S11) Head and Neck Cancers

Question 1

What are head & neck cancers?

Answer 1

HNC are a broad category of different tumour types which affect the upper aerodigestive structures, anywhere within the oral cavity, nose, nasal cavity and sinuses, pharynx and larynx

Question 2

HNC are relatively uncommon compared to other types of cancers.

What type of malignancy is observed?

Answer 2

Squamous cell carcinomas (>90% cases) are the predominant form as most HNC begin in the squamous mucosal surfaces lining these structures

Question 3

Where in the head and neck do HNC commonly occur?

Answer 3

• Most common: oral cavity, larynx and oropharynx
• Less comon: nasopharynx and laryngopharynx
• Rare: salivary glands, nasal cavity and sinuses

Question 4

Identify 6 risk factors for HNC

Answer 4

• Alcohol use
• Tobacco use (incl chewing tobacco)
• Age (common in ~60- 70 year olds)
• Gender (affects more men)
• EBV infection (esp nasopharyngeal cancers)
• Betal nut chewing (aka Paan – popular in Leicester & Asia)

Question 5

Why have HNC incidence been on the rise in younger patients despite a recent decline in smoking?

Answer 5

In more recent years HPV-related HNC has been identified, particularly causing oropharyngeal cancers in younger patients

Question 6

Clinical manifestations of HNCs vary greatly, depending on the location of the cancer, the structure(s) involved and the extent of cancer spread.

However, what are some common clinical presentations?

Answer 6

• Unexplained painful mucosal ulceration/lesion e.g. leukoplakia, erythroplakia, lump in oral cavity
• Unexplained hoarseness of voice
• Dysphagia / odynophagia (pain)
• Otalgia (pharynx or larynx cancers)

Question 7

Why do HNCs commonly present with a neck lump?

Answer 7

• HNC readily spread to lymph nodes, due to the rich vascular supply and lymphatic drainage of the region
• Hence, cervical lymphadenopathy due to cervical lymph node metastases is another common initial presenting sign

Question 8

Which investigations are involved in the clinical diagnosis and staging of the HNC?

Answer 8

• Clinical examination
• Biopsy of the lesion/neck lump
• Imaging e.g. CT/MRI
• -* Endoscopic investigation (HNC in nasal cavity, pharynx, larynx)

Question 9

Why is imaging involved in the clinical diagnosis of HNC?

Answer 9

Imaging evaluates the extent of the primary cancer as well as involvement of other structures and lymph nodes

Question 10

Why is endoscopy involved in the clinical diagnosis of HNC?

Answer 10

Endoscopy allows for direct visualisation of the cancer and enables biopsy

Question 11

When is a biopsy involved in the clinical diagnosis of HNC?

Answer 11

Biopsy (fine needle aspiration for cytology or a core biopsy) can be performed under ultrasound guidance if a neck lump is present

Question 12

What are the clinical benefits of staging HNCs?

Answer 12

• Determines the severity of the HNC
• Determines the appropriate treatment for the patient

Question 13

What is the TMN staging system?

Answer 13

• The TMN system is a staging system based on the tumour size and/or location, the degree of lymph node involvement and the presence or absence of distant metastases
• Patients can be classified as having Stage I to Stage IV

Question 14

Identify some members of the multidisciplinary team tackling HNC

Answer 14

• Radiologists
• Pathologists
• Specialist head and neck cancer surgeons
• Oncologists
• Dieticians
• Speech and language therapists
• Plastic surgeons

Question 15

What is the most common type of thyroid cancer?

Answer 15

Papillary adenocarcinoma