Head and Neck Cancers Flashcards
Describe the typical age distribution of H and N Cancers
85% are over 50
Smoking and Alcohol consumption are one of the biggest risk factors for H and N cancers. Describe this
They have a synergistic effect, and together account for >75% of head and neck cancer
Name three dietary risk factors for H and N cancers
VItamin A deficiency
Vitamin C Deficiency
Nitrosamines in salted fish
Name three infections associated with H and N cancers
HPV (particularly HPV16)
EBV (particularly nasopharyngeal)
Chronic Syphilis (Oral Cavity)
Name two precancerous lesions for H and N cancers
Leukoplakia
Erythroplakia
Name two genetic mutations associated with H and N cancers
p53 and Oral Cancers
Fanconi Anaemia - H and N SCC
Name three environmental agents associated with H and N cancers
Formaldehyde (Pharynx)
Soft wood dust (SCC Nasal Cavity)
Radiation (salivary gland tumour)
Describe the epidemiology of laryngeal cancer
75% in over 60s
Higher incidence in urban areas
Predominantly male
Describe the epidemiology of Oral Cavity cancer
Most common
South Asian population most at risk
10-30% develop second H and N tumour
Describe the epidemiology of Pharyngeal cancer
Rare
Most common site in UK is tonsils
Describe the epidemiology of Salivary Gland cancer
Mean presentation at 60 years
Describe the typical histology of a Head and Neck cancer
> 90% are SCC
Typically invade adjacent structures and prefer lymphatics to blood
Characterised by degree of kertatinisation
What is Leukoplakia?
Hyperparakeratosis and underlying epithelial hyperplasia
What is Erythroplakia?
Superficial red patches adjacent to normal mucosa, associated with epithelial dysplasia
What is the term for dysplasia involving full thickness mucosa?
Carcinoma in Situ
What is an Ackerman’s tumour?
Well differentiated SCC
White cauliflower like growth
Lymphatic spread is rare
Head and Neck cancer patients are more likely to develop a secondary primary tumour. Describe the timing of this
Synchronous - at or around same time as original lesion
Metasynchronous - occurring more than 6 months later
Describe a Salivary gland tumour
70-85% occuring in Parotid
Normally Pleomorphic Adenoma (benign epithelial, rarely undergoing transformation)
How is a Pleomorphic Adenoma managed?
Formal parotidectomy
Name a malignant Salivary gland tumour
Adenocarcinoma
How does laryngeal cancer present depending on the region it affects?
Supraglottic - Persistent cough, dysphagia
Glottis - Hoarse voice
Subglottic - Dyspnoea, Stridor
How might cancer of the Oral Cavity present?
Persistent mouth ulcers
Painful ulcerative lip lesion lasting > 3 weeks
White patches
Dental involvement
How does Nasopharyngeal Cancer present?
Cervical LN
Nasal obstruction/bleeding/discharge
Unilateral hearing loss
Headache
How does Oropharyngeal Cancer present?
Sore throat/lump in throat
Pain referred to ear
How does Hypopharyngeal Cancer present?
Dyphagia
Odynophagia
Hoarse voice
Pain referred to ear
How does Nasal Cavity Cancer present?
Epistaxis
Unilateral Nasal Obstruction
Pain and paraesthesia (cheek/nose/upper lip)
How does Salivary Gland Cancer present?
Painless lump within salivary gland rather than enlargement of whole gland
Infiltration of surrounding structures
Facial Pain/Palsy
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)
On blood investigations of Head and Neck Cancers why are LFTs and Coags concomitantly high?
Due to Alcohol
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)
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
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
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
Give two reasons to 2WW refer someone for Laryngeal cancer
Persistent unexplained hoarseness
Unexplained lump in neck
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
How are H and N cancers staged?
TNM
Slight variation between different cancers
What can complicate management of Head and Neck cancers?
Co-Existing socioeconomic deprivation
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
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
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
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
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
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
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
How is locally advanced unresectable Head and Neck disease managed?
Chemoradiotherapy
Usually Cisplatin based as also acts as a radiosensitiser
Give a biological therapy option for locally advanced unresectable head and neck disease
Chimeric IgG MAB
Targets EGFR
Cetuximab
Advanced squamous cell carcinomas of head and neck have a poor prognosis and require chemotherapy. Name two particularly radiosensitive subtypes
Nasopharyngeal
Salivary
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
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
Often Head and Neck cancers require extensive rehabilitation. Describe airway rehabilitation
May require stoma
May have to manage their own airway secretions
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
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)
Intraocular tumours can be Melanomas or Retinoblastomas. What are retinoblastomas?
Rare tumours arising in children less than 2y, normally autosomal dominant and bilateral
How do Retinoblastomas present?
Leukocoria
Glaucoma
Deteriorating vision
How can Retinoblastomas be managed?
Photocoagulation
Radiotherapy
Chemotherapy
Depending on severity
