Head & Neck Cancer

 

• Definition

  • Cancers of the lip, mouth, nose, sinuses, pharynx, larynx, and (possibly) trachea.
  • 90% are squamous cell carcinomas.

• Signs and symptoms

  • Throat lump.
  • Sore throat and odynophagia.
  • Dysarthria and dysphonia. A hoarse voice suggests laryngeal disease or lung cancer invading the recurrent laryngeal nerve.
  • Earache
  • Cough
  • Leukoplakia: white areas of keratosis in the mouth or throat, which can be premalignant. Hairy leukoplakia is a non-malignant type caused by EBV in HIV patients.
  • Weight loss.
  • Epistaxis
  • Cervical lymphadenopathy: cervical nodes are a common site of spread. Supraclavicular lymphadenopathy suggests GI or lung cancer.

• Risk factors

  UV-HEAD for SCC:

  • UV light: lip cancer.
  • HPV: oropharyngeal cancer.
  • EBV: nasopharyngeal cancer.
  • Alcohol
  • Having a Drag i.e. smoking, especially oral and laryngeal cancer.

  Adenocarcinomas:

  • Furniture factory workers are at increased risk due to wood dust exposure. Usually affects ethmoidal sinus.

• Investigations

  • Nasopharyngoscopy
  • Tissue biopsy and/or FNA of lymph nodes for diagnosis.
  • CT, MRI, and/or PET for staging.

• Management

  • Radiotherapy is mainstay, especially if small.
  • Many will also need surgery ± adjuvant chemotherapy.