Podcast
Questions and Answers
A patient presents with a primary complaint of a neck mass, which is later identified as a regional lymph node metastasis. Which anatomical location is most likely the primary source of this metastasis?
A patient presents with a primary complaint of a neck mass, which is later identified as a regional lymph node metastasis. Which anatomical location is most likely the primary source of this metastasis?
Which symptom is MOST indicative of a glottic cancer, as opposed to a supraglottic or subglottic tumor?
Which symptom is MOST indicative of a glottic cancer, as opposed to a supraglottic or subglottic tumor?
A patient exhibits symptoms including hearing loss and tinnitus. Based on the provided information, which anatomical location is most likely involved?
A patient exhibits symptoms including hearing loss and tinnitus. Based on the provided information, which anatomical location is most likely involved?
Which of the following is LEAST likely to be an early sign of an oral cavity malignancy?
Which of the following is LEAST likely to be an early sign of an oral cavity malignancy?
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A patient presents with stridor and dyspnea on exertion. According to the text provided, where is the most likely tumor location?
A patient presents with stridor and dyspnea on exertion. According to the text provided, where is the most likely tumor location?
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Which symptom is most commonly associated with both oropharyngeal and laryngeal cancers?
Which symptom is most commonly associated with both oropharyngeal and laryngeal cancers?
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A patient with a change in a pre-existing goiter should be evaluated for a possible malignancy in which anatomical location?
A patient with a change in a pre-existing goiter should be evaluated for a possible malignancy in which anatomical location?
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Which of the following is a possible symptom of a salivary gland tumor?
Which of the following is a possible symptom of a salivary gland tumor?
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A patient experiences obstructive sleep apnea and snoring with no other symptoms. Where is the most likely cancer location?
A patient experiences obstructive sleep apnea and snoring with no other symptoms. Where is the most likely cancer location?
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What tumor location is often identified late in its progression and is characterized by airway obstruction?
What tumor location is often identified late in its progression and is characterized by airway obstruction?
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Which of the following locations is NOT typically associated with the origin of head and neck cancers?
Which of the following locations is NOT typically associated with the origin of head and neck cancers?
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Which of the following options is MOST appropriate when considering the evaluation of head and neck masses?
Which of the following options is MOST appropriate when considering the evaluation of head and neck masses?
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If a patient presents with a neck mass, which of the following is NOT a key area that should be considered during the differential diagnosis process?
If a patient presents with a neck mass, which of the following is NOT a key area that should be considered during the differential diagnosis process?
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Which statement best reflects an understanding of treatment guidelines for head and neck masses and cancers?
Which statement best reflects an understanding of treatment guidelines for head and neck masses and cancers?
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A patient presents with a neck mass; they report a history of smoking and excessive alcohol use. Based on the objectives, this information is MOST relevant to:
A patient presents with a neck mass; they report a history of smoking and excessive alcohol use. Based on the objectives, this information is MOST relevant to:
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What is the PRIMARY focus when evaluating the presenting symptoms of head and neck masses?
What is the PRIMARY focus when evaluating the presenting symptoms of head and neck masses?
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If a provider is working through the objectives, which of these actions would be MOST important when evaluating physical findings?
If a provider is working through the objectives, which of these actions would be MOST important when evaluating physical findings?
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What is the BEST way to summarize the scope of head and neck cancers?
What is the BEST way to summarize the scope of head and neck cancers?
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When establishing treatment guidelines for head and neck cancers, it is critical to NOT:
When establishing treatment guidelines for head and neck cancers, it is critical to NOT:
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Why is it important to understand the common types of masses within the head and neck region?
Why is it important to understand the common types of masses within the head and neck region?
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Which histological type is the most common in head and neck cancers?
Which histological type is the most common in head and neck cancers?
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What risk factor is most strongly associated with oropharyngeal squamous cell carcinoma?
What risk factor is most strongly associated with oropharyngeal squamous cell carcinoma?
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What is the most common benign tumor of the salivary glands?
What is the most common benign tumor of the salivary glands?
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Which of the following is a malignant thyroid nodule?
Which of the following is a malignant thyroid nodule?
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What is a common cause of unilateral hearing loss associated with vestibular schwannoma?
What is a common cause of unilateral hearing loss associated with vestibular schwannoma?
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Which cancer has the highest incidence in males compared to females?
Which cancer has the highest incidence in males compared to females?
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What is a common treatment for small or non-growing vestibular schwannomas?
What is a common treatment for small or non-growing vestibular schwannomas?
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What factors are implicated in the malignant transformation of pleomorphic adenomas?
What factors are implicated in the malignant transformation of pleomorphic adenomas?
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Which of the following factors does NOT increase the risk of thyroid cancer?
Which of the following factors does NOT increase the risk of thyroid cancer?
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Which condition contributes to the development of oral squamous cell carcinoma?
Which condition contributes to the development of oral squamous cell carcinoma?
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What is the most common benign salivary gland tumor?
What is the most common benign salivary gland tumor?
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What is the most common malignant tumor of the salivary glands?
What is the most common malignant tumor of the salivary glands?
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What is the most common complaint associated with a nasopharyngeal tumor?
What is the most common complaint associated with a nasopharyngeal tumor?
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Study Notes
Head & Neck Masses/Cancers Objectives
- Determine risk factors for head and neck masses and cancers
- Summarize common types of head and neck masses and cancers
- Evaluate presenting symptoms and physical findings
- Establish treatment guidelines
Head & Neck Masses/Cancer
- Can develop in oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, and salivary glands
- Most common histology is squamous cell carcinoma
- Other common types include nasopharyngeal carcinoma and mucosal melanoma
Head & Neck Anatomy (Diagram Reference)
- Illustrates various anatomical parts of the head and neck cavity pertinent to head and neck cancers.
- Includes the oral cavity, nasal cavity, paranasal sinuses, tongue, larynx, trachea, esophagus, nasopharynx, oropharynx, epiglottis, hypopharynx
Head & Neck Cancers: Risk Factors
- Tobacco use
- Alcohol consumption
- Human papillomavirus (HPV) infection
- Oropharyngeal cancer
- Epstein-Barr virus (EBV) infection
- Nasopharyngeal cancer
Head & Neck Cancers: Epidemiology
- Worldwide: approximately 900,000 cases and over 400,000 deaths annually
- United States: 71,000 cases and 16,000 deaths annually
- Males are more affected than females (2-4x more)
- Laryngeal cancer incidence is approximately 50% higher in African American men (compared to other groups)
Head & Neck Cancer Subtypes: Incidence and Mortality Data
- Data presented in a table format displays the annual incidence and mortality rates worldwide and in the USA for various head and neck cancer subtypes. (oral cavity and lip, nasopharynx, laryngeal, nasopharyngeal, oropharynx, hypopharynx).
Oral (Squamous Cell) Carcinoma
- Defined as occurring between the vermillion border of lips and the junction of hard/soft palates or posterior 1/3 of tongue
- More than 95% of cases are associated with smoking/alcohol consumption.
- Can also arise from chronic irritation (such as ill-fitting dentures, dental caries, extensive mouthwash use, chewing tobacco).
Oropharyngeal Squamous Cell Carcinoma
- Cancer of the tonsil, base of posterior one-third of the tongue, soft palate, and posterior and lateral pharyngeal walls
- HPV (type 16), alcohol, and smoking are significant risk factors
Laryngeal Cancer
- Most common type is squamous cell carcinoma (>95% of cases linked to smoking)
- Occurs commonly in the true vocal cords (glottis) and supraglottic larynx.
- Subglottic larynx is the least common location.
Salivary Gland Tumors
- Most (75-80%) are benign and occur in the parotid gland (85%)
- Common benign tumor is pleomorphic adenoma
- Pleomorphic adenomas have a potential for malignant transformation after 15-20 years.
- Mucoepidermoid carcinoma is a common malignant tumor that typically occurs in 20-50-year-olds.
- Most common in the parotid gland, but can also affect submandibular and minor salivary glands, including those in the palate.
- Often fast-growing, firm, and nodular; may be fixed to adjacent tissues.
Thyroid Nodules
- Most are benign (hyperplastic colloid goiter, thyroid cyst, thyroiditis, and thyroid adenoma)
- Malignant nodules include papillary thyroid carcinoma, follicular thyroid carcinoma, oncocytic thyroid carcinoma, anaplastic thyroid carcinoma, medullary thyroid carcinoma, and radiation-induced thyroid carcinoma
Thyroid Cancer Risk Factors
- Irradiation (specifically in childhood)
- Age greater than 55 years
- Female
- Family history (of thyroid cancer or multiple endocrine neoplasia type 2)
- A solitary nodule or goiter
- Dysphagia (difficulty swallowing)
- Dysphonia (difficulty speaking)
- Increasing size of a nodule, especially during thyroid suppression treatment.
- Higher thyroid-stimulating hormone (TSH) levels
Vestibular Schwannoma (Acoustic Neuroma)
- Schwann cell-derived tumor of the 8th cranial nerve (vestibular division)
- Accounts for approximately 7% of intracranial tumors
- As it grows, it compresses the 7th and 8th cranial nerves.
- This leads to unilateral hearing loss, sometimes tinnitus and/or dizziness
- Diagnosis confirmed through audiology and MRI
- Treatment depends on size; small tumors may be observed with serial MRIs, while larger tumors may require stereotactic radiation or microsurgery
Clinical Presentation
- Otalgia (ear pain)
- Neck mass
- Hoarseness or voice change
- Nasal congestion or epistaxis (nosebleed)
- Odynophagia or dysphagia (painful or difficult swallowing)
- Hemoptysis or blood in saliva
- Mouth or skin ulcerations
- Unilateral tonsil enlargement
- Palpable lesions in salivary glands (especially without symptoms)
- Solitary masses in the thyroid (or changes in existing goiters)
Clinical Features by Tumor Site
- Describes symptoms and clinical features associated with specific tumor sites within the head and neck (oral cavity, nasopharynx, oropharynx, larynx, nasal cavity/sinuses, and salivary glands)
Head & Neck Cancer Evaluation
- Refer to a specialist for a focused head and neck exam with flexible laryngoscopy if indicated, including relevant history, including alcohol and tobacco use; determine if a PET/CT scan, or MRI/CT scan (with contrast) is indicated.
- Evaluation if distant metastatic disease or lymph node involvement is present; Fine needle aspiration (FNA) of potentially involved sites,
- Follow up necessary to monitor for recurrence or secondary primary tumors.
Head & Neck Cancer Staging
- Provides a classification system (TNM) that describes the extent of the tumor (primary tumor, regional lymph nodes, distant metastasis) in order to determine the stage of the disease.
Head & Neck Cancer Treatment
- Stages I and II head and neck cancer treated primarily with either surgery or definitive radiation therapy
- 5-year survival rate of 70-90% with early detection
- Advanced cases may require a combined approach (surgery, radiation, and/or chemotherapy)
- Requires follow-up for recurrence or secondary primary tumors
- Smoking/alcohol cessation is encouraged.
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Description
This quiz covers key objectives related to head and neck masses and cancers, including risk factors, common types, presenting symptoms, and treatment guidelines. It also references the anatomy of the head and neck, providing a comprehensive understanding of the subject.
