Head and neck cancer Flashcards Preview

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Flashcards in Head and neck cancer Deck (28):

Head and neck cancer primarily refers to carcinomas of where?

larynx; naso-, oro-, and hypopharynges; paranasal sinuses; salivary glands; and oral cavity.


majority of these cancers occurred in patients with a history of what?
What kind of cancer is most common in the upper aerodigestive tract of these pts?

smoking and alcohol use


Why is the incidence of oropharyngeal cancers increasing?

HPV-mediated cancers


___% of head and neck cancer is squamous cell carcinoma.



SCC originates from ___ cells along the BM of the mucosa

cuboidal cells (under microscope they look flat)


An adult patient with a persistent lump in the neck is very likely to have a (benign/malignant) process, with its origins in the upper aerodigestive tract.



What is the modern approach for neck lumps?

FNA biopsy follwing complete head and neck exam.
CT and possible PET for complete staging and tx plan


When should a pt with hoarseness be referred to oto?

Hoarsness >2 weeks


What's the most common cause of hoarseness?
6 wks of hoarseness in adult is suspicious for what?

URI with edema of the true vocal cords
Precancerous (dysplasia) or cancerous lesion of the larynx
If not cancerous may be GERD, allergic rhinitis postnasal drip, polyps, etc


Which CN innervate the oropharynx and hypopharynx and send a branch to where?

9 and 10
This is how a cancer in the throat could cause ear pain


The oral tongue is innervated by which CN?

5 (lingual portion). May cause jaw pain and otalgia


What is the most common cause of ear pain with a normal ear exam ?
How do you dx?

Pain on palpation of the joint in front of the tragus when the pt opens and closes the jaw


How can a unilateral serous otitis media (fluid in middle ear) in an adult be a sign of cancer?

Cancer in the nasopharynx can obstruct one of the eustachian tubes. URI is more common but must rule cancer out.


T/F Dysphagia or odynophagia may be due to cancer.



Pts w/ superficial LN in posterior triangle behind SCM may be due to?
What nerve is close to this area?

1. secondary to skin infection/inflam on scalp
2. Lymphoma
3. Rarely Upper aerodigestive tract SCC

Spinal accessory nerve


Most common parotid neoplasia?

Pleomorphic adenoma (benign mixed tumor)


T/f it's easy to distinguish bw somethign subcutaneous and something in the parotid gland

F. ascending ramus of the mandible is deep to the parotid gland; thus, a mass may be well within the substance of the gland and still feel very superficial, because there is a solid background immediately behind it.


When to refer a patient to a specialist in diseases of the head and neck for any symptoms that suggest the possibility of cancer:

1. Mass in the neck
2. hoarseness for 2+ weeks
3. Otalgia, odynophagia, dysphagia
4. lump below or in front of the ear
5. persistent oral ulcer
6. unilateral serous otitis media


Carcinogens like smoke and etoh acts in a ____ manner

synergistc. each promotes the occurrence of the cancer, but the combined effect is greater than the sum of the 2.


3 reasons for endoscopy for a suspicious lump

1. size and extent of primary tumor/locate it
2. look for second primaries
3. biopsy

Today imaging, in-office endoscopy and FNAB reduces need for endoscopy under anesthesia


How big are T1-4 cancers and how well do they respond to surgery or radiation?

T1: less than 2cm (75-85% 5yr survival)
T2: 2-4cm (75-85% 5yr survival)
T3: More than 4 cm
T4:: large and invasive (15-35%)


Cancer of the larynx, particularly ___ cancer is usually smaller at presentation bc of quick onset of symptoms.

Bc of quick onset different staging is used.


T/F small/early tumors without mets do well and large or metastatic tumors do poorly



Normal radiation for tumor with microscopic disease is ___ rads centigray.
Dose goes up to ___ for big bulky tumor

1. 5600
2. 7000-8000


T/F SCC tends to metastasize early from LN of the neck --> lung, liver, bone and brain



T/F • If the tumor has metastasized to the lungs or liver, the role of surgery is limited to palliation.



If the metastases are confined to the lymph nodes of the neck (rare), then a neck dissection—removing lymph nodes from the neck—is performed at the time of surgery.

F - this is common not rare


A radical neck dissection is performed when bulky metastasis demands radical surgery and includes removal of what 3 things?

the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve