

Head and Neck Cancers Flashcards

1
Q

clinical features

A
  • Neck pain/lump
  • Hoarse voice >6 weeks
  • Sore throat >6 weeks
  • Mouth bleeding
  • Mouth numbness
  • Sinus congestion
  • Sore tongue
  • Painless ulcers
  • Patches in mouth
  • Lumps
  • Speech change
  • Dysphagia
  • Epistaxis
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2
Q

causes of voice alteration not ENT

A

Can occur with a paralysed vocal cord due to e.g. lung pathology. This is because the left recurrent laryngeal nerve hooks under the arch of the aorta in the chest before coming back up to supply the larynx (the right recurrent laryngeal nerve hooks under the subclavian vein higher up).

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3
Q

causes of supraclavicular fossa lump

A

Lymph from the body drains into the thoracic duct on the left subclavian vein. This can be caused by pathology from all over the body.

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4
Q

where is nasopharyngeal carcinoma incidence highest

A

china, low in the UK

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5
Q

risk factors for Nasopharyngeal Carcinoma

A

male

tobacco, alcohol, viruses, betel nut and hardwood, smoking

eating foods containing volatile nitrosamines

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6
Q

which lymph nodes does Nasopharyngeal Carcinoma usually spread to

A

deep cervical

local spread may involve CN via the jugular foramen

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7
Q

which virus can cause Nasopharyngeal Carcinoma

A

EBV

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8
Q

EBV infection

A
  • The virus is a DNA herpesvirus that initially replicates in epithelial cells in the pharynx (causing pharyngitis), and later in B cells. The host immune response involves cytotoxic (CD8 +) T cells against infected B lymphocytes, resulting in atypical mononuclear lymphocytes.
  • To achieve long term persistence, EBV colonised the memory B cell pool, where it establishes latent infection characterized by the expression of a limited subset of viral genes – latent genes
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9
Q

what do EBV infected cell lines express

A
  • latent genes: latent membrane protein 1 and EBNA2
  • these activate cyclin D, which promotes transition from G0 to G1
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10
Q

presentation of oropharyngeal carcinoma

A

usually advanced at presentation

tumours found in mouth on buccal mucosa, or sides of tongue

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11
Q

typical older patient with oropharyngeal squamous cell carcinoma

A

smoker with sore throat, sensation of a lump, referred otalgia, local irritation from hot or cold foods and risk factors

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12
Q

causes of oropharyngeal carcinoma

A

85% squamous

HPV

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13
Q

HPV types 1-4

A

warts and verrucas

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14
Q

HPV 6 and 11

A

genital warts (and squamous papillomas in throat)

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15
Q

HPV 16 and 18

A

cervical cancer mainly

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16
Q

which strand of HPV causes oropharyngeal cancer

A

16

  • Produces proteins E6 and E7 which disrupt p53 and RB pathways respectively, leading to cellular immortality
17
Q

where does HPV and squamous cell cause cancer in ENT

A
  • HPV - orpharynx, tongue base and tonsils
  • Squamous - lip, oral cavity, tongue, pharynx, larynx, oesphagus
18
Q

what is a squamous epithelial cell that has undergone a number of structural changes due to HPV called

A

koilocyte

19
Q

typical patient with HPV caused oropharyngeal carcinoma

A

young, fit and healthy

often present with a lump in the neck as the tumour has already spread

20
Q

prognosis of HPV oropharyngeal carcinoma

A

tumours have a good prognosis, and are sensitive to therapy

21
Q

immunohistochemical staining of HPV

A

stain brown with Ki67 and p16 staining

22
Q

what is a squamous papilloma

A
  • Benign non-cancerous growth that begins in squamous cells of the skin, lip, oral cavity, tongue, pharynx, larynx, oesophagus, cervix, vagina or anal canal
23
Q

which strand of HPV causes squamous papillomas

A

6 and 11

24
Q

what are most squamous papillomas caused by

A

HPV types 6 and 11

25
Q

describe squamous papilloma lesions

A

oral lesions usually found on buccal mucosa, sides of tongue or lips

usually painless and not treated unless they interfere with eating or are causing pain

26
Q

what are the main risk factors for squamous cell laryngeal cancer

A

smoking and alcohol

27
Q

describe a typical older patient with squamous cell laryngeal cancer

A

male smoker with progressive hoarseness then stridor, difficulty/pain on swallowing ± haemoptysis ± ear pain

28
Q

which laryngeal tumours have the best prognosis

A

glottis as they cause hoarseness the earliest

29
Q

paraganglioma

A
  • tumours arising in neuroendocrine cells dispered throughout the body
  • non chromaffin ones seen in carotid and aortic bodies, and in clusters around oral cavity, nose, nasopharynx, larynx and orbit

RB Y2 ENT (22 decks)

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