Head and Neck Neoplasia - waldron

Question 1

what is the primary type of cancer of the oral cavity, pharynx and larynx

Answer 1

squamous cell carcinomas (SCC)

Question 2

what are the major risk factors of head/neck cancer

Answer 2

tobacco
alcohol
HPV (oropharyngeal cancer)
EBV (nasopharyngeal cancer)
Betel nut
sun exposure of lip carcinoma

Question 3

what can cause nasopharyngeal cancer

Answer 3

EBV - rare in US and europe

Question 4

What are signs and symptoms of head/neck cancer

Answer 4

location dependent
non-healing ulcer/sore
persistent mass
sore throat
hoarseness
dysphagia/odynophagia
cough
neck pass
weight loss

Question 5

what is a common clinical presentation of a nasopharyngeal cancer

Answer 5

majority present with a neck mass (90% of patients)
chronic serous otitis media
pain

Question 6

what is the clinical presentation of oropharynx cancer

Answer 6

chronic sore throat
referred otalgia

Question 7

what are the late symptoms with oropharynx cancer

Answer 7

change in voice/hoarseness
dysphagia
trismus (lockjaw)

Question 8

what is the presentation of posterior pharyngeal wall cancer

Answer 8

often asymptomatic for long period
presenting complaints: pain, bleeding, neck mass

Question 9

What is the presentation of hypopharynx cancer

Answer 9

70-80% of pts have clinically involved cervical nodes at the time of diagnosis

Question 10

when is supraglottic cancer usually diagnosed

Answer 10

at late stages
present with: airway obstruction, neck mass due to lymphadenopathy

Question 11

what are the common symptoms with Glottic laryngeal cancer

Answer 11

persistent hoarseness
dysphagia
referred otalgia
chronic cough
hemoptysis
stridor

Question 12

how are head and neck cancers diagnosed

Answer 12

biopsy

Question 13

if you suspect a patient has head/neck cancer - where should they be referred

Answer 13

EENT

Question 14

what are the different testing options for head/neck cancer

Answer 14

Panendoscopy
CT or MRI
PET scan
CBC, LFT’s, CMP

Question 15

what are congenital neck masses

Answer 15

Branchial cleft cysts
thyroglossal duct cysts
vascular abnormalities

Question 16

what is the typical first imaging study done for neck masses

Answer 16

CT scan

Question 17

what test is used for tissue diagnosis of neck masses

Answer 17

FNA (fine needle aspiration)

Question 18

how are head and neck cancers staged

Answer 18

TNM system
(Tumor, nodes, metastases)

Question 19

what is the common treatment for early stage 1 and 2 head and neck cancer

Answer 19

either surgery or radiation

Question 20

what is the gold standard treatment for locally advanced head/neck cancer

Answer 20

chemoradiotherapy

Question 21

what is the 5 year survival of oral cavity and pharynx cancer

Answer 21

about 65% overall

Question 22

what is the 5 year survival rate of laryngeal cancer

Answer 22

60% overall

Question 23

what is the rate of development of 2nd primary of the upper aero-digestive tract cancers

Answer 23

3-7% / year

Question 24

what is the survival rate of recurrent/metastatic head/neck cancer

Answer 24

9 months

Question 25

what is leukoplakia

Answer 25

white patch on oral mucosa that cannot be scraped off
pre-cancerous

Question 26

what is erythroplakia

Answer 26

red patch on oral mucosa
precancerous
more likely than leukoplakia to become malignant or have an invasive component

Question 27

what is Hairy leukoplakia

Answer 27

EBV induced lesion
~always HIV-infected or severe immunocompromised patients
NOT a premalignant lesion
painless white plaque

Question 28

what is the most common location for nasal/paranasal cancers

Answer 28

maxillary sinus
(second: ethmoid sinus)

Question 29

what are risk factors for Nasal/paranasal cancers

Answer 29

occupational exposures (leather, textile, wood dust, formaldehyde, nickel)
air pollution
tobacco smoke

Question 30

what are the most common types of nasal/paranasal cancers

Answer 30

50% are SCC
remainder are:
adenoid cystic carcinomas
adrenocarcinomas
mucoepidermoid carcinomas

Question 31

what are the typical presentation of nasal/paranasal cancers

Answer 31

pain
nasal obstruction
epistaxis
chronic sinus congestion

Question 32

how are nasal/paranasal cancers diagnosed

Answer 32

biopsy

workup: endoscopy, CT, MRI

Question 33

how are nasal/paranasal cancers treated

Answer 33

surgery and radiation
no randomized trails for treatment of these cancers

Question 34

what is the prognosis/5-year survival for paranasal/nasal cancers

Answer 34

poor prognosis
majority of deaths due to local invasion
< 50%

Question 35

What is the most common salivary gland tumor

Answer 35

parotid gland: benign