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 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
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
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
