• Primary
• SCC (90%)
• Salivary gland
• Lymphoma
• Thyroid
• Melanoma
• Secondary

History

• Local symptoms
• Pain
• 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
• Neck lumps
• Constitutional symptoms (often late sign)
  
• LOW
• LOA
• Sweats
• Bone pain
  

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)
• SCC
• Very poor prognosis
• 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

• 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