OS - Head & Neck Cancer Flashcards
What are the atieological factors of head and neck cancers? (8)
- cigarettes and alcohol use - Synergistic
- Race - Betel/pan: those from Pakistani, Indian and Bangladeshi origin
- Poor oral hygiene
- poor diet
- HIV - kosisarcoma
- EBV (epsteinbarr virus) – nasopharungeal cancer
- HPV – (most common)
- Biggest risk is previous SCC
Where are the most common sites in the oropharynx for H&N cancers? (3)
- Base of Tongue
- Tonsil
- Soft Palate
Where are the most common sites in the oral cavity for H&N cancers? (7)
- Buccal Mucosa
- Retromolar Trigone
- Alveolus
- Hard Palate
- Ant 2/3 Tongue (most prevalent)
- Floor of Mouth 2 (2nd most prevalent)
- Lip Mucosa
Describe the signs of malignancy. (7)
- Ulcer persists > 2/3 weeks despite removal of any obvious causation
- Rolled margins with central necrosis
- Speckled (erythroleukoplakia – red ad white patches)
- Cervical lymphadenopathy
- Worsening pain (neuropathic, dysesthesia, paraesthesia)
- Referred pain (teeth, ear, throat, mandible)
- Weight loss (systemic features) khectic appearance
Describe the lymphadenopathy that would raise suspicious if a malignancy in the head & neck. (6)
In the cervical region
enlarged size > 1cm
unilateral
firm
fixed to adjacent structures and can’t be moved easily - tethered
non-tender
Describe the lymph node sites 1-5 and their subdivisions.
Level 1:
1A = submental
1B = submandibular
Level 2- upper jugular chain
Subdivisions A&B In relation to the spinal accessory nerve;
Level 3 – midjugular chain
Level 4 – low jugular chain
Posterior triangle of neck:
Level 5: Subdivisions A&B In relation to the spinal accessory nerve;
What further special investigations do you carry out for a suspicious lymph node? (2)
ultrasound and fine needle aspirate of the node
How do we describe intra-oral lesions? (6)
- Site
- Depth
- Colour and consistency of ulceration
- Size – length and breadth
- Border (Firm, rolled, irregular etc)
- Feel/texture
How do we describe white patches?
Leukoplakia
- homogenous
- non homogenous (not uniform)
What further investigations do we do for a suspicious lesion? (5)
- OPT – ensure patient dentally fit for post surgical tx
- CT scans - primary scan of neck and then the thorax
- Ultrasound of nodes
- Biopsies = definitive test
- In the surgical setting - Leugolds iodone staining (highlights dysplastic tissue – premalignant cells)
Why do we carry out biopsies after radiological tests?
comes after radiological tests as biopsy artefacts can appear on x-rays
What investigations are used to stage a patient? (2)
- Tissue histology
- Imaging (CT or MRI for primary)
How do we stage a patient? Describe (4)
TNM(8) staging
T – description of primary tumour: size and depth of invasion (deeper the tumour the increased risk of metastasis)
N – involved LN in neck (1 or more & unilateral/bilateral & has tumour breached the peripheral capsule of LN – called ENE extra-nodal extension or ECS – extra-capsular spread)
M – distant metastasis
- Most common site of distant metastasis is the thorax
What is performance status?
Measures patient ability to cope with conditions and function
What is performance condition 0?
completely independent, well and able to work
