Head and Neck Squamous Cell Carcinoma

Question 1

What is the most common age for head and neck SCC?

Answer 1

> 50yrs

increasing incidence in young people

Question 2

What are the risk factors for head and neck SCC?

Answer 2

cigarette smoking - increases risk x 10 
excessive alcohol consumption 
vitamin A and C deficiency 
nitrosamines in salted fish 
HPV 
GORD
depravation

Question 3

What are the suspicious symptoms of head and neck SCC?

Answer 3

neck pain 
neck lump 
hoarse voice >6 weeks 
sore throat >6 weeks 
mouth bleeding 
mouth numbness 
sore tongue 
painless ulcers 
patches in mouth 
earache 
ear effusion 
lumps on lip, mouth or gum 
speech change 
dysphagia

Question 4

What is the management of patient’s with symptoms of head and neck SCC?

Answer 4

urgent referral to ENT

Question 5

What are the investigations of head and neck SCC?

Answer 5

fibre-optic endoscopy of the upper aerodigestive tract
fine needle aspiration or biopsy of any masses
CT or MRI of primary tumour site to stage and check for lymph node metastatic disease

Question 6

What is the treatment for SCC of the head and neck?

Answer 6

radiotherapy (tumour <4cm)

surgery

Question 7

What type of head and neck SCC is uncommon in the UK?

Answer 7

oral cavity and tongue

hypopharyngeal

Question 8

What are the signs and symptoms of oral cavity and tongue SCC?

Answer 8

persistent painful ulcers
white or red patches on the tongue, gums or mucosa 
otalgia 
odynophagia 
lymphadenopathy

Question 9

What is odynophagia?

Answer 9

painful swallowing

Question 10

What is the prognosis for SCC of the oral cavity and tongue?

Answer 10

> 80% 5yr survival in early disease

Question 11

What type of head and neck SCC is often advanced at presentation?

Answer 11

oropharyngeal carcinoma (includes soft palate, tonsils and tongue base) 
20% node +ve at presentation

Question 12

What is the epidemiology of oropharyngeal carcinoma?

Answer 12

5:1 males to females

older

Question 13

What is the classical presentation of oropharyngeal carcinoma?

Answer 13

smoker with sore throat, sensation of a lump and referred otalgia

Question 14

Wat are the risk factors for oropharyngeal carcinoma?

Answer 14

pipe smoking
chewing tobacco
number of sexual partners

Question 15

What is the prognosis for oropharyngeal carcinoma?

Answer 15

50% 5yr survival rate for stage I

tonsillar cancer and HPV associated have better prognosis

Question 16

What type of HPV is associated with oropharyngeal carcinoma and how is it transmitted?

Answer 16

HPV16 - oral sex

Question 17

What type of oropharyngeal carcinomas occur in younger people?

Answer 17

HPV associated

Question 18

What may decrease the risk of HPV associated oropharyngeal carcinoma?

Answer 18

vaccine

Question 19

What are the anatomical limits of the hypopharynx?

Answer 19

hyoid bone to lower edge of cricoid cartilage

Question 20

What is the presentation of SCC of the hypopharynx?

Answer 20

lump in throat 
dysphagia 
odynophagia 
referred otalgia 
hoarseness

Question 21

What is the prognosis of hypopharyngeal SCC?

Answer 21

60% mortality at 1 yr

Question 22

What is the typical presentation of an older patient with laryngeal SCC?

Answer 22

male smoker with progressive hoarseness
then difficulty or pain on swallowing 
\+/- 
haemoptysis 
ear pain (if pharynx involved)

Question 23

What is the typical presentation of a younger patient with laryngeal SCC?

Answer 23

HPV+

Question 24

What are the sites of laryngeal SCC?

Answer 24

supraglottic
glottic
subglottic

Question 25

What is the surgery for laryngeal SCC?

Answer 25

laryngectomy +/- block dissection of the neck gland

Question 26

What is the prognosis of laryngeal SCC?

Answer 26

66% 5yr survival rate | glottic tumours have best prognosis as they cause hoarseness earlier

Question 27

What type of cancer can EBV cause?

Answer 27

nasopharyngeal carcinoma Burkitt's lymphoma other B-cell lymphomas Hodgkin's lymphoma

Question 28

How does EBV cause carcinogenesis?

Answer 28

infects epithelial cells of oropharynx and B cells - hi-jacks and mimics helper T cell response - proliferation and survival of B cells mediated by latent membrane protein 1 (LMP-1) encodes EBNA-2 - activates cyclin D - promotes transition from G0 to G1

Question 29

How does HPV 16 cause cancer?

Answer 29

produces proteins EG and E7 - disrupt p53 and RB pathways respectively - causes cellular immortality

Question 30

How does nasopharyngeal carcinoma present?

Answer 30

``` cervical lymphadenopathy otalgia unilateral serous otitis media nasal obstruction and discharge +/- epistaxis cranial nerve palsies - e.g. III - VI headaches unilateral hearing loss ```

Question 31

What are the referral guidelines for patients with suspected laryngeal cancer?

Answer 31

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

Question 32

When should 2 week wait referrals to oral surgery be done?

Answer 32

unexplained oral ulceration or mass persisting for greater than 3 weeks unexplained red or red and white patches that are painful, swollen or bleeding unexplained one-sided pain in the head and neck area for greater than 4 weeks which is associated with ear ache but doesn't not result in abnormal findings on otoscopy unexplained recent neck lump or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks unexplained persistent sore throat signs and symptoms in the oral cavity persisting for more than 6 weeks that cannot be definitively diagnosed as a benign lesion

Question 33

What cancer may present as a painless as a painless lymphadenopathy?

Answer 33

nasopharyngeal carcinoma - tendency for early spread

Question 34

In what ethnic group is nasopharyngeal carcinoma most common?

Answer 34

Asian

Question 35

What is a red flag for nasal cancer?

Answer 35

recurrent unilateral epistaxis

Question 36

When should there be an urgent referral to ENT for suspected laryngeal cancer?

Answer 36

>45 with persistent unexplained hoarseness or an unexplained lump in the neck