Head & Neck Cancers Flashcards
Which cancers are included under the umbrella term “Head and neck cancers”?
- Oral cavity cancers
- Cancers of the pharynx including oropharynx, hypopharynx and nasopharynx
- Cancers of the larynx
What are oral cavity cancers?
Oral cavity cancers include cancers of lips, tongues, floor of the mouth, alveolar ridge, hard palate or buccal lining.
=> 90% are squamous cell carcinomas
What are the risk factors?
Who does it commonly affect?
- Smoking
- Alcohol
- Betel nut (esp. in indian subcontinent)
- Chronic dental infection
- Immunosuppression
=> typically seen in middle age / older male patients
=> Increasingly seen in women due to increased smoking
What are the signs and symptoms of oral cavity cancers?
- Painless ulcer / lump
=> pain is a late symptom - Impaired speech and swallowing due to increasing size of tumour
- Erythroplakia - red, erythematous, velvety mucous membrane
- Leukoplakia (white) or mixed red/white lesions (speckled leukoplakia)
- Lichen planus
- Non-healing ulcer
- Neck swelling if metastases present
- Discolouration
Carcinoma of the lip:
=> most curable carcinoma in head & neck
=> sun exposure = well established link
=> lower lip most affected - 90%
Risk factors:
=> male,
=> fair skin,
=> older patient
Treatment:
=> Small tumours - excision and primary closure
=> Larger tumours - local skin flaps for reconstruction
Carcinoma of the oral tongue:
=> incidence is increasing in younger adults
=> lateral border + anterior 2/3 of tongue commonly affected
=> presents with a persisting ulcer
Treatment:
=> Smaller tumours - surgical excision
=> Advanced cancer - resection of primary lesions, neck dissection and post-operative radiotherapy
What are the risk factors for carcinomas of the pharynx (nasopharynx, oropharynx and hypopharynx)?
- Smoking
- Alcohol
- Viruses:
=> Oropharynx - human papilloma virus 16 & 18
=> Nasopharynx - epstein barr virus
- Radiation
Nasopharynx cancer:
=> rare tumour
=> most common in south asian and north asian population
=> EBV plays a major causative role
INFO CARD
What are the signs & symptoms of nasopharynx cancer?
=> Cervical lymphadenopathy
=> Ear pain
=> Secretory otitis media
=> Hearing loss
=> Persistent unilateral otitis media with effusion and no preceding upper respiratory tract infection
=> Cranial nerve palsies (CN3,4,5)
=> Epistaxis
=> Nasal discharge / obstruction
=> Changes in smell
What is nasopharyngeal angiofibroma?
How is it diagnosed and managed?
Epistaxis in young adult secondary to juvenile nasopharyngeal angiofibroma
=> arises in lateral wall of the nose in young males
=> benign but locally invasive and highly vascular tumour
=> if suspected, do NOT biopsy
=> diagnosis by imaging
=> management by surgical resection
What are the investigations for nasopharyngeal cancers?
Nasopharyngeal cancers are managed by combined chemotherapy and radiotherapy.
- Detailed head & neck exam
- Nasendoscopy
- Formal biopsy
- Fine needle aspirate of neck lymph nodes
- Imaging
- MRI (better to assess soft tissue involvement)
- CT (better to assess bony involvement)
What are oropharynx cancers?
Tumours of the tongue base (posterior 1/3 of the tongue) and tonsils
=> 70% of tonsillar tumours = squamous cell cancers
=> minority of tonsil tumours = lymphomas
What are the symptoms of oropharynx cancers?
- Unilateral painless tonsillar swelling
- Hx of throat discomfort with worsening dysphagia
- Referred otalgia
- ‘Lump in throat’ sensation or evidence of metastatic cervical lymphadenopathy
- Trismus = red flag for surrounding structure tumour infiltration
What are the investigations and management for oropharynx cancer?
Investigations:
=> Detailed head & neck exam
=> Panendoscopy + biopsy
=> Fine needle aspirate of neck nodes
=> Imaging - MRI for margins of tumour + CT for staging
Management:
=> Surgery ± radiotherapy / chemotherapy
=> Chemoradiotherapy
What are hypopharynx cancers?
Hypopharynx tumours are squamous cell carcinomas
=> metastases common
=> typically affects men 55-70 years old with a history or tobacco use / alcohol use
What are the symptoms of hypopharynx cancers?
- Cervical lymphadenopathy
- Pain that radiates from throat to ear
- Sore throat
- Painful swallowing (odynophagia)
- Voice changes
- Paterson-Brown-Kelly syndrome
=> dysphagia
=> hypo chromic microcytic anaemia
=> oesophageal webs
=> potential development of postcricoid carcinoma
