13.03.14 Head and neck cancer

Classification

• • 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

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