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Head/Neck Cancers
ENT Exam 1 (Head and Neck cancers)
Question | Answer |
---|---|
Locations of head and neck cancers | Oral (mouth) Pharynx (throat) Larynx (voicebox and neck) Nasal cavity and sinuses Salivary glands |
Prevalence of head and neck cancers | Increased in patients over 40 Due to ingested (air and food) substances constantly exposed to these locations |
What is NOT included in head and neck cancers? | Brain Eye Ear Scalp/skin Teeth Bone/muscle |
What lymph nodes would be associated with head and neck cancers? | Superior cervical lymph nodes |
What would inferior cervical lymph node involvement indicate? | Metastatic cancer aka not head or neck cancer |
What nerves may be associated with head and neck cancers? | Cranial nerves |
What type of cancer accounts for 90% of head and neck cancers? What other type of cancer can be found? | Squamous cell carcinoma (SCC) May be adenocarcinoma |
What is SCC? | Squamous cell carcinoma Cancer of epithelial tissues/cells |
What is adenocarcinoma? | Cancer of glands and/or ducts May be mucous glands |
Risk factors for head and neck cancers | Smoking/tobacco use Alcohol Viral infx (EBV, HPV, HIV, ~HSV) Occupational exposures Poor oral hygiene |
Some radiological tests that may be used to screen for head and neck cancers | X-ray MRI CT scan PET scan Usually need a combination of tests to build an entire picture for dx |
What radiological test would be initially performed? | X-ray |
What site accounts for most metastases? | Lung (66%) |
What are some common sites of metastases? | Lung Bone (~20%) Liver (10%) |
Where does nasopharyngeal cancer usually spread? | Bone |
What cancer is EBV most associated with? | Nasopharyngeal cancer |
What are some symptoms of oral cancer? | Nonhealing ulcers Loose teeth/dentures Dysphagia/odynophagia Weight loss Bleeding |
What should be checked when oral cancer is suspected? | Lymph nodes! |
What are 3 major warning signs of oral cancer? | Leukoplakia Erythroplakia Leukoerythroplakia |
What virus should be thought of when oropharyngeal cancer is suspected? | HPV! |
Common locations of oropharyngeal cancer | Base of the tongue Tonsillar area |
What patient population has oropharyngeal cancer in an increasing incidence? | Young non-smoking males |
Symptoms of oropharyngeal cancer | Change in voice Otalgia Dysphagia Cough Leukoplakia Erythroplakia |
What virus should be thought of when nasopharyngeal cancer is suspected? | EBV! |
Where is nasopharyngeal cancer found commonly? | China Asia Middle East North Africa Arctic |
Symptoms of nasopharyngeal cancer | Headache Nasal obstruction Tinnitus Epistaxis Serrous OM Potential impaired function of CN II-VI |
Distant metastases are found in what percentage of nasopharyngeal cancer? | 50% of cases |
What diagnostic test should be used to detect nasopharyngeal cancer and metastases? | MRI (Look in distant sites for metastases) |
What patient population is most affected by laryngopharyngeal cancer? | 65 years old or older Mostly men |
Symptoms of laryngopharyngeal cancer | Hoarseness Dysphagia Chronic cough Hemoptysis Stridor Dyspnea |
What diagnostic tests can be performed to detect laryngopharyngeal cancer? | CT scan: initial imaging, hard tissue, assesses local tumor extent MRI: soft tissue, differentiate between muscles & mucosa & lymph PET scan: evaluate for metastases |
Laryngopharyngeal cancer tx | Radiation: primary tx Combination of radiation and surgery |
What is the primary purpose of laryngeal cancer tx? | Preservation of airway Preservation of swallowing |
When should chemotherapy be used in head and neck cancers? | When head/neck cancers reach stage III-IV |
Common symptoms of sinus tumors/cancer | Epistaxis Unilateral nasal obstruction Chronic sinusitis |
What might be found on a physical exam of a patient with a sinus tumor? | Sinusitis symptoms (usually will be chronic cases) Pooling of secretions Bleeding Asymmetries (unilateral) |
What is our best tx, as a primary care PA, when suspecting head or neck cancer? | REFER! ;-) |