Malady Wise

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Head Cancer

Summary of lecture on Head and Neck Cancer at HMRI ENT update 2023

Delayed presentation

  • Due to COVID

  • Smoking and alcohol are risk factors, these patients tend to minimize symptoms

Mortality

  • Increasing 5-year survival rate as some cancer are very treatable

  • Incidence increasing 3% per year, especially younger patients

  • More HPV virus induced cancers

Stats

  • 5000 in Aus diagnosed yearly

  • 1900 Oral

  • 700 Lip

  • 1300 Pharynx

  • 600 Laryngeal

  • 200 Nasal

Risk factors

  • Smoking, tobacco, cigars, vapes

  • ETOH

  • HPV

  • Beetel nut

  • Erythroplakia

  • Por dental hygiene

  • Immunosuppression

  • Sun

  • obesity

  • family history

Pharyngeal

  • Nasopharynx

    • Nasopharyngeal carcinoma

    • Asian descent, more endemic

    • EBV related commonly

  • Oropharyngeal

    • Common

    • Tonsil and back of the tongue

    • HPV

    • Expecting reducing in burden due to vaccine soon

HPV

  • 16 and 18

  • Affected tumour suppression genes

  • More common in smokers still

  • Oral cancers mostly

Larygneal Cancer

  • Reducing in incidence due to less smoking

  • Constant persistent change in voice

  • Concerns

    • Unilateral pain on swallow, referred to ear

    • Haemoptysis

Oral Cancer

  • Persisting buccal or oral lesion

  • 20 to 40-year-old non-smokers often present with an SCC

  • Persisting and growing = bad, needs biopsy

  • Aggressive tumours, not sure why

Thyroid lumps

  • Single node

    • Most are benign

    • More concerning in kids or if family history

    • Is there compression?

    • Is the patient toxic?

    • Papillary, follicular, medullary

  • Multiple nodes

  • Goitre

    • Large goitre often benign

    • Occasionally aggressive tumour

    • Needs cytology

  • Lateral nodes

  • Voice change

  • Thyrotoxic

ACR TI-RADS system = start with Ultrasound, FNA

Post-treatment HN cancer

  • Regular TFT

  • Post XRT should have Carotid U/S 2 years and 4 years post

  • Lymphodema PT

  • XRT increases risk of Thyroid Cancer