10.1 Surgical treatment of cancer

Question 1

What are risk factors for head and neck cancer?

Answer 1

• Poor OHI
• Low socioeconomic status
• Radiation
• Genetics
• Viruses and infection
• Tobacco and alcohol!

Question 2

Name the major premalignant oral lesions for head and neck cancer.

Answer 2

• Leukoplakia
• Erythroplakia
• Submucous fibrosis

Question 3

Name possible causes of neck lumps.

Answer 3

• Swollen lymph nodes
• Thyrdoid cancer
• Hodgkins disease
• Sialolith
• Strep throat
• Tonsillitis
• Abscessed tooth
• Mumps

Question 4

What are the 3 treatments for cancer?

Answer 4

• Surgery
• Radiotherapy
• Chemotherapy

Question 5

What are the factors behind choosing surgical treatment for cancer?

Answer 5

• Size of lump
• Site
• Psychological/socioeconomic needs of the patient
• Medical comorbidity
• Chance of cure

Question 6

What is the typical presentation of a patient with head and neck cancer?

Answer 6

• Ulcer/lump
• Pain
• Dysphagia
• Changes to the voice or complete voice loss
• Weight loss
• Otalgia (ear pain)
• Dyspnoea (laboured breathing)

Question 7

What should you enquire about with regards to the presenting patient’s history?

Answer 7

• Smoker? How long and how much
• Alcohol?
• Family/home circumstances
• Low socioeconomic group?
• Family history of cancer

Question 8

What examinations may a head and neck cancer patient require?

Answer 8

• Examine general demenaour e.g. breathless, nicotine smell, difficulty walking
• Examine regional lymph nodes
• Nasendoscope

Question 9

What special investigations may a head and neck cancer patient require?

Answer 9

• Radiographs
• Chest x-ray
• Biopsy+/- EUA (examination under anaesthetic)
• USS (ultrasound scan) +/- FNAC (fine needle aspiration cytology)
• CT scan
• MRI scan
• Angiograms
• Doppler ultrasound
• Bone scan / SPECT / PET (imaging modalities used to stage disease)

Question 10

Where do most squamous cell carcinomas present?

Answer 10

• Lips and oral cavity (90%)

Question 11

What is the typical presentation of an oral SCC patient?

Answer 11

• Non healing ulcer (6/12 duration)
• Smokes
• Drinks heavily and frequently

Question 12

If oral SCC spreads to lymphatics, how does this affect cure rate?

Answer 12

Cure rate reduced by 50%

Question 13

How is cancer staged?

Answer 13

Using the TNM system.

Question 14

Describe the TNM system.

Answer 14

• Tumour size (T1-T4)
• Node involvement (N0=none, N1=single and smaller than 3cm, N2=multiple or node larger than 3cm)
• Metastasis (M0=no distant metastasis, M1=distant metastasis)

Question 15

For cancer patients who cannot take food orally, what feeding methods might they use?

Answer 15

• Nasogastric tube
• PEG: percutaneous endodcopic gastronomy
• TPN: total parenteral nutrition

Question 16

What types of selective neck dissection are there?

Answer 16

Question 17

When performing a selective neck dissection to remove a primary lesion, should the margins be left?

Answer 17

No, must always leave clear margins.

Question 18

Lesions in the oral cavity may metastasise to what other sites?

Answer 18

• Bone
• Breast
• Bronchus
• Thyroid

Not exhaustive.

Question 19

What are the main 3 principles of surgical removal of cancer to remember?

Answer 19

• Resection
• Reconstruction
• Rehabilitation

Question 20

Briefly describe reconstruction following surgical removal of cancer.

Answer 20

• Local flap: close defect using skin from local areas
• Distant flap: close defect using skin from other body parts
• Skin/bone/fat/cartilage graft
• Primary closure: cutting out tumour and bringing the edges back together, excellent healing, better aesthetics
• Free tissue transfer: taking tissue from distant sites and transfer with blood vessels and connect to recipient site. Wide variety of available tissue types, provides immediate reconstruction