upper aero tract malignancy

Question 1

what is the dominant cancer type of the upper aerodigestive tract

Answer 1

90% are squamous cell carciomas - mucosal lining mostly.

Question 2

head and neck risk factors

Answer 2

counted as exposure.
10x more likely to get head and neck ca if smoke.
Dark spirits- 3x more likely.
smoke and drink together- 30x more likely.

twice as likely in men.

Question 3

signs and symptoms of laryngeal cancer

Answer 3

change in voice/ DIB

lump in neck

non healing ulcer or lesion

Dysphagia/ Odynophagia/ Aspiration

less common: ear pain, epistaxis, poor fitting dentures, nasal obstruction.

nerve paralysis, facial or other. Pain. Wt loss/ night sweats.

Question 4

how to stage tumors + prognosis of SCC of the larynx

Answer 4

T- extent or size
N- regional lymh node
M- metastasis

77% 5 year, 84% if no lymph node involvement

Question 5

name some premalignant signs for head and neck cancer

Answer 5

leukoplakia
erythroplakia
erythroleukoplakia

often found under the tounge.

Question 6

how are glotic cancers divided and which has the best prognosis

Answer 6

glottic
supraglottic
subglottic

glrottic tumors have no lymph drainage and so are less likely to locally spread

9-23% will re occur within 20 years

Question 7

investigation of head and neck squamous cell carcinomas

Answer 7

biopsy-
either by fleible nasal endoscopy (to try and see the lesion) if one is seen then they will undergo exam under anaesthesia

USS guided fine needle aspiration can be done if lymphadenopathy is only sign

they will then likely have both MRI and CT to gauge extent of disease (inc lung mets)

Question 8

management of HNSCC

Answer 8

varies widely

oral cancers - wide local excision +/- neck dissection. +/- flap formation larger will also get radio/ chaemo

Oropharynx- radio + surgery if smaller
larger will get radio + chaemo

Larynx- larger ones will get laryngectomy +/- radiotherapy.