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