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