Head + Neck Cancer Flashcards
Which cancers are included in ‘head and neck cancer’?
Oral cavity Pharynx Larynx Paranasal sinuses Nasal cavity Salivary glands
What type of cancer is most commonly seen in head and neck cancers?
Squamous cell carcinomas
–> HNSCCs (head + neck SCCs)
What are the risk factors for head and neck cancer?
Alcohol + smoking (75%) HPV type 16 Betel quid chewing Occupational wood dust EBV infection Male
What cancer head and neck cancer is linked to HPV 16?
Oropharyngeal cancer
Which cancer is linked to betel quid chewing?
Oral cancer
Which cancer is linked to occupational wood dust?
Sinonasal cancer
Which cancer is linked to EBV infection?
Nasopharyngeal
Which premalignant lesions are seen in oral cancer?
Leukoplakia, erythroplakia, erythroleukoplakia
Oral lichen planus
Actinic chelitis
–> biopsy
What are the non-specific clinical features seen in head and neck cancer?
Weight loss
Cervical lymphadenopathy
What are the clinical features of oral cavity cancer?
Painless mass on inner lip, tongue, floor of mouth or hard palate
May have been premalignant lesion
Bleeding, localised pain in oral cavity
May be jaw swelling
What are the clinical features of pharyngeal cancer?
Odynophagia Dysphagia Stertor Referred pain May be a neck lump if nasopharyngeal Trotter's syndrome
What is Trotter’s syndrome?
Triad suggesting nasopharyngeal malignancy:
- unilateral conductive deafness (middle ear effusion)
- trigeminal neuralgia
- defective mobility of soft palate
What does pharyngeal cancer often present at a late stage?
Often metastasises early due to extensive lymphatics
What are the clinical features of laryngeal cancer?
Hoarse voice Stridor (if advanced) Dysphagia Persistent cough Referred otalgia
How is head and neck cancer initially investigated?
Flexible nasal endoscopy to visualise lesion
Biopsy lesion - most done under GA except oral cavity lesions
If presenting solely with lymphadenopathy –> US-guided FNA
How is staging carried out for head and neck cancer?
CT neck + chest
–> tumour extension, local invasion + lymph nodes
- chest included to look for lung mets
MRI neck + CT chest for oral + oropharyngeal cancers
What is the role of PET CT in investigating head and neck cancer?
Can be used for tumours of unknown origin
What are the management options for head and neck cancer?
Varies greatly
- surgical resection +/- adjuvant radiotherapy or chemotherapy
- OR primary radiotherapy +/- chemotherapy
- -> discussed at neck + neck MDT
Which nerves may be injured following neck dissection?
Accessory
Vagus
Hypoglossal
Marginal mandibular
What are the early complications of salivary gland tumour removal?
Haematoma –> airway obstruction
Facial nerve injury (parotid surgery)
What is Frey’s syndrome?
Late complication of parotidectomy
- redness and swelling
