Head and neck disorders

Question 1

Head and Neck cancer : Pathophysiology

Answer 1

A group of malignancies that occur in various structures within the head and neck region.
* Histology : Squamous cell carcinoma

Question 2

Head and Neck cancer : Sites and Spread

Answer 2

• Mouth and salivary glands
• Nasal cavity and paranasal sinuses
• Pharynx and larynx

Spread : Lymphnodal spread

Question 3

Head and Neck cancer : Risk factors

Answer 3

Main RF : Tobacco and Alcohol exposure } Carinogenic
2. HPV 16 infection - especially oropharyngeal cancer
3. Chronic inflammation - Epstein Barr virus

Question 4

Head and Neck cancer : 2WW criteria - Laryngeal cancer

Answer 4

** >45 years old with**;

1. Persistent hoarseness
2. Neck lump

Or
**Any age with **
* Persistent sore throat

Question 5

Head and Neck cancer : 2WW criteria - Oral cancer

Answer 5

1. > 3 weeks of unexplained oral ulcer
2. Red/white patches - bleeding, swollen or painful
3. Unilateral pain in H+N associated with ear ache
4. Any lesions for > 6 weeks

Question 6

Head and Neck cancer : Refer for Dentist assess criteria : Oral ca

Answer 6

1. Lump on the lip or in the oral cavity
2. Leuko/Erythroplakia
   : Red granulomatous plaque on mucous membrane in oral cavity

• Premalignant Oral ca
• Caused by chronic irritation/ inflammation

Question 7

Nasopharyngeal ca : Red flag sx

Answer 7

1. Unilateral nasal polyps or sx of obstruction/rhinorrhea etc
2. Assoc bleeding

Question 8

Head and Neck cancer : Management

Answer 8

1. Chemo/Radiotherapy/Surgery
2. Monoclonal antibodies : targeted drugs

Question 9

Nasal Polyps : Clinical features

Answer 9

Features
* nasal obstruction
* rhinorrhoea, sneezing
* poor sense of taste and smell

Question 10

Nasal Polyps : Association

Answer 10

• asthma (particularly late-onset asthma)
• aspirin sensitivity
• infective sinusitis
• cystic fibrosis
  Samter’s triad.: association of asthma, aspirin sensitivity and nasal polyposis

Question 11

Neck lumps : Causes in Adults

Answer 11

1. Lymphadenopathy
2. Tumour - Laryngeal/Pharyngeal ca
3. Lipoma
4. Thyoid pathology : Thyroid ca, Goitre, Thyrglossal cyst
5. Benign : Carotid body tumor, Branchial cyst

Question 12

Neck lumps : Lymphadenopathy causes

Answer 12

1. Reactive : 2nd to URTI infection, tender on palpation
2. Infected LN : 2nd to chronic viral inflammation - Epstein Barr or HIV
3. Inflammatory LN : SLE
4. Malignancy : Lymphoma/leukaemia, LN metastasis
   * Hard, rubbery, tethered - non tender +/- systemic sx

Question 13

Neck lumps : Thyroid pathology causes

Answer 13

• Goitre : diffuse swelling, sx of hyperthyroidism - weight loss
• Thyroglossal cyst : single fluid lump, moves up and down with movement of tongue

Question 14

Neck lumps : Carotid body tumor

Answer 14

1. Definition : Over proliferation of ‘glomus’ chemoreceptor cells in carotid artery
2. Clinical features
   * Slow-growing lump that is:
   * near the angle of the mandible)**
   * Pulsatile** and painless
   * Associated with a bruit on auscultation**

Question 15

Neck lumps : Lipoma

Answer 15

Benign tumours of fat (adipose) tissue.
* Soft
* Painless
* Mobile

Question 16

Neck lumps : Branchial cyst

Answer 16

1. Non regression of branchial apparatus - arches that form pharyngeal region during embryonic development - 2nd branchial arch forms cyst

• Location : Angle of the mandible
• Presentation : > age 10, becomes more noticeable

Question 17

Neck lump : Red flag sx

Answer 17

1. 2WW referral
   * An unexplained neck lump in someone aged 45 or above
   * A persistent unexplained neck lump at any age
2. Urgent US scan
   * Lump growing In size