Oral Cancer Flashcards
What is the epidemiology or oral cancer?
- approx 530 new cases a yr in Scotland
- Higher incidence and mortality in scotland compared to england and wales
- 2:1 M:F inicidence
- Socioeconomic inequality (3 fold incidence difference)
What is the aetiology of mouth cancer?
- Local carcinogens (smoking , alcohol , Paan , Khat) and inflammation
What is the Aetiology of Oropharynx?
Local carcinogens like smoking tabacco , alcohol, Paan, Khat
- Inflammation
- HPV
What are the key things in your diagnosis that means an urgent suspicion of cancer referral for head and neck cancer? ** Exam**
Persistent unexplained head and neck lumps for >3 weeks
Unexplained ulceration or unexplained swelling/induration of the oral mucosa persisting for >3 weeks
All unexplained red or mixed red and white patches of the oral mucosa persisting for >3 weeks
Persistent (not intermittent) hoarseness lasting for >3 weeks.
Persistent pain in the throat or pain on swallowing lasting for >3 weeks
Symptoms and Signs of head and neck cancer?
Pain on eating
Difficulty Swallowing
Unilateral earache
Trismus
Dysarthria
Sensory loss
Unexplained loosening of teeth
Submucosal mass lesion
Verrucous lesion
Hemi-tongue atrophy/ fasciculation
Fracture of Mandible/acquired Malocclusion
Nasal Obstruction/ blood stained rhinorrhoea
Coughing blood
Unexplained weight loss
What is otalgia? Why is a warning sign of head and neck cancer?
- Ear pain
- Persistent unilateral earache start thinking tonsillar or tongue based cancer
- If not to do with teeth, look at tongue base and palatine tonsils begin to ask questions like
- ## referred pain of glossopharyngeal nerve that has crossed the oropharynx to tympanic membrane
What proportion of minor salivary gland tumours are malignant?
- 40-50% it is malignant
How does hemi-atrophy of the tongue / fasciculation occur?
- Loss of motor supply to the tongue
- Hypoglossal nerve CN 12
What cancer pt can cough up blood?
- Lung cancer
- Pharynx and larynx cancer
What is the metholody of staging cancer?
- Stage T (primary tumour) early cancer
- Stage N (regional lymph nodes metastasis) advanced cancer
- Stage M (Distant metastasis) incurable disease
What are the two txt options for head and neck cancer pts?
- Curative
- Palliative care
What us Curative care?
- Done with early recognistaion
- Done with locoregionally advanced
- Mostly surgery and adjuvant radiotherapy
What is the palliative care?
- Symptom control , radiotherpay mainly and rarely surgery
- Prolongation of survival (approx 20% survial rate with immunotherapy)
What is the surgery method for a primary tumour?
- Complete excision on histopathology
- Give a wide local excision of 1cm macroscopic margin
What is a sentinel node?
- Those with direct lymphatic afferent from the primary tumour
