Neck Cancer
By Dr Lim Poon Seong
ENT HPP
Definition
Tumour (Neoplasm) is a mass of tissue formed as a
result of abnormal, excessive and inappropriate
proliferation of cells.The growth will continues
indefinitely regardless of the mechanism which control
normal cell proliferation.
Colorectal (2866)
Sinonasal Cancer(113)
Risk Factors
Smoking
Alcohol
Surface epithelium
Malignant melanoma
Glandular epithelium
Adenocarcinomas in females
Mesenchymal tissues
Eustachian tube
Torus Tubaris
Fossa of Rosenmuller
Oral Cavity Anatomy
Parotid, submandibular,
sublingual
Nasal 20-30%
Nasal obstruction
Otological 10-20%
Neurological 5-10%
Early Cases
Advanced Cases
NPC Classifications
trismus
Neck swelling
Early Cases
tumour ulcer
Advanced Cases
must have high suspicion level and pick up early for better prognosis
Presentation: Oropharynx
Ca
posterior to oral cavity
Globus sensation
Difficultly swallowing
Slurred speech
trismus
Neck swelling
Hypopharynx Ca
Presentation
located at the oesophageal inlet so pt
will lost a lot of weight
Dysphagia
Pain
Referred otalgia
Hoarseness
Neck mass
Hemoptysis
Weight loss
rare for larynx Ca to spread for neck, hence if it does, prognosis is not so good
Presentation: Larynx Ca
cancer spread to paraglottic space --> vocal cord palsy
so when you speak, vocal cord cannot function properly
So got gap, when swallow, will get aspiration into
the lungs
Hoarse voice (most common)
Stridor
Cough, hx of GERD
Trouble swallowing
Neck swelling
General Management of
Head & Neck Ca Patient
Prevention and early diagnosis if cancer involves more subsites, prognosis is worse
Node metastasis
Haematogenous metastasis
Primary Tumour:
T1 tumour 2 cm or less
N2a Single
N2c - Bilateral lymph nodes
N2b Multiple
M0 No metastases present
Spread to lung and liver in
early cases and bone in late
M1 Metastases clinically demonstrable cases
Stage I: T1, N0, M0 1 and 2 early stage 1 and 2 only finger modality
3 early advanced as treatment eg surgery /
4 advanced radiotherapy
Stage II: T2, N0, M0 beyond that requires combined
modalities
5 Death
preferably
Karnofsky Scoring
Score Perfomance Status
100 Normal, no complaints, no evidence of disease
90 Able to carry on normal activity with minimal sign/symptoms of disease
80 Normal activity with effort, some sign/symptoms of disease
70 Able of self care but unable to carry on normal activities/active work
60 Requires occasional assistance but is able to most personal self care
50 Requires considerable assistance and frequent medical care
40 Disabled, requires special care and assistance
30 Severely disabled,hospital admission indicated but death not imminent
20 Very sick,hospital admission necessary with active supporting Rx
10 Moribund, fatal processes progressing rapidly
0 Dead
Treatment Modalities
eg Ca larynx --> will need to remove larynx so will lose voice
Radical neck dissection open neck > remove all levels of neck nodes > remove SCM,
internal jugular vein, and spinal accessory nerve
modified radical neck dissection > remove all levels of neck nodes but retain other structures
Conclusion
usually will need plastic and skin team
Include Rehabilitation team speech therapist to restore voice after removal of larynx
3. Alternative medicine
Early Ca Larynx treated With
Laser Surgery
stridor
tracheostomy
reconstruction
removal of larynx
Neck Dissection