head and neck cancer

Question 1

most common site for squamous cell carcinoma

Answer 1

tonsil - present at an advanced stage

Question 2

risk factors for tonsil SCC

Answer 2

smoking, high levels of alcohol intake and poor oral hygiene.

Question 3

which organism is linked to tonsilar carcinoma

Answer 3

HPV

Question 4

which organism is linked to nasopharyngeal or lymphoma

Answer 4

EBV

Question 5

HIV individuals are at increased risk of developing which type of head and neck cancer

Answer 5

kaposi sarcoma

Non-hodgkin lymphoma

Question 6

HTLV is associated with which virus

Answer 6

adult T cell leukaemia

Question 7

features of head and neck cancer

Answer 7

neck lump
hoarseness
persistent sore throat
persistent mouth ulcer

Question 8

criteria for laryngeal cancer 2 week referral

Answer 8

people aged 45 and over with:
persistent unexplained hoarseness or
an unexplained lump in the neck

Question 9

criteria for oral cancer 2 week referral

Answer 9

unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck.
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:
a lump on the lip or in the oral cavity or
a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.

Question 10

criteria for thyroid cancer 2 week referral

Answer 10

for thyroid cancer in people with an unexplained thyroid lump.

Question 11

Gold standard Ix for parapharyngeal abscess

Answer 11

CT scan with IV contrast

Question 12

what is nasopharyngeal carcinoma
type of cell
ass w

Answer 12

Squamous cell carcinoma of the nasopharynx
Rare in most parts of the world, apart from individuals from Southern China
Associated with Epstein Barr virus infection

Question 13

systemic and local features of nasopharyngeal carcinoma

Answer 13

1) painless Cervical lymphadenopathy AS IT CAN SPREAD EASILY
2) Epistaxis
3) headaches
4) lymph node metastasis
5) unilateral hearing loss

Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI

Question 14

Ix for nasopharyngeal carcinoma

Answer 14

combined CT and MRI

Question 15

treatment for nasopharyngeal carcinoma

Answer 15

radiotherapy

Question 16

red flags in chronic rhinosinusitis

Answer 16

unilateral symptoms, epistaxis, blood-stained discharge, crusting, orbital symptoms (such as diplopia or reduced visual acuity), or neurological symptoms or signs.

Question 17

premalignant lesions of the oral cavity

Answer 17

leukoplakia and erythroplakia

Question 18

risk factors of oral cavity cancer

Answer 18

Smoking
alcohol  
Chronic dental infection, e.g. caries, may result in malignant change
tertiary syphilis.
Betel nut

Question 19

risk factors for carcinoma of the lip

Answer 19

outdoor workers
near the equator
tobacco smokers

Question 20

clinical features

Answer 20

lower lip
Dyskeratosis - white patch - ‘actinic chelitis’
ulcer look alike

Question 21

DD for lip ulcer

Answer 21

keratoacanthoma, syphilis and tuberculosis

Question 22

Ix for lip cancer

Answer 22

biopsy

Question 23

management for lip cancer

Answer 23

lip shave

radical neck dissection - metastatic nodal disease

Question 24

clinical features of tongue cancer

Answer 24

persistent ulcer, painless

if the lesion grows - tongue fixation and invade the mandible

inflamed gland on the contralateral side

Question 25

clinical features of head and neck cancer

Answer 25

neck lump hoarseness persistent sore throat persistent mouth ulcer dysphonia - dysphagia/odynaphagia - dyspnoea - stridor from narrowing of airway, esp laryngeal tumors - neck mass - pain from site of pathology or referred eg. to ear - bleeding from nose or mouth depending on site of primary (rare presentation) - nasal blockage - normally unilateral progressive for nasal/nasopharyngeal pathology

Question 26

histopathology of head and neck cancer

Answer 26

SCC

Question 27

risk factors of Head and neck cancer

Answer 27

alcohol tobacco beetle nut chinese ethnic origin for nasopharyngeal malignancy

Question 28

Ix for primary tumor site in H&N cancer

Answer 28

1) examination under anaesthetic - panendoscopy or laryngopharyngo-oesophagoscopy in H&N - purpose - biopsy for histo diagnosis, assess size of tumour, look for secondary primary 2) CT neck - purpose - assess size of tumour and neck node metastasis

Question 29

Ix of neck metastasis for H&N cancer

Answer 29

CT not possible then do FNA if primary unknown then do FNA

Question 30

Ix for distant metastasis in H&N cancer

Answer 30

CT chest

Question 31

management of H&N cancer

Answer 31

Radiotherapy surgery - endoscopic - open surgery

Question 32

important cause if oropharyngeal cancer

Answer 32

HPV infection

Question 33

what is paterson-brown kelly syndrome / Plummer-vision syndrome

Answer 33

hypochromic microcytic anaemia, glossitis, koilonychia, splenomegaly and a postcricoid web with dysphagia low iron

Question 34

clinical features of hypopharyngeal neoplasia

Answer 34

``` otalgia enlarged neck node dysphonia resp difficulties dysphagia weight loss ```

Question 35

Ix for hypopharyngeal neoplasia

Answer 35

barium swallow

Question 36

name of the benign nose tumor

Answer 36

angiofibroma

Question 37

names of the malignant nose tumor

Answer 37

carcinoma non-hodgkins lymphoma chrodroma

Question 38

what is saguineous discharge

Answer 38

bloody discharge indicating SCC

Question 39

features of post-cricoid tumors

Answer 39

sensation of lump local pain otalgia anameia signs - chelitis

Question 40

pulsatile tinnitus hearing normal promotory in th emiddle ear behind TM

Answer 40

glomus tumor

Question 41

what are glomus tumor

Answer 41

benign tumors in the carotid arteries

Question 42

what is cricoarytenoid

Answer 42

rotate with the vocal chords