Head and Neck Seminar Flashcards
How common are head and neck cancers in the uk?
4th most common cancer in men, 13th most common cancer in women
Where is the most common site for head and neck cancer?
Larynx
What is the 5 year survival for head and neck cancer?
28-67% survival depending on stage
What is the most common cancer in type of head and neck cancer?
Squamous cell carcinoma
What part of the world are nasopharyngeal carcinomas common in?
South China = related to EBV, present with hearing problems
What is laryngeal carcinoma related to?
Cigarettes and alcohol
What is oropharyngeal carcinoma associated with?
HPV
Where are oral cavity carcinomas common in the world?
Southern Asia = associated with chewing tobacco
What is the stereotypical head and neck cancer patient?
Male, over 55, long exposure to cigarettes and alcohol
What are the risk factors for head and neck cancer?
Tobacco, HPV, alcohol, betel nut, EBV, hardwood
What is the typical patient for oropharyngeal carcinoma related to HPV?
Non-smoker, higher socio-economic class, multiple sexual partners
What are the presenting symptoms of head and neck cancer?
Dysphonia >3 weeks (urgent referral for laryngoscopy) Dysphasia (usually progressive) Odynophagia Unilateral Otalgia Neck lump = painless and progressive
Where do supraglottic tumours drain to?
Superior deep cervical nodes
Where do glottis tumours present?
On the vocal cords = 95% stay there as minimal lymphatic drainage
What are the symptoms of glottic and subglottic tumours?
Voice change and airway obstruction
Where do subglottic tumours spread to?
Paratracheal nodes
Where do oral cancers tend to present?
On lateral tongue borders
Where are pleomorphic adenomas common?
In parotid glands
Are blood tests usually done to investigate head and neck cancer?
No = they are of little value
What imaging techniques are used in diagnosis?
MRI = good for viewing soft tissues US = good for nodes CT = CT of chest for staging
What are biopsy and parendoscopy used for?
Confirming diagnosis
What are some investigations that require general anaesthetic?
Direct laryngoscopy, tracheoscopy, oesophagoscopy
What imaging techniques are used for staging?
CT = good for nodes and larynx MRI = nasopharynx and tongue base
How is laryngeal carcinoma treated?
T1/T2 = transoral laser surgery, radiotherapy T3/T4 = partial or total laryngectomy, chemo/radiotherapy
How are neck nodes treated?
Chemo/radiotherapy, surgery
What are some features of a total laryngectomy?
Often curative, morbidity significant
What is the management of oropharyngeal carcinoma?
T1/T2 = chemo/radiotherapy, transoral surgery T3/T4 = chemo/radiotherapy
What is the 5 year survival for laryngeal and oropharyngeal carcinomas?
> 90%
What are the symptoms of nasopharyngeal carcinoma?
30-40% have unilateral ear symptoms, up to 50% have nasal symptoms, up to 70% have palpable lymphadenopathy
What nerves may be involved in nasopharyngeal carcinoma?
CN III, IV, V
What is the treatment for nasopharyngeal carcinoma?
Radiotherapy
What is the 5 year survival for nasopharyngeal carcinoma?
Stage 1 = 100%
Stage 4a = 67%
What are masses in the parotid gland likely to be?
Benign (60%) = of these about 60% are pleomorphic adenomas
What are tumours in the submandibular and sublingual glands likely to be?
Malignant
What structures must be taken care of when carrying out a superficial or total parotidectomy?
Facial nerve, retromandibular vein, external carotid artery
