HNSCC Flashcards
What are most head and neck cancer?
Squamous cell carcinoma from lining of aerodigestive tract
Where can head and neck cancers arise?
Oral cavity Oropharynx Hypopharynx Larynx Trachea
> 80% arise in >50 years old
Spreads via lymphatics
What are symptoms of hear and neck cancer?
Neck pain/lump Hoarse voice > 6 weeks Sore throat > 6 weeks Mouth bleeding Mouth numbness Sore tongue Painless ulcers Patches in the mouth Earache/effusion Lumps (lip, mouth, gum) Speech change Dysphagia
What is associated with HNSCC?
Smoking Alcohol consumption Vitamin A and C deficiency Nitosamines in salted fish HPV GORD Deprivation
What investigations in head and neck cancer?
Fibre-optic endoscopy
Fine-Needly aspiration or biopsy of any masses and CT/MRI of the primary tumour site to stage the neck for nodal metastases
Describe staging of HNSCC
TNM
Tumour - T1<2cm, T4 = extension to bone, muscle, skin, antrum, neck
Node - N0 = no involvement N3 = any lymph node > 6cm
Submandibular, submental, high/mid/low jugular chain
Posterior triangle
Metastases M0 = none, M1 = distant mets
What are features of oral cavity/tongue SCC?
Persistent painful ulcers White or red patches on the tongue, gums or mucosa Otalgia Odonophagia Lymphadenopathy
What are features of oropharyngeal carcinoma? What investigation? What management?
Older patient - smoker with sore throat, sensation of lump, referred otalgia
MRI
Surgery and radiotherapy
How can oral sex give you cancer?
High risk HPV16 has been linked to cancer of tongue, tonsil and pharynx
Vaccination may reduce risk
Associated with younger people
What are hypo pharyngeal tumour features? Anatomical limits?
Lump in throat Dysphagia Odonophagia Pain referred to ear Hoarse voice
Anatomic limits of hypo pharynx are hyoid bone to lower edge of cricoid cartilage
What is the typical laryngeal cancer older patient? younger patient?
Older: Male smoker with progressive hoarseness, stridor, difficulty or pain on swallowing ± haemoptysis ± ear pain
Younger: HPV +ve
Where can laryngeal cancer occur?
Supraglottic
Glottic - best prognosis as cause hoarseness earlier
Subglottic
Describe diagnosis and management of laryngeal cancer.
Laryngoscopy + biopsy
HPV status
MRI staging
Radiotherapy for small tumour
Partial/total laryngectomy for larger tumours
Describe how voice is restored after laryngectomy.
Trans-oesophageal puncture: one way valve is inserted between trachea and the pharynx/oesophagus which vibrates the pharyngeal-oesophageal segment
The valve is activate when the patient occludes their stoma and breathes out
Exhaled air is modified with the lips and teeth into speech
Artificial larynx - can be held firmly against patients neck which causes the tissues to vibrate producing electronic voice sound
What are features of nasopharyngeal carcinoma? What is it associated with? Investigations? Management?
Cervical lymphadenopathy Otalgia Unilateral serous otitis media Nasal obstruction/discharge/epistaxis Cranial nerve III, IV, V, VI palsy
Southern China
EBV
CT/MRI
Radiotherapy first line
