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Flashcards in Head & neck cancers Deck (9)
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Risk factors for head & neck cancer

Tobacco and alcohol use

their combined use synergistically increases risk


RIsk factor for oropharyngeal cancer

Human papillomavirus infection

it does not affect therapy, but the prognosis is better than that for non-HPV-related cancer.


The most common histopathology of head & neck cancer

Squamous cell carcinoma


How to obtain a tissue sample in head & neck cancer

In patients suspected of having head and neck cancer, fine-needle aspiration should be performed to establish the diagnosis.


Px of head & neck cancer

  • depends on the location of the cancer
  • persistent or progressive lymph node enlargement or other neck mass
  • unilateral hearing loss
  • unilateral ear pain
  • nasal obstruction
  • oral pain, nonhealing oral ulcers
  • dysphagia, odynophagia, and hoarseness.


Ix of head & neck cancer

  • direct laryngoscopy
  • Fine-needle aspiration of suspicious lesions
  • HPV status using tumor staining for p16, which is overexpressed in HPV-positive cancers
  • Once histopathology diagnosis established, imaging to assess extent of disease
    • MRI preferred over CT for anatomic assessment of the primary tumor
    • PET-CT to identify primary tumors and evaluate regional lymph nodes, tumor invasion, and distant metastatic disease (although not accurate if <5mm nodes)


Mx of head & neck cancer

  • Early-stage oral cancers: surgery.
  • Early stage larynx tumour: Radiation 
  • Locally advanced: surgery + adjuvant radiotherapy alone or chemoradiation
  • Advanced/unresectable tumors: first combined chemotherapy (cisplatin or cetuximab) and radiation. If persistent / resistant disease, surgery. 


Screening for recurrence of head & neck cancer post treatment

  • history and physical examinations every 1 to 3 months for the first year, decreasing in frequency through year 5, and then annually.
  • If radiotherapy including tbe thyroid bed, assess TFTs and a physical examination as at risk of hypothyroidism & thyroid cancer. Routine USS not indicated. 
  • No routine imaging unless suggestive of recurrence
  • for head and neck cancer after a negative posttreatment scan is not indicated unless there are signs and symptoms suggestive of recurrent disease.


Mx of recurrent head & neck cancer

- favourable factors

  • Favorable factors: small, localized disease, longer time to recurrence, site of recurrence in the larynx or nasopharynx.
  • Advanced head and neck cancer not amenable to surgery or radiation:
    • chemotherapy (cisplatin or carboplatin) with 5-fluorouracil and cetuximab (EGFR inhibitor), if medically fit 
    • if progresses after above, PD-1 inhibitor (pembrolizumab, nivolumab)
    • if medically unfit, palliative/hospice care.