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Ear, Nose & Throat > Head and Neck Carcinoma > Flashcards

Head and Neck Carcinoma Flashcards

1
Q

What are differentials for a hoarse voice (dysphonia)?

A

Allergies and chemical/environmental irritants

Direct trauma

Infections

Laryngopharyngeal or gastrooesophageal reflux

Medications

Vocal abuse

Benign vocal fold lesions

Dysplasia and squamous cell carcinoma

Age-related vocal atrophy

MS, myasthenia gravis, Parkinsons, stroke

Acromegaly, amyloidosis, hypothyroidisim

Inflammatory arthritis, lupus, sarcoidosis

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2
Q

What is the anterior triangle?

A
  • lower border of mandible
  • midline of neck
  • anterior border of SCM
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3
Q

What is the posterior triangle?

A
  • posterior border of SCM
  • anterior border trapezius
  • middle part of clavicle
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4
Q

What are the common types of head and neck cancer?

A

Squamous cell carcinoma

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5
Q

What are the (3) main risk factors for HNSCC?

A
  • smoking → inc x7.5
  • alcohol XS → inc x6
  • alcohol + smoking → inc x38
  • HPV
    • HPV 16 associated w/ oropharyngeal cancer
    • very common infection
    • almost always cleared w/ no adverse effect
    • presents in younger pts → more aggressive, increasing incidence, more amenable to treatment + vaccine available
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6
Q

What is the mode of spread of HNSCC?

A
  • different to other cancers
  • metastasises to cervical lymph nodes first
  • hard, fixed neck lump
  • still curable
    • neck radiotherapy
    • surgical lymph node clearance (“neck dissection”)
  • distant mets usually to lung
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7
Q

What are the relevant investigations for suspected HNSCC?

A
  • referral to 2-week-wait ENT clinic
  • thorough ENT history + examination
  • flexible nasolaryngoscopy
  • CT neck + chest
  • some tumours need MRI to assess extent
  • lymph nodes → FNA +/- ultrasound guidance
    • core or exicision biopsy risks seeding of SCC
  • usually need GA to biopsy primary tumour via panendoscopy
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8
Q

How does nasopharyngeal cancer present?

A
  • presents late → v poor diagnosis (50% 5 year survival)
  • unilateral middle ear effusion
  • epistaxis
  • nasal blockage
  • common in south china (salt fish diet + genetic risks)
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9
Q

How does oropharyngeal cancer present?

A
  • usually tonsillar - beware asymmetric tonsils
  • may be SCC or lymphoma
  • consider tonsillectomy
  • persistent pain in throat / ear
  • feelings of lump in throat
  • dysphagia
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10
Q

How does hypopharyngeal cancer present?

A

Late

50% w/ nodal metastases

5 year survival <40%

Throat/ear pain

Dysphagia

Dysphonia (late sign)

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11
Q

When should you suspect oral cavity cancer?

A
  • cigar smoking + chewing tobacco/betel nut
  • poor oral hygeine
  • non-healing ulcer, lump or lesion
  • refer if >14 days
  • not always painful

Treated by maxfax - but keep an eye out!

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12
Q

How does parotid cancer present?

A
  • gradually growing parotid lump
  • usually always benign
  • facial palsy very suspicious
  • symptoms rare (late)
    • trismus
    • pain
    • dysphagia

All parotid lumps need referral!

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13
Q

How does laryngeal cancer present?

A
  • most common tumour site
  • persistent unexplained hoarseness → 2-week-wait referral
  • dysphagia
  • throat pain
  • otalgia
  • cough
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14
Q

What causes vocal cord palsy and what are the investigations?

A
  • recurrent laryngeal nerve dysfunction
  • course of RLN - longer on right than left
  • caused by: trauma, neoplasm, stroke
  • investigation → nasoendoscopy, imaging whole course of RLN

Treatment option → thyroplasty, the affected cord is medialised with silastic

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15
Q

What causes bilateral vocal cord palsy?

What are the most common causes?

A
  • Airway emergency
  • Cords sit together, near midline
  • Stridulous patient
  • Most common causes → large neck tumours, thyroid surgery, idiopathic
  • may need tracheostomy
  • may resolve w/ time
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16
Q

What is the treatment for head + neck cancer?

A
  • primarily surgical excision or radiotherapy
  • chemotherapy as adjuvant treatment
  • complex treatment decisions
  • all cases discussed in head + neck MDT
  • try to treat using consensus decision
17
Q

What is discussed at the head and neck MDT?

A

Case history

Imaging

Histology

Treatment options

Social factors

18
Q

What do the speech and language therapy teams provide?

A
  • pre-treatment assessment + counselling
  • alleviation of morbidity → esp swallowing + speech
  • specialised treatments after laryngectomy
19
Q

How would a patient communicate after laryngectomy?

A

‘Speaking valve’ gold standard of care

Allows air from trachea to neopharynx

Difficult to learn

Frequent care required

SALT input vital

Other options: electrolarynx, oesophageal speech, written communication

Ear, Nose & Throat (20 decks)

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