Head and Neck Cancers Flashcards
clinical features
- 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
causes of voice alteration not ENT
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).
causes of supraclavicular fossa lump
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.
where is nasopharyngeal carcinoma incidence highest
china, low in the UK
risk factors for Nasopharyngeal Carcinoma
male
tobacco, alcohol, viruses, betel nut and hardwood, smoking
eating foods containing volatile nitrosamines
which lymph nodes does Nasopharyngeal Carcinoma usually spread to
deep cervical
local spread may involve CN via the jugular foramen
which virus can cause Nasopharyngeal Carcinoma
EBV
EBV infection
- 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
what do EBV infected cell lines express
- latent genes: latent membrane protein 1 and EBNA2
- these activate cyclin D, which promotes transition from G0 to G1
presentation of oropharyngeal carcinoma
usually advanced at presentation
tumours found in mouth on buccal mucosa, or sides of tongue
typical older patient with oropharyngeal squamous cell carcinoma
smoker with sore throat, sensation of a lump, referred otalgia, local irritation from hot or cold foods and risk factors
causes of oropharyngeal carcinoma
85% squamous
HPV
HPV types 1-4
warts and verrucas
HPV 6 and 11
genital warts (and squamous papillomas in throat)
HPV 16 and 18
cervical cancer mainly
which strand of HPV causes oropharyngeal cancer
16
- Produces proteins E6 and E7 which disrupt p53 and RB pathways respectively, leading to cellular immortality
where does HPV and squamous cell cause cancer in ENT
- HPV - orpharynx, tongue base and tonsils
- Squamous - lip, oral cavity, tongue, pharynx, larynx, oesphagus
what is a squamous epithelial cell that has undergone a number of structural changes due to HPV called
koilocyte
typical patient with HPV caused oropharyngeal carcinoma
young, fit and healthy
often present with a lump in the neck as the tumour has already spread
prognosis of HPV oropharyngeal carcinoma
tumours have a good prognosis, and are sensitive to therapy
immunohistochemical staining of HPV
stain brown with Ki67 and p16 staining
what is a squamous papilloma
- Benign non-cancerous growth that begins in squamous cells of the skin, lip, oral cavity, tongue, pharynx, larynx, oesophagus, cervix, vagina or anal canal
which strand of HPV causes squamous papillomas
6 and 11
what are most squamous papillomas caused by
HPV types 6 and 11
describe squamous papilloma lesions
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
what are the main risk factors for squamous cell laryngeal cancer
smoking and alcohol
describe a typical older patient with squamous cell laryngeal cancer
male smoker with progressive hoarseness then stridor, difficulty/pain on swallowing ± haemoptysis ± ear pain
which laryngeal tumours have the best prognosis
glottis as they cause hoarseness the earliest
paraganglioma
- 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
