Head & Neck Cancers Flashcards
What is the most common type of head and neck cancer? What percentage?
(as in cell type)
Squamous cell carcinoma (SCC), which accounts for more than 80% of all head and neck cancers.
arise from mucosal linings of upper digestive tract (epithelial tissue).
What is the primary lymphatic drainage of the lower lip?
Submental nodes.
What is the most common presenting symptom of oral cancer?
Ulceration
What percent of patients report Otalgia (ear pain)?
60%
What is the function of the sternocleidomastoid muscle in relation to head and neck cancer staging?
It divides the neck into anterior and posterior triangles, important for disease spread and clinical descriptions.
What are common risk factors for head and neck cancer?
Tobacco and alcohol use, UV light exposure, viral infections (e.g., HPV, EBV), and occupational exposures (e.g., wood dust, nickel).
Smoking increases by how many times vs a non-smoker?
6 times
Alcohol damages the mucosa and makes it more__________
permeable
Combines usage of both alcohol consumption AND smoking increases the risk by how many times?
35 times
Ultraviolet light – what H&N cancer would be linked to this risk factor?
Lip Cancer (specifically, cancers of the lip and oral cavity)
Occupational exposures:
dust, fumes, formaldehyde, and other chemicals
Risks related to diet:
vitamin A & E deficiency, fried and processed foods
Risk factors associated with viruses?
- Epstein-Barr virus: nasopharyngeal
- Herpes simplex virus 1 (HSV-1): higher risk in smokers in the anterior oral cavity
- Human Papillomavirus (HPV): most oral cavity, oropharynx, larynx
Genetic risks:
Bloom Syndrome: A rare genetic disorder characterized by short stature, sun-sensitive skin, and an increased risk of various cancers due to mutations in the BLM gene that affects DNA repair.
Li-Fraumeni Syndrome: An inherited condition that significantly increases the risk of developing several types of cancer, particularly in children and young adults, due to mutations in the TP53 gene, which plays a crucial role in regulating the cell cycle and preventing tumor formation.
What percentage of the bodies lymph nodes are located in the head and neck area?
Nearly 1/3
Which cranial nerve is involved when facial paralysis occurs due to head and neck tumors?
Cranial nerve VII (facial nerve)
What is the 5-year survival rate for HPV-positive oropharyngeal cancer?
Around 90%
What is xerostomia and when does it typically occur during radiation therapy?
Dry mouth due to damage to salivary glands, typically occurring after 2000 cGy of radiation.
What occupations are associated with an increased risk of head and neck cancer?
Nickel refining, woodworking, steelwork, and textile work.
What is the primary treatment for most small tumors of the nasal septum or maxillary sinus?
Surgery
What is the role surgery in H&N tumors?
Is crucial in staging
Provides good outcomes with early-stage tumors
It is common to see a total or partial laryngectomy along with a tracheostomy in clinic patients
What is the role of chemotherapy in H & N tumors?
Usually reserved for advance nasopharyngeal cancers (NPCs) before RT, a radiosensitizer during RT, or as adjuvant after RT
What are the commonly prescribed chemotherapy drugs for H & N tumors?
Cisplatin and 5-fluorouracil (5-FU) is most frequently used combination.
Cisplatin can be combined with other chemo drugs.
In general, the morbidity ________ and prognosis _________ as the affected area progresses backward from the lips to hypopharynx (but excludes the larynx)
Increases,
decreases
What are the characteristics of advanced stage H & N disease?
Common characteristics of advanced stage disease and poor prognosis include tumors that cross the midline, exhibit inward growth (into organ or structure), are poorly differentiated, and are (non)-SCC
What is the significance of HPV in head and neck cancers?
HPV is a major risk factor for oropharyngeal cancers, especially in younger patients, with better prognosis compared to non-HPV-associated cancers.
HPV tumors are more radiosensitive, have fewer genetic mutations compared to cancers caused by smoking/alcohol
Typically younger patients have HPV-related cancer & they are healthier and able to tolerate treatment better due to their age.
What is involved in a Radical neck dissection?
Radical neck dissection is the gold standard for treatment of neck disease
It involves the removal of I-V level nodes (W&L pg. 653), the sternocleidomastoid muscle, the internal jugular vein, and the spinal accessory/11th cranial nerve
A modified radical neck dissection attempts to decrease morbidity by sparing muscle, blood vessels, and nerves
what is considered the mainstay of cancer management for H&N cancers.
Although RND is the gold standard and surgery holds a high priority in H&N cancers radiation therapy is considered the mainstay of cancer management for H&N cancers.
What are common symptoms of parotid gland tumors?
mass or lump, pain, muscle weakness on one side of the face.
Paratoid gland tumors are what type of cancer?
Adenocarcinoma (not SCC; it’s a gland
Most of the salivary tumors occurring in the parotid are (benign or malignant?)
What are the routes of spread?
BOTH
benign or arise from metastatic skin cancer
Routes of spread:
1.Most common is local invasion (ipsilateral (meaning on the same side) neck lymph nodes
2. perineural (around a nerve or group of nerves) invasion)
What is the most common site of disease of the oral cavity?
The lips
What are the presenting symptoms (plural) of oral cavity cancer?
- chronic, non-healing ulcers
- mouth pain
- other pre-malignant conditions such as leukoplakia and erythroplasia
What type of cancer (cell type) is oral cavity cancer? And by what percentage?
SCC – 90-95%
Oral cavity routes of spread?
(think anatomicaly & which lymph nodes)
1.Lips – direct invasion
2. Floor of mouth/oral tongue – commonly present with submental and submandibular lymph node involvement
Metastatic node involvement is relatively rare in oral cavity cancers when compared to other H&N cancers
Nasopharynx
where is it located anatomicaly?
What is the clinical presentation?
Most common cancer (cell type) at what %?
routes of spread?
It is located posterior to the soft palate with a rich lymphatic network
Presentation: mass or lump, hearing loss, ringing in the ear, feeling of fullness in the ear, nasal blockage, nosebleeds, headaches
SCC – 90%
Routes of spread: most commonly spreads to lymphatics
Oropharynx
what anatomical areas is it composed of?
what kind of cancer (cell type)?
what is the clinical presentation?
routes of spread?
It includes the uvula, tonsillar fossae and pillars (most common site of disease), base of tongue, soft palate, and vallecula
Presentation: painful swallowing, sore throat
SCC
Routes of spread: direct extension or lymphatic spread
Hypopharynx cancer
anatomical site?
presentation?
cell type?
routes of spread?
think “pear”
It consists of the pyriform sinus (most common site of disease) and the posterior pharyngeal wall
Pyriform sinus, meaning “pear shaped” is a recess on either side of the layrngeal oriface
Presentation: dysphagia, painful neck nodes, mass or lump, ear pain
SCC
Routes of spread: tumors commonly have positive nodal spread to JD and midjugular nodes
Maxillary sinus tumors
describe the anatomical site
common symptoms?
cell type?
routes of spread?
prevalence?
Largest paranasal sinus, located on both sides of the nose in the cheek area; rare tumors, but maxillary sinus tumors account for the majority of all paranasal sinus tumors
Common symptoms include nosebleeds, nasal obstructions, pain above or below the eyes, decreased sense of smell
SCC
2:1 male prevalence; age > 40
Route of spread: direct extension into the orbit, oral cavity, nasal cavity, and base of skull
Salivary Gland tumors
what % of all H&N tumors?
What kind is the most common?
It has 2 specific causes…
average age?
gender?
Rare – 3-4% of all head and neck cancers
Parotid is the most common in this category (80-90%) and 2/3 of these are benign
Specific etiology – childhood RT, hardwood dust
Average age 55 years, with benign tumors occurring around 40 years
Equal between male and female
Larynx
cell type?
what sex is it more common in? at what age?
routes of spread?
SCC
More common in men (90%), mainly at ages 50-60
Routes of spread:
Supraglottic lesions present with nodal involvement in the JD and midjugular nodes
Glottic lesions rarely spread due to lack of lymph nodes in the region; prognosis of glottis tumors depends on vocal cord fixation
Subglottic lesions spread to the peritracheal and cervical nodes
What is the most common site of distant metastasis for head and neck cancers?
The lungs
What are some long-term side effects of radiation therapy for head and neck cancer patients?
Xerostomia, dysphagia, dental caries, osteoradionecrosis, and trismus.
What is the impact of radiotherapy on thyroid function?
Radiation to the neck area can cause hypothyroidism, requiring thyroid function monitoring and potentially lifelong hormone replacement therapy.
What is mucositis, and at what dose does it typically occur?
Inflammation of the oral mucosa, typically occurring after 3000 cGy of radiation.
What is osteoradionecrosis, and what causes it?
A condition where irradiated bone becomes necrotic and fails to heal, often due to high radiation doses to the jaw.
Review Question From Book
- Multiple tumor types are included in the head and neck region. Which type of primary tumor is most common?
a. Adenocarcinoma.
b. Squamous cell carcinoma.
c. Basal cell carcinoma.
d. Fibrosarcoma.
b. Squamous cell carcinoma.
Review question in book
- The primary lymphatic drainage of the lower lip is to the:
a. Submental nodes.
b. Submaxillary nodes.
c. Subdigastric node.
d. Posterior cervical chain.
a. Submental nodes.
Review Question in book
- What healthy tissue is at most risk of radiation damage with treatment of the maxillary antrum?
a. Brain.
b. Eye.
c. Skin.
d. Pituitary.
B. Eye
Review Question in Book
- The most common sign or symptom of oral cancer is: a. Ulceration. b. Hoarseness. c. Odynophagia. d. Xerostomia.
A. Ulceration
Review question in Book
- The most commonly involved group of nodes in oropharyngeal cancer is the: a. Submandibular nodes. b. Retropharyngeal nodes. c. Jugulodigastric nodes. d. Supraclavicular nodes.
C. Jugulodigastric nodes
(The jugulodigastric lymph node is a large node found in the proximity of where the posterior belly of the digastric muscle crosses the internal jugular vein.)
Review Question in Book
- A tumor confined to the larynx with cord fixation in glottic cancer is staged as a: a. T1. b. T2. c. T3. d. T4.
C. T3
T Staging in Glottic Cancer:
T1: Tumor is limited to one vocal cord, with normal movement of the cord.
T2: Tumor involves both vocal cords, possibly with superficial spread, but without fixation.
T3: Tumor is still confined to the larynx but has caused cord fixation (immobility of the vocal cord) or invasion into the surrounding structures without extending beyond the larynx.
T4: Tumor has extended beyond the larynx into adjacent structures (e.g., thyroid cartilage or other tissues).
Review question in book
- Palpation of the cricoid cartilage indicates the inferior border of the: a. Oral cavity. b. Oropharynx. c. Larynx. d. Hypopharynx.
C. Larynx
Review question in Book
- For patients with carious teeth, when is dental work recommended when anticipating oral cavity irradiation? a. After treatment. b. Before treatment. c. Both a and b. d. Neither a nor b.
B. Before treatment
Review question in book
- Postcricoid cancers occur predominantly in: a. Adult women. b. Adult men. c. Both women and men equally. d. Pediatric patients under 18 years.
A. Adult women
Review question in book
- Tumors of the head and neck may involve the cranial nerves that control the major senses. This involvement may lead to signs and symptoms that can point to a possible location of a tumor. Which cranial nerve may be involved in facial paralysis? a. XII. b. I. c. VIII. d. VII.
D. VII
The role of HPV status when staging
HPV Status: Oropharyngeal cancers are classified as p16-positive (containing HPV DNA) or p16-negative (without HPV).
Separate staging systems are used for p16-positive and p16-negative cancers because p16-positive cancers generally have a better prognosis.
