Head and Neck Squamous Cell Carcinoma Flashcards
What is the most common age for head and neck SCC?
> 50yrs
increasing incidence in young people
What are the risk factors for head and neck SCC?
cigarette smoking - increases risk x 10 excessive alcohol consumption vitamin A and C deficiency nitrosamines in salted fish HPV GORD depravation
What are the suspicious symptoms of head and neck SCC?
neck pain neck lump hoarse voice >6 weeks sore throat >6 weeks mouth bleeding mouth numbness sore tongue painless ulcers patches in mouth earache ear effusion lumps on lip, mouth or gum speech change dysphagia
What is the management of patient’s with symptoms of head and neck SCC?
urgent referral to ENT
What are the investigations of head and neck SCC?
fibre-optic endoscopy of the upper aerodigestive tract
fine needle aspiration or biopsy of any masses
CT or MRI of primary tumour site to stage and check for lymph node metastatic disease
What is the treatment for SCC of the head and neck?
radiotherapy (tumour <4cm)
surgery
What type of head and neck SCC is uncommon in the UK?
oral cavity and tongue
hypopharyngeal
What are the signs and symptoms of oral cavity and tongue SCC?
persistent painful ulcers white or red patches on the tongue, gums or mucosa otalgia odynophagia lymphadenopathy
What is odynophagia?
painful swallowing
What is the prognosis for SCC of the oral cavity and tongue?
> 80% 5yr survival in early disease
What type of head and neck SCC is often advanced at presentation?
oropharyngeal carcinoma (includes soft palate, tonsils and tongue base) 20% node +ve at presentation
What is the epidemiology of oropharyngeal carcinoma?
5:1 males to females
older
What is the classical presentation of oropharyngeal carcinoma?
smoker with sore throat, sensation of a lump and referred otalgia
Wat are the risk factors for oropharyngeal carcinoma?
pipe smoking
chewing tobacco
number of sexual partners
What is the prognosis for oropharyngeal carcinoma?
50% 5yr survival rate for stage I
tonsillar cancer and HPV associated have better prognosis
What type of HPV is associated with oropharyngeal carcinoma and how is it transmitted?
HPV16 - oral sex
What type of oropharyngeal carcinomas occur in younger people?
HPV associated
What may decrease the risk of HPV associated oropharyngeal carcinoma?
vaccine
What are the anatomical limits of the hypopharynx?
hyoid bone to lower edge of cricoid cartilage
What is the presentation of SCC of the hypopharynx?
lump in throat dysphagia odynophagia referred otalgia hoarseness
What is the prognosis of hypopharyngeal SCC?
60% mortality at 1 yr
What is the typical presentation of an older patient with laryngeal SCC?
male smoker with progressive hoarseness then difficulty or pain on swallowing \+/- haemoptysis ear pain (if pharynx involved)
What is the typical presentation of a younger patient with laryngeal SCC?
HPV+
What are the sites of laryngeal SCC?
supraglottic
glottic
subglottic
What is the surgery for laryngeal SCC?
laryngectomy +/- block dissection of the neck gland
What is the prognosis of laryngeal SCC?
66% 5yr survival rate
glottic tumours have best prognosis as they cause hoarseness earlier
What type of cancer can EBV cause?
nasopharyngeal carcinoma
Burkitt’s lymphoma
other B-cell lymphomas
Hodgkin’s lymphoma
How does EBV cause carcinogenesis?
infects epithelial cells of oropharynx and B cells - hi-jacks and mimics helper T cell response - proliferation and survival of B cells
mediated by latent membrane protein 1 (LMP-1)
encodes EBNA-2 - activates cyclin D - promotes transition from G0 to G1
How does HPV 16 cause cancer?
produces proteins EG and E7 - disrupt p53 and RB pathways respectively - causes cellular immortality
How does nasopharyngeal carcinoma present?
cervical lymphadenopathy otalgia unilateral serous otitis media nasal obstruction and discharge +/- epistaxis cranial nerve palsies - e.g. III - VI headaches unilateral hearing loss
What are the referral guidelines for patients with suspected laryngeal cancer?
aged 45 and over with:
persistent unexplained hoarseness
an unexplained lump in the neck
When should 2 week wait referrals to oral surgery be done?
unexplained oral ulceration or mass persisting for greater than 3 weeks
unexplained red or red and white patches that are painful, swollen or bleeding
unexplained one-sided pain in the head and neck area for greater than 4 weeks which is associated with ear ache but doesn’t not result in abnormal findings on otoscopy
unexplained recent neck lump or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
unexplained persistent sore throat
signs and symptoms in the oral cavity persisting for more than 6 weeks that cannot be definitively diagnosed as a benign lesion
What cancer may present as a painless as a painless lymphadenopathy?
nasopharyngeal carcinoma - tendency for early spread
In what ethnic group is nasopharyngeal carcinoma most common?
Asian
What is a red flag for nasal cancer?
recurrent unilateral epistaxis
When should there be an urgent referral to ENT for suspected laryngeal cancer?
> 45 with persistent unexplained hoarseness or an unexplained lump in the neck
