Head and Neck - Malignancy Flashcards
What questions should you ask when asking about a neck lump?
what is its size? What is its site? What is its shape? Is it smooth or lobulated? Is it in the midline? Is it solid or cystic? Is there more than one lump? Is it tender? Is it attached to viscus or skin? Is it connected to the thyroid when swallowing? Is it pulsatile? Is there any associated inflammation or ulceration?
What investigations would you carry out on a neck lump?
Blood tests - FBC
Monospot or Paul Bunnell test for glandular fever
HIV testing
Radiology - CT scan or chest x ray or MRI
USS of lump
Cytology - fine needle aspiration cytology (FNAC) = most useful
Endoscopy
What are the main risk factors for squamous cell carcinomas in head and neck?
Smoking and alcohol consumption
Leukoplakia can also be considered a risk factor as 1/3 of cases develop into cancer
What other risk factors for cancer of the head and neck?
Holding cigarettes between lips - lip cancer
Exposure to sun - cancer to head and ears
People who chew tobacco or bethel nuts - cancer of the lip/skin/especially ear
Breathing in certain chemicals and hardwood dusts - for example in workplaces
What are the different regions of the head and neck?
LOOK AT ANATOMY IN PICTURES
Nasopharynx Oral cavity Oropharyx Hypopharynx Larynx Nasal cavity and paranasal sinuses
What is the main pathological type of cancer seen in the head and neck?
squamous cell carcinoma
What are the common symptoms of cancer of the head and neck?
LONG LIST
persistent pain in the throat pain on swallowing difficulty swallowing persistent hoarseness of the voice or change in voice referred pain to the ear bleeding in the mouth or throat enlarging neck nodes persistent ulceration, leukoplakia (white patches), erythroplakia (red patches)
What is the significance of leukoplakia and erythroplakia?
Half of all head and neck cancers originate in the ORAL CAVITY
any white or red lesion that does not heal should be evaluated by a specialist and considered for biopsy
What is an important secondary symptom of head and neck cancer?
weight loss
What are the chances of metastasis with a squamous cell carcinoma?
tend to be well localised to the head and neck region unless advanced
What are the other symptoms of head and neck cancer which are less common?
lump or thickening in oral soft tissues
soreness or feeling that something is stuck in the throat
difficulty chewing or opening mouth
difficulty moving the tongue
numbness of the tongue or other part of the mouth
swelling of the jaw that causes dentures to fit poorly or become uncomfortable
anyone experiencing these for more than 2 weeks should see their GP or dentist asap
What are the first two steps to confirm a diagnosis of head and neck cancer?
Detailed history and an examination of the upper aerodigestive tract
Fine needle aspiration for the cytology (FNAC)
After the initial assessment what tests follow to aid diagnosis?
CT/MRI of neck from skull base to thoracic outlet
CXR or CT chest
Blood tests (U&E, FBC, LFT, Glucose, Albumin, TFT)
ECG
Assessment of nutritional status
What is the final stage of the diagnosis process?
Diagnosis MUST be confirmed with biopsies - usually involves a panendoscopy with biopsies taken of suspicious areas under general
The results are then presented to head and neck oncology MDT and treatment options are discussed and a plan is recommended to patient
Who is involved in the head and neck oncology MDT?
Oncologists
Speech therapists
Dieticians
Specialist nurses
What are the treatment options in head and neck cancers?
LONG
Radiotherapy Chemotherapy Surgery Laryngectomy Neck dissection
Curative or palliative
Combined modality therapy is becoming the principle method of treating patients with locally and advanced head and neck cancers
Where is the treatment plan decided?
At MDT - after reviewing results and general performance of patient
Describe the staging of cancer?
Based on:
- size of primary tumour (T)
- the degree to which nodes (N) are involved
- the absence or presence of distant metastases (M)
How is a stage decided?
One the T, N and M are determined a stage is given
stage 1 - small, localized and usually curable
stage 2/3/4 - more advanced/ have spread to local lymph nodes/ have distant mets
How does reactive lymphadenopathy present?
Hx of local infection or generalised viral illness
How does lymphoma present?
rubbery painless lymphadenopathy
look for night sweats
weight loss
splenomegaly
What should you look for with a thyroid swelling?
look for thyroid symptoms
moves upwards on swallowing
How do thyroglossal cysts present?
look for thyroid symptoms
moves upwards on swallowing
How does a pharyngeal pouch present?
seen in older men
midline lump that gurgles on palpation
dysphagia, regurgitation and chronic cough common
How does cystic hygroma present?
congenial lymphatic lesion found typically on left side
90% present before 2
How does branchial cyst present?
oval mobile cystic mass between SCM and pharynx
usually presents in early adulthood
How does a cervical rib present?
more common in adults females
10% develop thoracic outlet syndrome
How does carotid aneurysm present?
pulse tile lateral mass
does not move on swallowing
Which cancers present in the oropharynx?
SCC, non-hodgkins, salivary gland tumours
RF include HPV infection, IDA, betel nut chewing
What are the hypopharyngeal cancers?
almost exclusively SCC
RF - HPV, IDA, jewel nut chewing
What are the laryngeal cancers?
SCC
some salivary gland tumours and sarcomas
What are the other important questions to ask when investigating potential head and neck cancers?
dysphagia odynophagia voice changes referred pain in the ear trismus weight loss night sweats
