Head and Neck Cancer ☺️ Flashcards
Describe the main features of head and neck cancer
Risk factors
Generally remain local
High incidence of secondary primary cancer
Smoking and alcohol Ext radiation Viruses - HPV, EBV Genetics - TP53 GERD
Epidemiology and prognosis
Rare but increasing in some sites
Prognosis and survival depends on stage of presentation
-late stage = worse
Investigations and diagnosis of suspected head and neck cancer
History,
Examination of mouth, all 3 sections of pharynx, larynx, nose, ears, neck
Fibreoptic nasendoscopy
US FNA for neck lumps
FBC, U&E, LFT, CXR
CT/MRI/PETCT
What holistic management would you offer for all head and neck patients
What would you need to assess before treatment
Describe the general medical management you would give depending on staging?
Speech and swallowing rehab
Nutritional support
-enteral/parenteral via PEG or RIG
Psychosocial impacts
-risk of suicide is the greatest due to their intrusive impacts on QoL
-eating, tasting, speaking, kissing, breathing, dysarthria affected
-depression, anxiety
Smoking and alcohol intake habits => potential for 2nd primary tumours
Peformance status preop => surgery or radio?
Stage 1/2 - single modality
Stage 3/4 - combined modality
Presentation and possible history
Investigations - diagnosis and staging
Management of ear and temporal bone
Symptoms depend on location of tumour in ear
- pain
- ear discharge
- hearing loss, tinnitus, dizziness
- CNVII palsy - forehead involvement
- swollen LN
Hx of chronic otitis media
Diagnostic - Biopsy
Staging - MRI/CT
Curative surgery
Radio
Chemo
Presentation
Investigations - diagnostic and staging
Management of nose and sinuses (ethmoid, sphenoid, frontal, maxillary)
Unilateral nasal obstruction, anosmia Nosebleeds, Eye symptoms - changes in sight, eye pain Lump on face Lymphadenopathy
Diagnostic
- nasoendoscopy
- biopsy and FNA
Staging
-CT/MRI/PETCT/US
Endoscopic surgery
Chemo
Radio
Presentation
Investigations - diagnostic, staging
Management of nasopharyngeal cancer
Common in Chinese Neck lump Nasal obstruction Unilateral conductive hearing loss, tinnitus, fluid in ear PND
Diagnostic - Nasendoscopy - biopsy
FNA of LN
Staging - CT/MRI/PETCT, bone scan
Radio
Chemo
Surgery - residual/recurrent
Viral serology in followup for EBV
Presentation
History findings
Investigations - diagnostic, staging
Management of oral and nasopharyngeal cancer
2WW - Ulcers, red/white patches in mouth, mouth/neck lump Mouth pain => unable to eat, weight loss Persistent sore throat Referred ear pain (IX) HPV
Diagnostic - biopsy, FNA LN
Staging - CT/MRI/CTPET/US
Surgery - may remove LN
Radio
Chemo
Presentation
Investigations
Management of larynx cancer
-considerations to make
2WW - Hoarseness, neck lump
Difficulty/pain swallowing
SOB
Diagnostic - endoscopy to biopsy, FNA LN
Staging
Retain as much function as possible
Surgery - partial/full removal of larynx
Chemo
Radio
Presentations
Investigations - diagnostic, staging
Management of hypopharynx
Difficulty/pain swallowing
Referred ear pain
Hoarseness
Neck pain
Diagnostic - endoscopy biopsy, FNA LN
Staging - CT, MRI needed
Surgery
Radio
Chemo
Presentation of neck/occult primary
-what is this
Neck lump
-biopsy proven cancer with an unidentifiable primary tumour
Assess with US FNA
- PETCT
- biopsy
Presentation and management of salivary glands
Slow, non painful/painful growing jaw/mouth/neck lump => most are benign Numb face CNVII palsy - face droop Swallowing difficulty Facial swelling
Diagnostic - biopsy, FNA
Staging - US/CT/CTPET/MRI
Surgery
Radio
Chemo
Presentation - 2ww
Investigations - diagnostic, staging
Types and epidemiology
Management of thyroid cancer
2WW - Neck lump
Hoarse voice
Sore throat, difficulty swallowing
Diagnostic - biopsy
Staging 2- US/CT/MRI/PETCT
Differentiated carcinoma = most common
- papillary = best prognosis, most common in young
- follicular = common in middle age women
Non differentiated carcinoma =
Medullary => high calcitonin, often genetic
Anaplastic = worst prognosis, common in older but v rare
Lymphoma (type of NHL)
Surgery - lobectomy/thyroidectomy
-T4, T3 to replace lost function
Radioactive iodine,
Chemo
When can robotic surgery be used
Oropharyngeal Supraglottic laryngeal cancer Total laryngectomy Salvage nasopharyngectomy Parapharyngeal space tumours Thyroidectomy
