Upper Aerodigestive Tract Cancer

Question 1

What is the type of cancer causing most upper aerodigestive tract cancers?

Answer 1

> 90% squamous cell carcinomas

Question 2

What are the risk factors for upper aerodigestive tract cancer?

Answer 2

1. 80-90% tobacco exposure
2. Alcohol, especially in dark spirits
3. Viral EBV, common in SE Asian population
4. Viral HPV, sexually transmitted
5. UV light/radiation

Question 3

What is this a presentation of?
>4 weeks of: hoarse voice, lump in neck, non-healing ulcer lesion. Also dysphagia/odynophagia/aspiration, unilateral otalgia/deafness.

Answer 3

Upper aerodigestive tract cancer (urgent 2ww referral to ENT surgeon)

Question 4

How is a suspected upper aerodigestive tract cancer investigated?

Answer 4

1. History - time course, alcohol and smoking
2. FNA best diagnostic modality for all lumps
3. CT head if FNA reveals something other than SCC (find primary)
4. Staging important - prognosis, resectability and extent of spread.

Question 5

What is the management for upper aerodigestive tract cancer?

Answer 5

1. If in nodes - 50% chance of cure. If metastasised - 0%.
2. Ideally surgical excision with 1cm margin
3. Adjuvant radiotherapy, chemotherapy
4. Palliative care
5. Depends on stage