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Medicine Notes Oncology Notes

Head And Neck Cancer Notes

Updated Head And Neck Cancer Notes

Oncology Notes

Oncology

Approximately 27 pages

Concise notes on Oncology, including palliative care. These notes cover the most common cancers and all of the oncology emergencies. Very clinically relevant - great for written and practical exams for medical finals. Colour coded by topic including diagrams and tables where relevant...

The following is a more accessible plain text extract of the PDF sample above, taken from our Oncology Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Head and Neck cancer

Epidemiology

  • Mostly SCC (90%)

    • Common sites

  • Oropharyngeal cancer = 6th commonest cancer

  • Incidence increasing

  • M>F (excluding thyroid cancer)

Risk factors

  • Smoking

  • Alcohol

  • Low socioeconomic status

  • Male

  • Age

Clinical features

  • Symptoms arise from local irritation, ulceration and swelling

  • Ulceration in oral cavity = pain

  • Swelling in larynx = hoarseness, breathing problems + local pain

    • “Sore throat” is commonest complaint

  • NICE referral criteria (low pick up rate, non-specific)

    • Unexplained ulceration of mass in oral mucosa for > 3 weeks

    • Unexplained tooth mobility for > 3 weeks

    • Persistent hoarseness for > 3 weeks with normal CXR

    • Unexplained neck lump of recent onset/ not previously diagnosed + changed over past 3-6 weeks

    • Persistence of unexplained swelling of parotid/submandibular gland

    • Unexplained/persistent sore/painful throat

    • Persistent/unexplained pain in H+N area for > 4 weeks, associated with otalgia + normal otoscopy

Prognostic factors

  • SCC of H+N region is staged using TNM system

  • Lung, liver + bone are commonest sites of metastatic spread

  • The lower the location of nodal involvement in the neck, the worse the prognosis

  • If patient survives the primary tumour they have an increased risk of developing a second malignancy

Management

  • Oral cavity cancer

    • Surgery +/- radiotherapyRadiotherapy alone if small tumour

    • Chemo + radiotherapy for inoperable disease

  • Laryngeal cancer

    • Early glottic cancer – endoscopic laser surgery/radiotherapy

    • Advanced glottic cancer – chemo + radiotherapy/total laryngectomy

    • Supraglottic – if small - radiotherapy, if larger, surgery/chemo/radiotherapy

Prognosis

  • Depends on stage at presentation

  • Management concentrated on quality of life + quality of dying

Cancers of the Larynx

Epidemiology

  • Rare

  • More common in males > 40 years

Aetiology

  • Risk factors include

    • Smoking

    • Alcohol excess

    • HPV

    • Asbestos, solvents

Pathology

  • Mostly squamous cell carcinomas

  • Pre-malignant stages exist – need excision as they have malignant potential

Presentation

  • Glottic cancers – hoarseness (commonest)

  • Supraglottic cancers – dysphagia, irritation, cough

  • Subglottic cancers – dyspnea, stridor (rare)

Investigations

  • Indirect and direct laryngoscopy and biopsy

  • CT/MRI

Management

  • Radiotherapy

  • Surgery

Prognosis

  • Varies with TNM staging

  • 90% of recurrences occur within 3 years (therefore strict follow-up)

Cancers of oral cavity

Aetiology

  • Risk factors

    • Smoking

    • Alcohol

    • Reduced vitamin A

    • Poor dental hygiene

Pathology

  • Commonest = squamous cell (can be very aggressive)

Presentation

  • Usually on tounge

  • Causes mucosal irregularity – ulcers/growth

  • Leukoplakia/erythroplakia

Investigations

  • Biopsy

  • MRI for nodes (FNA if present)

  • CXR to exclude primary/mets

  • Surgery and radiotherapy (causes dry mouth and mucositis which may be permanent)

  • Chemotherapy in advanced disease

Cancers of the Nasopharynx

Epidemiology

  • Rare in the western world

Aetiology

  • Risk...

Buy the full version of these notes or essay plans and more in our Oncology Notes.