Head and Neck Neoplasms Flashcards
Where are head and neck cancers located the highest by location?
- oral cavity
- larynx
- pharynx
- other
- salivary
Risk factors for head & neck cancer?
- 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
What are some presenting symptoms of head and neck cancer?
- bleeding
- persisent sore throat
- otalgia (often referred pain CN 9 &10)
- dysphagia & odynophagia
- hoarseness (>2 weeks)
- facial pain
- numbness
- nasal airway obstruction
- white plaques
- 10-25% malignant transformation
- tongue, floor of mouth, buccal mucosa
- can’t scrape off
pre cancerous lesion
leukoplakia
DX: inflammation, ulceration, dysplasia
- red plaques, slightly raised, bleeds easily when scraped
- 70-80% malignant transformation
- warrants biopsy
- more worrisome
erythoplakia
- nonhealing ulcer, painful bleeding
- men>women (2x)
- increases w/age
- etiology (tobacco use, alcohol, poor oral hygiene)
squamous cell carcinoma
- 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
Nasopharyngeal cancer
symptoms of nasopharyngeal cancer?
- non-tender neck mass (posterior- usually in posterior triangle)
- hearing loss, fullness
- recurrent OM
- Nasal obstruction
- nosebleeds
- headache
- facial pain/numbness
- blurred vision
- 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
laryngeal cancer
symptoms of laryngeal cancer?
- hoarseness
- sore throat
- constant cough
- pain/trouble swallowing, weight loss
- ear pain
- trouble breathing/stridor
- neck mass
treatment of layngeal cancer?
surgery
XRT
combination
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
sinus cancer
warning signs and symptoms of Nasal tumors?
- Unilateral
- epistaxis
- loss of smell
- pain
- change in vision
- persistence despite treatment
Salivary gland anatomy
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
- 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
salivary gland neoplasms
- 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
Warthin Tumor
what about a neck tumor causes concern for malignancy?
- lacks infectious etiology (warmth, erythema, tender to touch, fever, tachycardia
- mass present for > 2 weeks or uncertain duration
function of the salivary gland
- Lubricant & protection
- buffering & clearance
- maintenance of tooth integrity
- antibacterial activity
- tatste and digestion
- 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
sialadentitis (salivary gland dysfunction)
- 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
Mumps
symptoms of mumps?
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
- classically staphylococcus
- acute or chronic
- retrograde bacterial contamination
- stasis of salivary flow- dehydration
- parotid gland most susceptible
- tx: hydration & antibiotics
suppurative sialadenitis
- 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
Acute suppurative sialadenitis
what are some predisposing factors to accute suppurative sialadenitis?
diabetes
immune suppresion
radiation or chemotherapy
hypothyroidism
renal failure
sjogren’s
medications
stenosis of salivary ducts
- 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)
sialolithiasis
Pain and tenderness w involved gland, intermittent swelling w/ meals
diagnosis and treatment of sialolithiasis?
- 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
- ductal obstruction of minor salivary gland
- painless
- fluid filled
- surgical excision vs Incision & drainage
- recurrent
mucocele
- 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
Herpes stomatitis
- elongation of the papillae
- temporary
- harmless
hairy tongue
- venous dilation
- blanches with palpation
venous lake
