OMFS- Head and Neck Oncology Flashcards
What is the most common type of oral cancer?
Squamous cell carcinoma
What are the main risk factors for head and neck cancer?
Alcohol
Tobacco
Betel/Pan use
HPV
EBV
HIV
Poor OH
What cancers are HIV/EBV/HPV associated with?
HIV- caposi sarcoma
EBV- naso-pharyngeal carcinoma (prevalent in Chinese males)
HPV- Oral pharyngeal and laryngeal carcinoma
What are the sites for cancer in the oropharynx?
Base of Tongue
Tonsil
Soft Palate
What are the sites for cancer in the oral cavity? (in order of prevalence)
Lateral/ anterior of tongue
Floor of mouth
Retromolar trigone
Buccal mucosa
Hard palate/alveolus- rarer
What are the red flags for malignancy? (7)
1) Ulcer perists (t > 2 weeks) despite removal of any obvious causation
2) Rolled margins, central necrosis
3) Speckled erythroleukoplakia- red and white patches
4) Cervical lymphadenopathy (enlarged (size > 1cm), firm, fixed, tethered, non-tender, unilateral)
5) Worsening pain (neuropathic, dysaethesia, paraesthesia)
6) Referred pain (ear, throat, mandible)
7) Weight loss (local / systemic effects)- cachexia
What is meant by rolled margins?
Raised peripheral areas that are firm and hard
What cancerous sites tend to be associated with pain?
Primary- neuropathic, sharp, radiating pain
Metastatic sites- painless
Why do patients suffer from rapid weight loss when they have cancer?
Increased metabolic demands of systemic processes
Who should we refer to if we are suspicious of oral cancer?
MFS
What are the descriptors when trying to diagnose Oral cancer?
Shallow/deep
Size- width/length
Borders
Consistency- Soft/hard
Shape
Painful
Homegenous/uniform
What are the features of a traumatic ulcer?
shallow, soft, white, small
Why do raised white and red patches on the attached gingival raise suspicion?
Could be PLV
-> high malignant transfer rate
What is a crusting lesion on the lip most likely to be caused by?
Herpes simplex- resolves on tx
If it fails to resolve - refer
What is chronic hyper plastic candidiasis? What should be done if this is detected?
Premalignant condition
Refer for biopsy to exclude underlying dysplasia
What are the different levels of the regional lymph node basin in the anterior triangle of neck?
Ia- Submental nodes
Ib- submandibular nodes
II- upper jugular chain(divided into a/b in relation to spinal accessory nerves- also divides level V)
III- mid jugular chain
IV- lower jugular chain
What is level 5?
Posterior triangle
What is the most common cause of enlarged LNs?
Infection
What should be done if lymphadenopathy persists?
Refer even in young adults
What is used for initial investigation into enlarged LNs?
Ultrasound
-> If suspicious- ultrasound guided fine needle aspirate taken to be analysed by cytology
What are the main investigations for head and neck cancer?
CT scan of primary site- neck/thorax
OPT- assess dentition (dentally fit for treatment- to prevent complications)
Ultrasound and FNA
Punch biopsy- delayed until required (after radiology- to prevent biopsy artefacts skewing radiographs)
In theatre- iodine staining (highlights dysplastic tissue- potential malignant)
What suggests tumour in one side of the maxilla?
Obliteration of maxillary buttress and sinus (unilateral)
What investigations are required to produce a TMN staging?
Tissue (Histology)
Imaging (CT or MRI for primary site and CT Chest)
How does TMN staging work? (TMN8- most recent)
Tumour- size and depth of invasion (deeper means increased risk of metastases)
Nodes- number, laterality, has it breached peripheral capsule of nodes (extra capsular spread)
Metastases- most common for H/N cancer is thorax
