Pathophysiology
Head and neck cancers are cancers that originate from the nasal cavity, paranasal sinuses, oral cavity, pharynx, salivary glands, larynx.
These cancers are usually squamous cell carcinomas in origin and are termed head and neck SCC (HNSCC).
They tend to spread through lymph nodes in 25% of patients via the cervical chain of lymph nodes.
Sometimes we are unable to identify the primary tumour and instead find an SCC in a lymph node, this is called a cancer of unknown primary.
⚠️ Risk factors
- Smoking
- Chewing tobacco and paan (betel quid) - paan is a more common cause in South Asia.
- Alcohol
- HPV-16 particularly. ~75% of all HNCs are due to chronic HPV infection.
- EBV
- Radiation exposure - more likely to cause salivary gland cancer.
😷 Presentation
→ A persistent lump (>3 weeks).
→ Lymphadenopathy.
- Lump in mouth/lip
- Ulcer in mouth - lasting >3 weeks and of unknown aetiology.
- Erythroplakia or erythroleukoplakia - these are red or red + white patches in the oral cavity that bleed easily when scraped. They have a high risk of becoming cancerous.
- Unexplained neck/thyroid lump and/or unexplained hoarse voice.
🔍 Investigations
Flexible nasal endoscopy can be done. If we identify a lesion, then we can do a biopsy.
🏆 As with most cancers, biopsy is the gold standard for HNSCC.
US-guided FNA is used for patients with solely lymphadenopathy.
🧰 Management
An MDT discussion will decide the management for these patients which can involve:
- Chemotherapy
- Radiotherapy
- Surgery
- Immunotherapy - cetuximab is a common monoclonal antibody implemented in HNSCC.
- Palliative care
📝 Referral
We can use the 2WW pathway for referral of patients when we have:
Laryngeal cancer:
- Persistent unexplained hoarse voice
- Unexplained lump in the neck
Oral cancer:
- Lump on lip/oral cavity
- Erythroplakia or erythroleukoplakia
- Unexplained ulcer lasting >3 weeks
- Persistent and unexplained neck lump
Thyroid cancer:
- Unexplained thyroid lump
