OMFS- Head and Neck Oncology

Question 1

What is the most common type of oral cancer?

Answer 1

Squamous cell carcinoma

Question 2

What are the main risk factors for head and neck cancer?

Answer 2

Alcohol
Tobacco
Betel/Pan use
HPV
EBV
HIV
Poor OH

Question 3

What cancers are HIV/EBV/HPV associated with?

Answer 3

HIV- caposi sarcoma
EBV- naso-pharyngeal carcinoma (prevalent in Chinese males)
HPV- Oral pharyngeal and laryngeal carcinoma

Question 4

What are the sites for cancer in the oropharynx?

Answer 4

Base of Tongue
Tonsil
Soft Palate

Question 5

What are the sites for cancer in the oral cavity? (in order of prevalence)

Answer 5

Lateral/ anterior of tongue
Floor of mouth
Retromolar trigone
Buccal mucosa
Hard palate/alveolus- rarer

Question 6

What are the red flags for malignancy? (7)

Answer 6

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

Question 7

What is meant by rolled margins?

Answer 7

Raised peripheral areas that are firm and hard

Question 8

What cancerous sites tend to be associated with pain?

Answer 8

Primary- neuropathic, sharp, radiating pain

Metastatic sites- painless

Question 9

Why do patients suffer from rapid weight loss when they have cancer?

Answer 9

Increased metabolic demands of systemic processes

Question 10

Who should we refer to if we are suspicious of oral cancer?

Answer 10

MFS

Question 11

What are the descriptors when trying to diagnose Oral cancer?

Answer 11

 Shallow/deep
 Size- width/length
 Borders
 Consistency- Soft/hard
 Shape
 Painful
 Homegenous/uniform

Question 12

What are the features of a traumatic ulcer?

Answer 12

shallow, soft, white, small

Question 13

Why do raised white and red patches on the attached gingival raise suspicion?

Answer 13

Could be PLV
-> high malignant transfer rate

Question 14

What is a crusting lesion on the lip most likely to be caused by?

Answer 14

Herpes simplex- resolves on tx

If it fails to resolve - refer

Question 15

What is chronic hyper plastic candidiasis? What should be done if this is detected?

Answer 15

Premalignant condition
 Refer for biopsy to exclude underlying dysplasia

Question 16

What are the different levels of the regional lymph node basin in the anterior triangle of neck?

Answer 16

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

Question 17

What is level 5?

Answer 17

Posterior triangle

Question 18

What is the most common cause of enlarged LNs?

Answer 18

Infection

Question 19

What should be done if lymphadenopathy persists?

Answer 19

Refer even in young adults

Question 20

What is used for initial investigation into enlarged LNs?

Answer 20

Ultrasound

-> If suspicious- ultrasound guided fine needle aspirate taken to be analysed by cytology

Question 21

What are the main investigations for head and neck cancer?

Answer 21

 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)

Question 22

What suggests tumour in one side of the maxilla?

Answer 22

Obliteration of maxillary buttress and sinus (unilateral)

Question 23

What investigations are required to produce a TMN staging?

Answer 23

Tissue (Histology)

Imaging (CT or MRI for primary site and CT Chest)

Question 24

How does TMN staging work? (TMN8- most recent)

Answer 24

 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

Question 25

What are the treatment options in oral cancer?

Answer 25

Nil

Surgery alone

Radiotherapy alone

Chemo radiotherapy

Dual or Triple Modality- combination

Question 26

What are the different ends of the WHO performance level spectrum for patients receiving cancer treatment?

Answer 26

 Go to work- level 0
 Bed bound 24 hours- level 4

Question 27

What are the surgical options for primary sites?

Answer 27

Resection and packing

Resection and Primary closure

Resection and reconstruction

Question 28

What types of flaps can be used in cancer surgical reconstruction?

Answer 28

 Local- utilising flaps from other areas in mouth (FAM flap- buccal mucosa with facial artery to floor of mouth)
 Pedicled- attached to origin blood supply- pectoralis major
 Free- skin, fascia, bone is detached with blood vessels from blood supply and anastomosed to local blood supply

Question 29

Which flaps are better for tongue/manidble?

Answer 29

Tongue- thin pliable flaps

Mandible- bony

Question 30

What aids are used for reconstruction?

Answer 30

Planning with 3-D CT

+/- Model/mirror image if asymmetric tissue loss

Cutting guides & templates

Question 31

What are the most common donor sites for reconstruction?

Answer 31

Radial Forearm
Rectus Abdominus
Latissimus Dorsi
Anterolateral Thigh
DCIA
Fibula
Composite Scapula

Question 32

What is a composite flap?

Answer 32

Bone and soft tissue
-> fibula is most common, scapula is second

Question 33

What is a pedicle?

Answer 33

Loop of vessels created in reconstruction
-> Vein and artery from a free flap (donor site) are anastomosed to new site