Often seen in context of smoking and alcoholism and poor health with cardiorespiratory disease
About
- Rare in those who do not misuse smoking and alcohol
- A comprehensive approach by multiple specialists
Aetiology
- Smoking, High alcohol intake
- Increasing Age, Leukoplakia
- EBV and HPV16
Pathology
- Most are squamous cell carcinomas
- Spread to local lymph nodes
- Perineural spread into skull
Affects
- Larynx, oral cavity, hypopharynx, Nasopharynx
- Salivary glands, Paranasal sinuses, Nasal cavity
- Tumours can be multiple and spread to lungs and oesophagus
Clinical
- Lump, neck mass, dysphagia, pain
- Dental noted leukoplakia and changes
- Progressive localised disease
- Mouth ulcer or nodule, nasal mass, epistaxis, otitis media
- Often an ulcer which does not heal, leucoplakia
- Cervical lymph nodes may be enlarged
Investigations
- FBC, U&E, LFTS, Clotting, CXR
- Endoscopic examination of oral cavity, pharynx, larynx, oesophagus
- FNAC Biopsy of primary tumour and lymph nodes
- CT CAP for lower hypopharynx tumour s
Management
- MDT with ENT and Maxillofacial, plastics and Oncology
- Focus on nutrition, feeding, airways management, smoking cessation
- Localised disease: Attempts at surgical cure or radiation
- Locally advanced disease: Chemotherapy/Surgery/Radiation
- Recurrent/Metastatic disease: palliative chaemotherapy
- Chemotherapy may be used to reduce tumour size to facilitate radiotherapy or surgery
- Radiotherapy to the head and neck is difficult with risks of localised damage to structures. Complications are dry mouth and radiation mucositis
- Reconstructive surgery has helped patients greatly with newer techniques and the use of flaps.
- Palliation for some with PEG and hospice care
References