Head & Neck Cancer

FreeMedSite USMLE STEP 1 REVIEW

Interactive Study:

Definition

Malignancies arising from the oral cavity, pharynx, larynx, nasal cavity, and nasopharynx.
MC Type: Squamous cell carcinoma (SCC)

Risk Factors

Lifestyle (Synergistic)

• • Tobacco (Smoked & Smokeless)
• • Alcohol Consumption

Viral Associations

• • HPV-16 → Oropharyngeal Cancer
• • EBV → Nasopharyngeal Carcinoma

Key Concept

Field Cancerization

Chronic exposure to carcinogens (tobacco/alcohol) damages wide areas of mucosa, leading to multiple independent tumors in the same region.

Result: Explains high recurrence & secondary primary tumors.

Nasopharyngeal (NPC)

Common Presentation

• Unilateral obstruction • Nasal discharge • Epistaxis (nosebleeds) • Eustachian tube obstruction

Complication: May cause otitis media ± effusion and conductive hearing loss.

Clinical Pearls

"Persistent unilateral nasal symptoms or middle ear effusion in an adult should raise immediate suspicion for Nasopharyngeal Carcinoma."

Note: SCC is the most common overall; NPC has a strong EBV association. Field cancerization explains why patients are at risk for multiple primaries.

High Yield Rapid Fire

1. What is the most common histological type of head and neck cancer?

Answer: Squamous Cell Carcinoma (SCC).

2. Which virus is strongly associated with Nasopharyngeal Carcinoma?

Answer: Epstein-Barr Virus (EBV).

3. Define "Field Cancerization".

Answer: Wide-area mucosal damage leading to multiple independent primary tumors.

4. What type of hearing loss is associated with NPC and why?

Answer: Conductive; due to Eustachian tube obstruction and middle ear effusion.

5. Which lifestyle risk factors are synergistic for SCC?

Answer: Tobacco and Alcohol.

6. What nasal symptom (besides obstruction) is high-yield for NPC?

Answer: Epistaxis (nosebleeds) and nasal discharge.