Head & neck cancers Flashcards Preview

Oncology > Head & neck cancers > Flashcards

Flashcards in Head & neck cancers Deck (9)
Loading flashcards...
1

Risk factors for head & neck cancer

Tobacco and alcohol use

their combined use synergistically increases risk

2

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.

3

The most common histopathology of head & neck cancer

Squamous cell carcinoma

4

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.

5

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.

6

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)

7

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. 

8

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.

9

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.