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ENT Head and Neck Cancers - Coggle Diagram
ENT Head and Neck Cancers
Cases
SJH 50-60 more H/N cancers
Often in hosp for weeks
Ripe for examination
Flaps
Minor cases and some major cases
Shorts
PEGs
Trache
Flaps
Drains
Neck dissection
What is
1. Mucosal surface
Skin
Thyroid
Salvivary
Lymphoma
Sarcoma
SCC
Oral cavity
Larynx
Lip
Oropharynx
Pathology
Most common SCC
Ultrative
Infiltrative
Exophytic
RF
Smoking
Alcohol
Synergy
Occupations
Viral
M>F - smooking trends
Spread of Caner
Local
Regional (nodal)
Distant
Diagnosis
FNA
Radiology
PET / CT - advanced cancer
MRI
Panendoscopy
Second primaries
Field changes
Routine
Symptom led
Second Cancer
Field Change
Synchronous 5%
Metachronous 5% per year
Management
Depends on stage
MDT
Curative 85%
Palliative
Treatment
Tumour factors
Site
Stage
Patient factors
Pulmonary fx
Previous therapy
Treatment factors
Availability of expertise
General principles
Treat primary site and neck
Early cancer - one modality
Advanced - combined therapy
Prognosis
Site
Stage (TNM)
Deifferentiation
Viral status - oralpharyngeal (HPV pos has better prognosis)
Overal 40-45% cure ate
Significance
Function
Speech
Mastication
Swallowing
Life threatening
Cosmetic
Lip Cancer
Lower lip most common
Ass
Smoking
Sun exposure
Mx
Resection and reconstruction
Presentation
Non healing uplcer
Oral cavity
Presentation
Most common site
Lateral aspect of tongue
Non healing ulcer
Pain
Bleeding
Poorly fitting dentures
Neck Lump
Ass
Pre-malignanct conditions - leukoplacia
Oropharyngeal
Presentation
Persistent sore throat
Hot potato voice
Dysphagia
Neck lump - HPV
Cystic neck lumps - HPB
EPi
Increasing prevelance
HPV
Younger age
Oropharyngeal cancer
More sensitive to chem-radiation
Better Prognosis
RF
Smoking / drinking
HPV - better prognosis
Tx
Chemo-radiation cure rate 80%
Studies on de-escalation
Nasopharyngeal
Presentation
Nasal obstruction
Epistaxis
Middle ear effusion
Laryngeal
Functions
Voice
Respiration
Deglutition
Airway protection
Presentation
Hoarseness
Sore throat
Stridor - inspirator
Haemoptysis
Persistent
Earlier presentation - hoarse voice
Majority glottis
EArly pres
Single modality tx
Tx
Early
Per-oral endolaryngeal surgery
Single modality
Radiotherapy
Advanced
Organ preservation - keep larynx if you can
Combined tx radio-chemo
40-50% cure rate
t3 chemo-radio
Laryngectomy
Thyroid cartilage invasion
Post op Laryngectomy
Speech valve
3 ways
Oesophageal speech
Electrolarynx
Bloom singer valve - most common
Hypopharyngeal Cancer
Presentation
Dysphagia
Sore throat
Odynophagia
Neck lump
Late presentation
Case
REcosntruction with jejunal free flap
Total laryngectomy and oesophagectomy
Bloom singer valve for speech
Mets
Supra- omohydoid
Case
Oropharyngeal cancer
Inital radio
Advance neck mets
Radical neck dissection paroditecomy and wide skin exision
Rehab
MDT
Mastication
Swallowing
Aspiration
Speech
Cosmesis
Palliative Care
No treatment
Tracheostomy
PEG
Radiotherapy for relief of pain
Analgesia