Classification- Primary
- SCC (90%)
- Salivary gland
- Lymphoma
- Thyroid
- Melanoma
- Secondary
History
- Local symptoms
- Odynophagia
- Static/changing?
- With solids/liquids?
- Still able to eat meals?
- Dysphagia
- Voice change
- Stridor (late sign)
- Bleeding
- Trismus
- Unable to open jaw => Pterigoids, Bone
- Otalgia
- Referred pain from throat (glossopharyngeal, vagus)
- Epistaxis
- Nasal obstruction
- Globus
- Subjective feeling of a lump or foreign body in the throat
- Regional symptoms
- Constitutional symptoms (often late sign)
Risk factors
- Smoking (x40) + Alcohol
- Synergise: 50% more than additive effect
- Previous radiation
- Previous cancer
- Wood dust
- Heavy metals
- HPV
- From oral sex
- Suppresses p53
- Family history
Sites
- Larynx
- 95% SCC, 1% adenoma
- 90% 5-year survival for stage 1
- Nasopharynx
- Southern China, EBV, Salted fish
- Present with neck mass (already very big!) or unilateral middle ear effusion (GP: worrying sign => refer)
- Treat with chemoradiotherapy - No surgical option
- Hypopharynx (hyoid => cricoid cartilage)
- Oropharynx
- >95% SCC; Some lymphoma
- Tonsil/lateral pharyngeal wall most common
- Poor prognosis: Often present with cervical mets
Anatomy
- Supraglottis
- Hyoid to apex of ventricle
- Glottis
- Apex of venticle to 1 cm below true folds
- Subglottis
- 1 cm below cords to cricoid cartilage
Laryngectomy
- Can't breathe at all through mouth
- cf Intubation, oxygen etc
- Blom-Singer valve allows air into oesophagus + mouth
Notes- Rich blood + lymphatic supply => Rapid local spread
- But rarely spread further
- Lung > Bone > Liver if they do
- Never brain, except melanoma
- MRI is useless for lung as it moves
- FNA is much better than open or core biopsy as there's less risk of seeding
- NEVER remove a neck node in isolation without FNA/MRI for diagnosis/to check for others
|
|