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ENT > Head and Neck Neoplasms > Flashcards

Head and Neck Neoplasms Flashcards

1
Q

Where are head and neck cancers located the highest by location?

A
  1. oral cavity
  2. larynx
  3. pharynx
  4. other
  5. salivary
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2
Q

Risk factors for head & neck cancer?

A
  • Tobacco and alcohol use
  • > in males
  • age (avg. is 62)
  • human papilloma virus (HPV 16) 70% of all cancers of the oropharynx; EBV
  • workplace exposure (UV light, wood dust, formaldehyde, asbestos, and other chemicals)
  • radiation treatment
  • nutrition
  • ancestery
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3
Q

What are some presenting symptoms of head and neck cancer?

A
  • bleeding
  • persisent sore throat
  • otalgia (often referred pain CN 9 &10)
  • dysphagia & odynophagia
  • hoarseness (>2 weeks)
  • facial pain
  • numbness
  • nasal airway obstruction
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4
Q
  • white plaques
  • 10-25% malignant transformation
  • tongue, floor of mouth, buccal mucosa
  • can’t scrape off

pre cancerous lesion

A

leukoplakia

DX: inflammation, ulceration, dysplasia

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5
Q
  • red plaques, slightly raised, bleeds easily when scraped
  • 70-80% malignant transformation
  • warrants biopsy
  • more worrisome
A

erythoplakia

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6
Q
  • nonhealing ulcer, painful bleeding
  • men>women (2x)
  • increases w/age
  • etiology (tobacco use, alcohol, poor oral hygiene)
A

squamous cell carcinoma

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7
Q
  • most common: southern china, singapore, vietnam, NW canada & greenland
  • 50% < 55 years old
  • greater in males
  • diet: high salt-cured fish &meat, low frutis & vegetables, nuts, legumes
  • EBV found in almost all cells
A

Nasopharyngeal cancer

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8
Q

symptoms of nasopharyngeal cancer?

A
  • non-tender neck mass (posterior- usually in posterior triangle)
  • hearing loss, fullness
  • recurrent OM
  • Nasal obstruction
  • nosebleeds
  • headache
  • facial pain/numbness
  • blurred vision
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9
Q
  • squamous cell carcinomas (minor salivary, sarcomas (connective tissue/cartilage) melanomas (mucosal surfaces)
  • risk factors: tobacco, alcohol, HPV, poor nutrition, excess body weight, workplace exposures, males, age
A

laryngeal cancer

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10
Q

symptoms of laryngeal cancer?

A
  • hoarseness
  • sore throat
  • constant cough
  • pain/trouble swallowing, weight loss
  • ear pain
  • trouble breathing/stridor
  • neck mass
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11
Q

treatment of layngeal cancer?

A

surgery
XRT
combination

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12
Q

mimic benign sinonasal disease
* nasal obstruction, rhinorrhea, congestion
* facial pain, epistaxis
* orbital symptoms: diplopia, proptosis, visual loss ,HA

Physical Exam
* nasal mass, loose dentition, mass involving hard palate, facial swelling proptosis, loss of smell

A

sinus cancer

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13
Q

warning signs and symptoms of Nasal tumors?

A
  • Unilateral
  • epistaxis
  • loss of smell
  • pain
  • change in vision
  • persistence despite treatment
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14
Q

Salivary gland anatomy

A

Major
* parotid- stenson duct: located near the second upper molar, superficial and deep lobe
* submandibular- wharton’s duct- just lateral to the base of the frenulum in the floor of the mouth
* sublingual- 8-15 exretory ducts

minor
* individual secretory units
* line the mucosa of lip, tongue, palate, & pharynx

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15
Q
  • painless masses, any age, usually 40-70 years
  • no known environmental risk factors, prior hx of radiation exposure
  • pleomorphic adenoma- most common benign
  • mucoepidermoid carcinoma- most common malignant
  • tx: surgical excision (70% involves the parotid)
  • the larger the gland- higher chance that it’s benign
A

salivary gland neoplasms

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16
Q
  • found almost exclusively in the parotid gland (can occur bilaterally, 2nd most common bengin tumor)
  • 5% of all salivary gland tumors
  • M>F
  • 5th to 7th decade of life
  • associated risk in smokers
A

Warthin Tumor

17
Q

what about a neck tumor causes concern for malignancy?

A
  • lacks infectious etiology (warmth, erythema, tender to touch, fever, tachycardia
  • mass present for > 2 weeks or uncertain duration
18
Q

function of the salivary gland

A
  • Lubricant & protection
  • buffering & clearance
  • maintenance of tooth integrity
  • antibacterial activity
  • tatste and digestion
19
Q
  • inflammatory process of affected gland (suppurative vs nonsuppurative)
  • viral- most common infectious cause; most common cause example of nonsuppurative- mumps
  • bacterial- often caused by staphylococcus
A

sialadentitis (salivary gland dysfunction)

20
Q
  • Acute, nonsuppurative viral parotitis (paramyxovirus)
  • 85% occur in children <15 years old
  • highly contagious, occurs worldwide, peaks in spring or tropical environments
  • spread my means of airborne droplets from salivary, nasal and urinary secretions.
  • maintained by spread of acute cases
  • incubation of 2-3 weeks
A

Mumps

21
Q

symptoms of mumps?

A

7-10 days
* low grade fever
* headache
* myalgia/arthralgia
* anorexia
* malaise
* bilateral parotid swelling (pain, otalgia, trismus, dysphagia, pain exarcebated by chewing, no evidence of erythema/warmth

22
Q
  • classically staphylococcus
  • acute or chronic
  • retrograde bacterial contamination
  • stasis of salivary flow- dehydration
  • parotid gland most susceptible
  • tx: hydration & antibiotics
A

suppurative sialadenitis

22
Q
  • rapid onset of pain and swelling over the afected salivary gland
  • complication of chronic dehydration (postsurgical pts, diabetics)
  • fever, chills, malaise
  • PE: dry mucous membranes, tenderness, warmth, induration of overlying skin, purulent discharge from duct
  • WBC: leukocytosis with neutrophilia
A

Acute suppurative sialadenitis

23
Q

what are some predisposing factors to accute suppurative sialadenitis?

A

diabetes
immune suppresion
radiation or chemotherapy
hypothyroidism
renal failure
sjogren’s
medications
stenosis of salivary ducts

24
Q
  • fomation of stones in the salivary gland
  • submandibular gland is affected in about 80% of cases (wharton’s duct)
  • can be from chronic sialadentitis, local injury/inflammation
  • predisposing condition: any conditon that can cause ductal stenosis or alter salivary secetions (dehydration,diabetes, EtOH, smoking , hypercalcemia, medications: anticholinergics diuretics)
A

sialolithiasis

Pain and tenderness w involved gland, intermittent swelling w/ meals

25
Q

diagnosis and treatment of sialolithiasis?

A
  • dx: intraoral inspection or bimanual palpation of calculi; sialogram; CT imaging
  • tx: remove calculi- expressed bimanually, intraoral incision, sialoendoscopy, gland removal
  • as well as prompt fluid and electrolyte replacement, reversal of salivary stasis, oral hygiene, antimicrobial therapy
26
Q
  • ductal obstruction of minor salivary gland
  • painless
  • fluid filled
  • surgical excision vs Incision & drainage
  • recurrent
A

mucocele

27
Q
  • reactivation of herpes simplex virus no. 1 or 2
  • transmission: oral sex, bodily fluids
  • treatment: observation, acyclovir or valcyclovir (initate w/in 48 hours) immunocompromised
A

Herpes stomatitis

28
Q
  • elongation of the papillae
  • temporary
  • harmless
A

hairy tongue

29
Q
  • venous dilation
  • blanches with palpation
A

venous lake

ENT (13 decks)

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