Head & neck cancer (oral cavity, laryngeal, nasopharyngeal, salivary gland)

Question 1

What does “head and neck cancers” typically include?

Answer 1

Oral cavity cancers
Cancers of the pharynx (oropharynx, hypopharynx, nasopharynx)
Cancers of the larynx

Question 2

How do head and neck cancers typically present?

Answer 2

Neck lump
Hoarseness
Persistent sore throat
Persistent mouth ulcer

Question 3

When should you refer as 2WW for suspected laryngeal cancer according to NICE?

Answer 3

45yrs of over with:

• Persistent unexplained hoarseness OR
• Unexplained lump in the neck

Question 4

When should you refer as 2WW for suspected oral cancers according to NICE?

Answer 4

• Unexplained ulceration in the oral cavity lasting more than 3 weeks OR
• A persistent and unexplained lump in the neck

Refer urgently to dentist if:

• Lump in lip or oral cavity OR
• Red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia

Question 5

What type of cancer are most head/neck tumours?

Answer 5

Squamous cell carcinoma
The rest are:

• Salivary gland tumours
• Lymphomas
• Ethmoidal adenocarcinomas

Question 6

Are metastases common in head and neck cancers?

Answer 6

Only 10% metastasise - the lymph nodes are an effective barrier to spread in most

Question 7

What are the clinical features of a salivary gland tumour?

Answer 7

• hard
• fixed
• painful
• infiltrating surrounding structures such as the facial nerve and local lymph nodes
• a cause of overlying skin ulceration

Question 8

What are the clinical features of nasal cavity and paranasal sinus cancer and nasopharyngeal cancer ?

Answer 8

Maxillary sinus cancer:

• ocular effects - proptosis, epiphora, diplopia
• nasal effects - bloody rhinorrhoea, nasal obstruction, anosmia
• oral effects - loose teeth, ill-fitting dentures, palatal swelling
• facial effects - facial swelling or paraesthesia
• metastatic lymph nodes in neck
• retro-antral spread causing trismus (pterygoid invasion) or trigeminal neuralgia

Frontal sinus cancer:

• orbital symptoms

Nasopharyngeal cancer:

• nasal - postnasal obstruction; unilateral or bilateral nasal obstruction; loss of smell; epistaxis; blood stained nasal discharge
• aural - secretory or less commonly, suppurative otitis media; deafness; otalgia; tinnitus; rarely, ear discharge
• orbital - proptosis; restricted eye movement; diplopia; impaired vision; rarely, blindness
• pharyngeal - difficulty in speaking; dysphagia; excessive salivation; airway obstruction
• neurologic - CN III, IV and VI, and IX, X, XI and XII with trigeminal involvement
• neck metastases

Question 9

What are the clinical features of hypopharyngeal/oropharyngeal cancers?

Answer 9

• neck metastases are common at presentation
• dysphagia - first for solids, then for liquids
• weight loss
• dysphonia - either from direct invasion of larynx or as a result of vocal cord paralysis from recurrent larygneal nerve involvement
• otalgia
• sore throat

Question 10

What is the management of head and neck cancers?

Answer 10

MDT approach - surgeons, oncologists, radiologists, dentists, SALT, dieticians, rehabilitation therapists
Early stage - surgery or radiotherapy alone
Advanced disease - radiotherapy and chemotherapy
Locally recurrent/metastatic - palliative chemotherapy, immunotherapy