Head and Neck Carcinoma

Question 1

Pathophysiology of Head and Neck Cancers.

Answer 1

Usually SCC arising from squamous cells of mucosa.

Question 2

Sites of Head and Neck Cancers.

Answer 2

1. Nasal Cavity.
2. Paranasal Sinuses.
3. Mouth.
4. Salivary Glands.
5. Pharynx.
6. Larynx.

Question 3

Mode of Spread of Head and Neck Cancers.

Answer 3

First Lymph Nodes - Lymphadenopathy.

Question 4

What is Cancer of Unknown Primary?

Answer 4

SCC cells may be found in an enlarged abnormal lymph node and the original tumour cannot be found.

Question 5

Risk Factors of Head and Neck Carcinoma (5).

Answer 5

1. Smoking.
2. Chewing Tobacco, Betel Quid.
3. Alcohol.
4. HPV - Strain 16.
5. EBV Infection.

Question 6

Clinical Features of Head and Neck Carcinoma (4).

Answer 6

1. Neck Lump.
2. Hoarseness.
3. Persistent Sore Throat.
4. Persistent Mouth Ulcer.

Question 7

Red Flag Features of Head and Neck Carcinoma.

Answer 7

1. Lump in Mouth/on Lip.
2. Unexplained Ulcer in Mouth for 3+ Weeks.
3. Erythroplakia/Erythroleukoplakia.
4. Persistent Neck Lump.
5. Unexplained Thyroid Lump.

Question 8

2 Week Wait Referral Criteria (3).

Answer 8

1. Unexplained Neck Lump in 45+ Person.
2. Persistent Unexplained Neck Lump.
3. Soft Tissue Sarcoma in US (Direct Access Investigation).

Question 9

Direct Access Investigation of Neck Lump.

Answer 9

Urgent US in patients with a lump that is growing in size - within 2 weeks if 25+ and within 2 days if <25.

Question 10

Management of Head and Neck Carcinoma (3).

Answer 10

1. MDT.
2. Staging - TNM.
3. Chemotherapy, Radiotherapy, Surgery, Immunotherapy, Palliative Care.

Question 11

Immunotherapy in Head and Neck Carcinoma.

Answer 11

Cetuximab - Monoclonal Antibody targets EGFR to inhibit growth and metastasis of tumour.

Question 12

Differentials of Neck Lumps in Adults (10).

Answer 12

1. Skin Abscess.
2. Lymphadenopathy.
3. Tumour e.g. SCC, Sarcoma.
4. Lipoma.
5. Goitre/Thyroid Nodules.
6. Salivary Gland Stones/Infection.
7. Carotid Body Tumour.
8. Haematoma.
9. Thyroglossal Cysts.
10. Branchial Cysts.

Question 13

Differential Diagnoses of Neck Lumps in Kids (4).

Answer 13

1. Cystic Hygromas.
2. Dermoid Cysts.
3. Haemangiomas.
4. Venous Malformations.

Question 14

Imaging Investigations of Neck Lumps (3).

Answer 14

1. US (1st Line).
2. CT/MRI.
3. Nuclear Medicine Scan - Toxic Thyroid Nodules or PET for Metastasis.

Question 15

Histological Investigations of Neck Lumps (4).

Answer 15

1. FNA Cytology.
2. Core Biopsy.
3. Incision Biopsy.
4. Removal of Lump.

Question 16

Differential Diagnoses of Hoarse Voice (4).

Answer 16

1. Laryngeal Cancer (3+ Weeks and Diagnosis of Exclusion).
2. Chronic Laryngitis (GORD and Worse AM).
3. Laryngitis (Viral, Self-Limiting).
4. Reinke’s Oedema (Enlargement of Vocal Cords - Hypothyroidism).