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Year 4 Cancer Care and Haem > Head and Neck Cancers > Flashcards

Head and Neck Cancers Flashcards

1
Q

Describe the typical age distribution of H and N Cancers

A

85% are over 50

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2
Q

Smoking and Alcohol consumption are one of the biggest risk factors for H and N cancers. Describe this

A

They have a synergistic effect, and together account for >75% of head and neck cancer

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3
Q

Name three dietary risk factors for H and N cancers

A

VItamin A deficiency
Vitamin C Deficiency
Nitrosamines in salted fish

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4
Q

Name three infections associated with H and N cancers

A

HPV (particularly HPV16)
EBV (particularly nasopharyngeal)
Chronic Syphilis (Oral Cavity)

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5
Q

Name two precancerous lesions for H and N cancers

A

Leukoplakia

Erythroplakia

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6
Q

Name two genetic mutations associated with H and N cancers

A

p53 and Oral Cancers

Fanconi Anaemia - H and N SCC

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7
Q

Name three environmental agents associated with H and N cancers

A

Formaldehyde (Pharynx)
Soft wood dust (SCC Nasal Cavity)
Radiation (salivary gland tumour)

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8
Q

Describe the epidemiology of laryngeal cancer

A

75% in over 60s
Higher incidence in urban areas
Predominantly male

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9
Q

Describe the epidemiology of Oral Cavity cancer

A

Most common
South Asian population most at risk
10-30% develop second H and N tumour

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10
Q

Describe the epidemiology of Pharyngeal cancer

A

Rare

Most common site in UK is tonsils

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11
Q

Describe the epidemiology of Salivary Gland cancer

A

Mean presentation at 60 years

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12
Q

Describe the typical histology of a Head and Neck cancer

A

> 90% are SCC

Typically invade adjacent structures and prefer lymphatics to blood

Characterised by degree of kertatinisation

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13
Q

What is Leukoplakia?

A

Hyperparakeratosis and underlying epithelial hyperplasia

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14
Q

What is Erythroplakia?

A

Superficial red patches adjacent to normal mucosa, associated with epithelial dysplasia

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15
Q

What is the term for dysplasia involving full thickness mucosa?

A

Carcinoma in Situ

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16
Q

What is an Ackerman’s tumour?

A

Well differentiated SCC
White cauliflower like growth
Lymphatic spread is rare

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17
Q

Head and Neck cancer patients are more likely to develop a secondary primary tumour. Describe the timing of this

A

Synchronous - at or around same time as original lesion

Metasynchronous - occurring more than 6 months later

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18
Q

Describe a Salivary gland tumour

A

70-85% occuring in Parotid

Normally Pleomorphic Adenoma (benign epithelial, rarely undergoing transformation)

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19
Q

How is a Pleomorphic Adenoma managed?

A

Formal parotidectomy

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20
Q

Name a malignant Salivary gland tumour

A

Adenocarcinoma

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21
Q

How does laryngeal cancer present depending on the region it affects?

A

Supraglottic - Persistent cough, dysphagia
Glottis - Hoarse voice
Subglottic - Dyspnoea, Stridor

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22
Q

How might cancer of the Oral Cavity present?

A

Persistent mouth ulcers
Painful ulcerative lip lesion lasting > 3 weeks
White patches
Dental involvement

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23
Q

How does Nasopharyngeal Cancer present?

A

Cervical LN
Nasal obstruction/bleeding/discharge
Unilateral hearing loss
Headache

24
Q

How does Oropharyngeal Cancer present?

A

Sore throat/lump in throat

Pain referred to ear

25
How does Hypopharyngeal Cancer present?
Dyphagia Odynophagia Hoarse voice Pain referred to ear
26
How does Nasal Cavity Cancer present?
Epistaxis Unilateral Nasal Obstruction Pain and paraesthesia (cheek/nose/upper lip)
27
How does Salivary Gland Cancer present?
Painless lump within salivary gland rather than enlargement of whole gland Infiltration of surrounding structures Facial Pain/Palsy
28
What should the physical examination of H and N cancers involve?
Bimanual examination of oral cavity Palpation of regional lymph nodes General physical (?metastatic disease)
29
On blood investigations of Head and Neck Cancers why are LFTs and Coags concomitantly high?
Due to Alcohol
30
What imaging techniques are used for Head and Neck cancers?
Flexible fibre-optic endoscopy CT (extent of invasion, nodal involvement and metastases) MRI (better soft tisssue)
31
What is FDG PET-CT and when is it used?
If advanced cancer or high risk of metastatic disease Reflects rates of glucose meyabolism in tissue Superior to MRI and CT at detecting secondary primary tumours
32
How is histology for suspected Head and Neck cancer gathered?
Biopsy - if primary tumour is identified and accessible (exception is salivary gland - seeding risk too great) FNA of lymph node mass
33
Give two reasons to 2WW refer someone for Oral Cavity cancer
Unexplained ulceration in oral cavity lasting >3 weeks Persistent and unexplained lump in neck
34
Give two reasons to 2WW refer someone for Laryngeal cancer
Persistent unexplained hoarseness Unexplained lump in neck
35
Give two reasons to 2WW refer someone for Salivary Gland cancer
Unexplained neck lump when 45y or older Persistent and unexplained neck lump in any patient
36
How are H and N cancers staged?
TNM Slight variation between different cancers
37
What can complicate management of Head and Neck cancers?
Co-Existing socioeconomic deprivation
38
How are premalignant lesions of the Head and Neck managed?
Requires management as they might develop into carcinomas Excised and histologically examined May require radiotherapy if recurring/diffuse
39
How is malignant Head and Neck disease managed?
Generally treated with surgery/radiotherapy or combination of the two (esp if bulky) If early disease can typically use single modalities
40
What should be done before beginning definitive management for Head and Neck disease?
Establish nutritional status Refer for dental assessment Correct any anaemia Encourage smoking cessation
41
In early Head and Neck disease, the cure rate when using surgery alone and radiotherapy alone is the same. Give three benefits of using surgery alone
Complete pathological staging Quick clearance Avoids toxicities of radiotherapy
42
In early Head and Neck disease, the cure rate when using surgery alone and radiotherapy alone is the same. Give three benefits of using radiotherapy alone
Avoids operative mortality Organ conservation is more likely Surgical clearance may be difficult/impossible
43
In early Head and Neck disease, the cure rate when using surgery alone and radiotherapy alone is the same. Give three disadvantages of using radiotherapy alone
Mucositis Pituitary dysfunction CNS necrosis
44
What is the difference between radical neck dissection and modified neck dissection?
Radical (superficial and deep fascia with enclosed nodes, omohyoid, jugular veins, accessory nerve and submandibular glands) Modified - preserves vital structures such as accessory nerve
45
How is locally advanced unresectable Head and Neck disease managed?
Chemoradiotherapy Usually Cisplatin based as also acts as a radiosensitiser
46
Give a biological therapy option for locally advanced unresectable head and neck disease
Chimeric IgG MAB Targets EGFR Cetuximab
47
Advanced squamous cell carcinomas of head and neck have a poor prognosis and require chemotherapy. Name two particularly radiosensitive subtypes
Nasopharyngeal | Salivary
48
What are the risks with treated Laryngeal cancer?
High risk of secondary primary malignancy Patients with supraglottic are particularly at risk of subsequent primary lung cancer
49
Often Head and Neck cancers require extensive rehabilitation. Describe speech rehabilitation
Total voice loss if laryngectomy Can use: Oesophageal speech, artificial larynx device, creation of fistula
50
Often Head and Neck cancers require extensive rehabilitation. Describe airway rehabilitation
May require stoma | May have to manage their own airway secretions
51
Often Head and Neck cancers require extensive rehabilitation. Why do dentists need to be involved?
Frequent dental caries Poor healing after tooth extraction Late osteoradionecrosis
52
Often Head and Neck cancers require extensive rehabilitation. Why do dieticians need to be involved?
Pre-existing lifestyle factors Direct effects of cancer Acute effects of treatment Late effects of treatment (reduced saliva)
53
Intraocular tumours can be Melanomas or Retinoblastomas. What are retinoblastomas?
Rare tumours arising in children less than 2y, normally autosomal dominant and bilateral
54
How do Retinoblastomas present?
Leukocoria Glaucoma Deteriorating vision
55
How can Retinoblastomas be managed?
Photocoagulation Radiotherapy Chemotherapy Depending on severity

Year 4 Cancer Care and Haem (16 decks)

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