HNN Flashcards
what regions are included in head and neck cancers?
nasopharyngeal, laryngeal, oral cavity, nasal cavity, paranasal sinuses, salivary glands, middle ear, lips *not skin, oesophageal, eye or thyroid
why is the incidence of oral cancers increasing?
linked to
- betal chewing
- smoking rates
- HPV
what are some risk factors for HNN cancers?
smoking and alcohol
EBV
HPV
betal nut chewing
radiation exposure
increase in age
male
immunosuppression
occupational
diet - high salt
southern Chinese ancestry
what are some clinical features of nasal cancers?
frequent nose bleeds persistent nasal congestion and rhinorrhoea
persistent foul smell if tumour necrotic
what are some features of paranasal sinus cancers?
recurrent sinusitis
pressure/ pain
ocular-paresis
what are some clinical features of oral cancers?
- chronic mouth ulcers >3w, leuco/erythroplakia, lump, changes in speaking
- mass, painless, bleeding, localised pain, jaw swelling
- pre-malignant conditions like leukoplakia, erythroplakia, oral lichen planus
what are some features of salivary cancers?
halitosis
dry mouth
pain on eating
asymmetry
what are some features of pharyngeal cancers?
- odynophagia, dysphagia, stertor, referred otalgia, neck lump
- hypopharynx presents as advanced disease
what are some features of larynx cancers?
- hoarse voice, stridor, dysphagia, persistent cough, referred otalgia
- glottic tumours better prognosis as they present earlier with hoarse voice as no lymph drainage
what are the referral criteria for oral cancers?
- Lump on the lip or in the oral cavity(urgent)
- Erythroplakia or erythroleukoplakia(urgent)
- Unexplained ulceration in the oral cavity for >3 weeks(consider)
- Persistent and unexplained lump in the neck(consider)
what are the referral criteria for laryngeal cancers?
- Persistent unexplained hoarseness(urgent)
- Unexplained lump in the neck(urgent)
what are the referral criteria for oral cancers?
- erythroplakia, leucoplakia
- ulceration in oral cavity >3w
how might you investigate HNN cancers?
- endoscopies + biopsies to rule out other primary tumours
- flexible nasal endoscopy - direct visualisation
- EUA and biopsy
- USS guided fine needle aspiration
- CT scan - staging of chest too
- immunohistochemical staining
- PET CT
how might you stage HNN cancers?
TNM staging
*CT scan neck and chest, PET CT, MRI scan to assess
- direct local excision
- invading adjacent structure
- metastasis to regional LN
how is HNN cancer managed?
- surgery - limited by invasions, co-morbidities +/- maxfax
- with radiotherapy and chemo
- radiotherapy - aduvant or neo or palliative, facial mould to hold still
- external beam, brachytherapy
- oral cavity - small tumours wide local excision, larger - surgical resection
- oropharynx - resection with laser or robotics
