Head and Neck cancer Flashcards
(40 cards)
What is the most common type of head and neck cancer?
Squamous Cell Carcinoma (SCC)
What are the main risk factors for developing head and neck SCC?
- Smoking
- HPV infection - type 16
- alcohol consumption
Which HPV type is most commonly associated with oropharyngeal SCC?
16
What is the typical patient demographic for head and neck SCC?
- Typically male
- Aged >55 years
- With long-term exposure to cigarettes and alcohol
What histological feature is seen in well-differentiated squamous cell carcinoma?
keratinisation and the presence of prickle cells
How do squamous cell carcinomas typically spread?
via the lymphatic system, with predictable patterns of spread, allowing for targeted investigations and treatments
Which neck nodes are involved in supra-glottic tumours?
Supra-glottic tumours drain to the superior deep cervical nodes
What is a common presenting symptom of head and neck cancer?
- dysphonia (difficulty speaking)
- dysphagia
- unilateral otalgia
- neck lump
What investigation is used to confirm the diagnosis of head and neck cancer?
- Panendoscopy
(direct laryngoscopy, tracheoscopy, oesophagoscopy) - with biopsy under general anaesthesia is used to confirm the diagnosis.
What is the management for early-stage laryngeal cancer (T1 and T2)?
transoral laser surgery or radiotherapy, with a >90% 5-year survival rate
What is the treatment for advanced laryngeal cancer (T3 and T4)?
Partial or total laryngectomy, often combined with chemo and radiotherapy
How is oropharyngeal cancer treated in its early stages (T1 and T2)?
transoral laser surgery and radiotherapy, with a >90% 5-year survival rate
What is the treatment for nasopharyngeal cancer?
chemoradiotherapy
What is the survival rate for stage 1 nasopharyngeal cancer?
The 5-year survival rate for stage 1 nasopharyngeal cancer is 100%
When would you consider a non-urgent referral for a patient presenting in primary care with a thyroid lump?
- Patients with thyroid nodules with abnormal thyroid function tests (TFTs)
- Sudden-onset pain in a thyroid lump (bleeding into a benign thyroid cyst)
- Newly presenting thyroid lump with no concerning features
What is the most common cause of vocal cord paralysis?
Trauma after surgery to the neck
When would you consider an urgent referral (2-week rule) for a patient presenting in primary care with a thyroid lump?
- Unexplained hoarseness or voice changes associated with a goitre
- Lymphadenopathy associated with a thyroid lump
= usually deep cervical or supraclavicular region - Rapidly enlarging painless thyroid mass increasing in size for weeks
- A child with thyroid nodule
Which head and neck squamous cell carcinoma is most commonly associated with HPV infection?
Oropharyngeal SCC
What is the imaging modality of choice for a neck lump?
ultrasound
Which nerve if compressed or damaged will cause a hoarse voice?
Recurrent laryngeal nerve (branch of vagus nerve)
How does vocal cord paralysis present?
Change in voice
Stridor
A Chinese investment banker in his 40s presents with right-sided unilateral mild hearing loss associated with tinnitus over the last 2 months. He denies otalgia or otorrhoea. He reports occasional episodes of mild epistaxis over the past month, which he puts down to ‘working hard’. Otherwise, he is feeling completely well in himself. When asked about his past medical history, he recalls having ‘bad tonsillitis’ requiring overnight hospital admission at the paediatric ward when he was 16 years old. Otoscopy reveals a glued ear on the right side.
What is the next best investigation?
Flexible nasoendoscopy
A 42-year-old man presents to the ENT clinic with a neck lump. He is otherwise asymptomatic. He occasionally drinks alcohol and smokes. The lump is located 7 cm below the right ear lobe, just anterior to the anterior border of the sternocleidomastoid muscle. A biopsy is taken. Pathology results indicate squamous cell carcinoma (SCC) that is p16 positive.
What is the most likely primary site?
Oropharynx
A 54-year-old male presents to the GP with 1 week history of sore throat. He denies coughing, runny nose or temperature. On examination, the tonsils are unremarkable but there is an ulcer on the left soft palate. When asked about the ulcer, he says he first noticed it 4 weeks ago and it has not changed in size since then. The ulcer has become painful recently and occasionally bleeds. He has had mouth ulcers many times before, and he is aware of his very poor diet with hardly any fruit and vegetables. He is a heavy smoker and drinks alcohol daily. He has no significant past medical history.
What is the most likely diagnosis?
SSC
