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ENT > Head and Neck Squamous Cell Carcinoma > Flashcards

Head and Neck Squamous Cell Carcinoma Flashcards

1
Q

What is the most common age for head and neck SCC?

A

> 50yrs

increasing incidence in young people

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2
Q

What are the risk factors for head and neck SCC?

A 
cigarette smoking - increases risk x 10 
excessive alcohol consumption 
vitamin A and C deficiency 
nitrosamines in salted fish 
HPV 
GORD
depravation
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3
Q

What are the suspicious symptoms of head and neck SCC?

A 
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
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4
Q

What is the management of patient’s with symptoms of head and neck SCC?

A

urgent referral to ENT

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5
Q

What are the investigations of head and neck SCC?

A

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

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6
Q

What is the treatment for SCC of the head and neck?

A

radiotherapy (tumour <4cm)

surgery

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7
Q

What type of head and neck SCC is uncommon in the UK?

A

oral cavity and tongue

hypopharyngeal

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8
Q

What are the signs and symptoms of oral cavity and tongue SCC?

A 
persistent painful ulcers
white or red patches on the tongue, gums or mucosa 
otalgia 
odynophagia 
lymphadenopathy
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9
Q

What is odynophagia?

A

painful swallowing

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10
Q

What is the prognosis for SCC of the oral cavity and tongue?

A

> 80% 5yr survival in early disease

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11
Q

What type of head and neck SCC is often advanced at presentation?

A 
oropharyngeal carcinoma (includes soft palate, tonsils and tongue base) 
20% node +ve at presentation
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12
Q

What is the epidemiology of oropharyngeal carcinoma?

A

5:1 males to females

older

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13
Q

What is the classical presentation of oropharyngeal carcinoma?

A

smoker with sore throat, sensation of a lump and referred otalgia

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14
Q

Wat are the risk factors for oropharyngeal carcinoma?

A

pipe smoking
chewing tobacco
number of sexual partners

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15
Q

What is the prognosis for oropharyngeal carcinoma?

A

50% 5yr survival rate for stage I

tonsillar cancer and HPV associated have better prognosis

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16
Q

What type of HPV is associated with oropharyngeal carcinoma and how is it transmitted?

A

HPV16 - oral sex

17
Q

What type of oropharyngeal carcinomas occur in younger people?

A

HPV associated

18
Q

What may decrease the risk of HPV associated oropharyngeal carcinoma?

A

vaccine

19
Q

What are the anatomical limits of the hypopharynx?

A

hyoid bone to lower edge of cricoid cartilage

20
Q

What is the presentation of SCC of the hypopharynx?

A 
lump in throat 
dysphagia 
odynophagia 
referred otalgia 
hoarseness
21
Q

What is the prognosis of hypopharyngeal SCC?

A

60% mortality at 1 yr

22
Q

What is the typical presentation of an older patient with laryngeal SCC?

A 
male smoker with progressive hoarseness
then difficulty or pain on swallowing 
\+/- 
haemoptysis 
ear pain (if pharynx involved)
23
Q

What is the typical presentation of a younger patient with laryngeal SCC?

A

HPV+

24
Q

What are the sites of laryngeal SCC?

A

supraglottic
glottic
subglottic

25
Q

What is the surgery for laryngeal SCC?

A

laryngectomy +/- block dissection of the neck gland

26
Q

What is the prognosis of laryngeal SCC?

A

66% 5yr survival rate

glottic tumours have best prognosis as they cause hoarseness earlier

27
Q

What type of cancer can EBV cause?

A

nasopharyngeal carcinoma
Burkitt’s lymphoma
other B-cell lymphomas
Hodgkin’s lymphoma

28
Q

How does EBV cause carcinogenesis?

A

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

29
Q

How does HPV 16 cause cancer?

A

produces proteins EG and E7 - disrupt p53 and RB pathways respectively - causes cellular immortality

30
Q

How does nasopharyngeal carcinoma present?

A 
cervical lymphadenopathy 
otalgia 
unilateral serous otitis media 
nasal obstruction and discharge +/- epistaxis 
cranial nerve palsies - e.g. III - VI 
headaches 
unilateral hearing loss
31
Q

What are the referral guidelines for patients with suspected laryngeal cancer?

A

aged 45 and over with:
persistent unexplained hoarseness
an unexplained lump in the neck

32
Q

When should 2 week wait referrals to oral surgery be done?

A

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

33
Q

What cancer may present as a painless as a painless lymphadenopathy?

A

nasopharyngeal carcinoma - tendency for early spread

34
Q

In what ethnic group is nasopharyngeal carcinoma most common?

A

Asian

35
Q

What is a red flag for nasal cancer?

A

recurrent unilateral epistaxis

36
Q

When should there be an urgent referral to ENT for suspected laryngeal cancer?

A

> 45 with persistent unexplained hoarseness or an unexplained lump in the neck

ENT (21 decks)

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