Head and Neck Squamous Cancers

Question 1

Associations of nasopharyngeal ca. (5)

Answer 1

chinese
EBV
HPV
toxins: tobacco, formaldehyde, wood dust
weaning onto salted fish

Question 2

Sx of nasopharyngeal ca. (9)

Answer 2

chronic sinusitis (>12wks)
earache/effusion from blocked eustachian tubes>conductive hearing loss
mouth bleeding
painless ulcers
dysphagia/epistaxis
numbness
neck pain/lump
hoarse voice/sore throat/speech change
sore tongue

Question 3

signs of nasopharyngeal ca. (4)

Answer 3

diplopia
conductive hearing loss
CN palsies
nasal obstruction

Question 4

Ix for nasopharyngeal ca. (2)

Answer 4

endoscopy/biopsy

MRI for staging

Question 5

Staging nasopharyngeal ca. (4)

Answer 5

T1: naso/oropharynx and nasal cavity
T2: parapharyngeal extension
T3: bony structures of skull base/paranasal air sinuses
T4: intracranial, CNs, hypopharynx

Question 6

Rx and prognosis (2)

Answer 6

radiotherapy 1st line (SEs: xerostomia, dysphagia)

EBV+ve has worst prognosis

Question 7

common site of oropharyngeal ca. (2)

Answer 7

floor of mouth

lateral border of tongue

Question 8

typical pt. w. oropharyngeal ca. (6)

Answer 8

smoker
sore throat
sensation of lump
referred otalgia
local irritation w. hot/cold drinks
"hot potato voice"
(often present w. advanced disease)

Question 9

RFs for oropharyngeal ca. (2)

Answer 9

smoking/chewing tobacco

alcohol synergistic w. smoking

Question 10

Ix and Rx of oropharygeal ca.

Answer 10

MRI

Rx w. surgery/radiotherapy

Question 11

Pre-malignant conditions for hypopharyngeal ca. (2)

Answer 11

Plummer-Vinson syndrome: IDA+dysphagia+ oesophageal web in upper oesophagus (post-cricoid tumours)

Leukoplakia

Question 12

Assoc. and mortality rate of hypopharyngeal ca. (5)

Answer 12

assoc. w.:
- previous irradiation
- smoking
- alcohol
- asbestos

high mortality rate

Question 13

Typical pt. w. laryngeal ca. (6)

Answer 13

younger pt.:

• cannabis smoker
• HPV +ve

older pt.:

• male w. progressive hoarseness>stridor
• pain swallowing
• EAR PAIN
• haemoptysis

Question 14

Ix for laryngeal ca. (3)

Answer 14

laryngoscopy+biopsy
HPV test
MRI

Question 15

Rx of laryngeal ca. (2)

Answer 15

radiotherapy (risk of hypothyroidism)

total laryngectomy: will need permanent tracheostomy

(glottic tumours have best prognosis since present w. early hoarseness)

Question 16

signs of sinus squamous cell cancer (6)

Answer 16

blood stained nasal discharge
nasal obstruction
ptosis/diplopia
pain in maxillary division of trigeminal nerve
cheek swelling/ulcers
epiphora-overflow of tears onto face due to blocked nasolacrimal duct
(suspect when chronic sinusitis presents later in life)

Question 17

Ix for sinus squamous cell cancer

Answer 17

MRI+/-CT>biopsy

Question 18

histology of sinus ca. (4)

Answer 18

50% squamous
lymphoma
adenocarcinoma
benign (inverted papilloma)

Question 19

assoc. of maxillary sinus carcinoma

Answer 19

assoc. w. inhalation of wood.