Head & Neck Cancers Flashcards
What do we mean by head & neck cancers?
Cancer that develops in the mouth, nose, throat, salivary glands and other areas of head and neck.
More than 30 different areas, some include:
- mouth and lips
- vocal cords (larynx)
- throat (pharynx)
- salivary glands
- nose and sinuses
- area at the back of the nose and mouth (nasopharynx)
Oesophageal, thyroid, brain and eye cancer do not tend to be classified as a head and neck cancer.
How common is head & neck cancer?
Which gender more common in?
Age of presentation
- 8th most common in UK
- Men (4th most common) > women (13th most common)
- Most cases arise in those >50yrs (however, does occur in younger pts and when it does it is often due to HPV)
What type of cancer are over 90% of H&N cancers?
Squamous cell carcinomas
When thinking about H&N cancers, we can classify the cancers into 6 anatomical regions; each has a slightly different TNM classification & tumour pattern. State the 6 anatomical areas
- Sino-nasal (nose and sinuses)
- Nasopharynx (the back of the nose and very top of the throat)
- Oral (from lips, hard palate to anterior 2/3rds of the tongue)
- Oropharynx (posterior 1/3rd of the tongue, tonsils and soft palate)
- Hypopharynx (the area of the throat behind the vocal cords and above the oesophageal opening)
- Larynx (area of the voice box and airway inlet)
State some risk factors for H&N cancer
- Smoking
- Alcohol
- Betel nut chewing (mostly linked to oral cancer)
- Chewing tobacco
- Sunlight exposure
- Previous radiation to H&N
- Viruses e.g. HPV (especially HPV 16- linked mostly to oropharyngeal), EBV
- Occupational exposure e.g. wood dust (sinonasal), asbestos, formaldehyde
- Ethnicity: NPhx (check from lecture)
Many H&N cancers, particularly oral cancers, can develop from visible premalignant conditions; state some examples and describe their appearances
These conditions are heavily associated with smoking & alcohol consumption.
- Leukoplakia: white patch on oral mucous membranes that cannot be rubbed off
- Erythroplakia: red patch on oral mucous membranes
- Erythroleukoplakia: combination of the above
-
Oral lichen planus: different presentations:
- White lace-like pattern that may also be swollen & red
- White & red patches
- Areas of ulceration
- Actinic cheilitis: most commonly affects lower lip: dry & cracked lips, thinned fragile skin, thickened scaly plaques & papules. Due to chronic sun exposure
Signs & symptoms of H&N cancer vary dependent on location of tumour; state some signs & symptoms of cancer in the oral cavity
*Most common symptoms are highlighted
- Mouth ulcers
- Unexplained, persistent lumps in mouth
- Pain, discomfort in mouth
- Unusual bleeding in mouth
- Numbness in mouth
- Loose teeth for no clear reason
*NOTE: erythroplakia (red patches) and leukoplakia (white patches) can be a sign of precancerous changes. Note if patch rubs off/away then more likely thrush
Signs & symptoms of H&N cancer vary dependent on location of tumour; state some signs & symptoms of cancer in the oropharynx, laryngopharynx/hypopharynx
*Most common symptoms are highlighted
- Persistent swelling or lump in neck (>3 week)
- Sore throat or tongue
- Earache
- Difficulty swallowing, moving mouth & jaw
- Bad breath
- Changes to voice
- Unequal looking tonsils
Signs & symptoms of H&N cancer vary dependent on location of tumour; state some signs & symptoms of cancer in the nasopharynx
*Most common symptoms are highlighted
- Persistent neck lump (>3 weeks)
- Nosebleeds
- Blocked or stuffy nose
- Hearing loss (unilateral)
- Tinnitus
- Numbness in lower part of face
- Double vision
- Headaches
- Difficulty swallowing
Signs & symptoms of H&N cancer vary dependent on location of tumour; state some signs & symptoms of cancer in the larynx
*Most common symptoms are highlighted
- Hoarse voice (> 3 weeks)
- Sore throat
- Difficulty swallowing
- Dysphagia
- SOB
- Sensation of lump in throat
- Halitosis (bad breath)
Signs & symptoms of H&N cancer vary dependent on location of tumour; state some signs & symptoms of cancer in the nose & sinuses
- Nosebleeds
- Unilateral persistent stuffiness/blocked nose
- Decreased sense of smell
- Blood stained mucus
- Post-nasal drip
- Persistent lump
- Eye problems (visual changes, swelling)
- Pain, numbness & paraesthesia in upper cheek
- Lump in neck
Signs & symptoms of H&N cancer vary dependent on location of tumour; state some signs & symptoms of cancer in the salivary glands
- Lump or swelling near jaw, mouth or neck (this could be gland or lymph nodes)
- Numbness in face
- Facial palsy/drooping one side of face
- Difficulty swallowing
- Difficulty opening mouth fully
Cancer is most common in which salivary gland?
Parotid
Discuss the 2WW referral criteria for suspected oral cancer (HINT: think about referral a dentist and to a doctor)
Consider 2WW referral for oral cancer in people with either:
- Unexplained ulceration in oral cavity lasting >3 weeks
- Or a persistent & unexplained lump in the neck
Consider an urgent (within 2 weeks) referral for assessment for possible oral cancer by a dentist who people with either:
- A lump on lip or in oral cavity
- Or a red or red & white patch in oral cavity consistent with erythroplakia or ertyrholeukoplakia
Discuss the 2WW referral for suspected laryngeal cancer
Consider 2WW referral for people aged >/=45yrs with either:
- Persistent, unexplained hoarseness
- Or an unexplained lump in the neck
Summary of NICE guidelines for H&N cancer 2WW referral
Image shows what PassMedicine says about 2WW referral for mouth lesions
What staging is used for H&N cancers?
TNM
**Don’t need to know details
Discuss the prognosis of H&N cancers
Prognosis varies:
- P16+ oropharynx 5yr survival >90%
- Hypopharynx/laryngopharynx 5yr survival ~25%
- Metastatic prognosis is very poor
