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...
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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...
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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...
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