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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
Q

How does Hypopharyngeal Cancer present?

A

Dyphagia
Odynophagia
Hoarse voice
Pain referred to ear

26
Q

How does Nasal Cavity Cancer present?

A

Epistaxis
Unilateral Nasal Obstruction
Pain and paraesthesia (cheek/nose/upper lip)

27
Q

How does Salivary Gland Cancer present?

A

Painless lump within salivary gland rather than enlargement of whole gland
Infiltration of surrounding structures
Facial Pain/Palsy

28
Q

What should the physical examination of H and N cancers involve?

A

Bimanual examination of oral cavity
Palpation of regional lymph nodes
General physical (?metastatic disease)

29
Q

On blood investigations of Head and Neck Cancers why are LFTs and Coags concomitantly high?

A

Due to Alcohol

30
Q

What imaging techniques are used for Head and Neck cancers?

A

Flexible fibre-optic endoscopy

CT (extent of invasion, nodal involvement and metastases)

MRI (better soft tisssue)

31
Q

What is FDG PET-CT and when is it used?

A

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
Q

How is histology for suspected Head and Neck cancer gathered?

A

Biopsy - if primary tumour is identified and accessible (exception is salivary gland - seeding risk too great)

FNA of lymph node mass

33
Q

Give two reasons to 2WW refer someone for Oral Cavity cancer

A

Unexplained ulceration in oral cavity lasting >3 weeks

Persistent and unexplained lump in neck

34
Q

Give two reasons to 2WW refer someone for Laryngeal cancer

A

Persistent unexplained hoarseness

Unexplained lump in neck

35
Q

Give two reasons to 2WW refer someone for Salivary Gland cancer

A

Unexplained neck lump when 45y or older

Persistent and unexplained neck lump in any patient

36
Q

How are H and N cancers staged?

A

TNM

Slight variation between different cancers

37
Q

What can complicate management of Head and Neck cancers?

A

Co-Existing socioeconomic deprivation

38
Q

How are premalignant lesions of the Head and Neck managed?

A

Requires management as they might develop into carcinomas
Excised and histologically examined
May require radiotherapy if recurring/diffuse

39
Q

How is malignant Head and Neck disease managed?

A

Generally treated with surgery/radiotherapy or combination of the two (esp if bulky)
If early disease can typically use single modalities

40
Q

What should be done before beginning definitive management for Head and Neck disease?

A

Establish nutritional status
Refer for dental assessment
Correct any anaemia
Encourage smoking cessation

41
Q

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

A

Complete pathological staging
Quick clearance
Avoids toxicities of radiotherapy

42
Q

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

A

Avoids operative mortality
Organ conservation is more likely
Surgical clearance may be difficult/impossible

43
Q

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

A

Mucositis
Pituitary dysfunction
CNS necrosis

44
Q

What is the difference between radical neck dissection and modified neck dissection?

A

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
Q

How is locally advanced unresectable Head and Neck disease managed?

A

Chemoradiotherapy

Usually Cisplatin based as also acts as a radiosensitiser

46
Q

Give a biological therapy option for locally advanced unresectable head and neck disease

A

Chimeric IgG MAB

Targets EGFR

Cetuximab

47
Q

Advanced squamous cell carcinomas of head and neck have a poor prognosis and require chemotherapy. Name two particularly radiosensitive subtypes

A

Nasopharyngeal

Salivary

48
Q

What are the risks with treated Laryngeal cancer?

A

High risk of secondary primary malignancy

Patients with supraglottic are particularly at risk of subsequent primary lung cancer

49
Q

Often Head and Neck cancers require extensive rehabilitation. Describe speech rehabilitation

A

Total voice loss if laryngectomy

Can use: Oesophageal speech, artificial larynx device, creation of fistula

50
Q

Often Head and Neck cancers require extensive rehabilitation. Describe airway rehabilitation

A

May require stoma

May have to manage their own airway secretions

51
Q

Often Head and Neck cancers require extensive rehabilitation. Why do dentists need to be involved?

A

Frequent dental caries
Poor healing after tooth extraction
Late osteoradionecrosis

52
Q

Often Head and Neck cancers require extensive rehabilitation. Why do dieticians need to be involved?

A

Pre-existing lifestyle factors
Direct effects of cancer
Acute effects of treatment
Late effects of treatment (reduced saliva)

53
Q

Intraocular tumours can be Melanomas or Retinoblastomas. What are retinoblastomas?

A

Rare tumours arising in children less than 2y, normally autosomal dominant and bilateral

54
Q

How do Retinoblastomas present?

A

Leukocoria
Glaucoma
Deteriorating vision

55
Q

How can Retinoblastomas be managed?

A

Photocoagulation
Radiotherapy
Chemotherapy

Depending on severity

Year 4 Cancer Care and Haem (16 decks)

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