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Chapter 084. Head and Neck Cancer (Part 2)

Clinical Presentation and Differential Diagnosis Most head and neck cancers occur after age 50, although these cancers can appear in younger patients, including those without known risk factors. The manifestations vary according to the stage and primary site of the tumor. Patients with nonspecific signs and symptoms in the head and neck area should be evaluated with a thorough otolaryngologic exam, particularly if symptoms persist longer than 2–4 weeks. Cancer of the nasopharynx typically does not cause early symptoms. However, on occasion it may cause unilateral serous otitis media due to obstruction of the eustachian tube, unilateral or bilateral nasal. | Chapter 084. Head and Neck Cancer Part 2 Clinical Presentation and Differential Diagnosis Most head and neck cancers occur after age 50 although these cancers can appear in younger patients including those without known risk factors. The manifestations vary according to the stage and primary site of the tumor. Patients with nonspecific signs and symptoms in the head and neck area should be evaluated with a thorough otolaryngologic exam particularly if symptoms persist longer than 2a 4 weeks. Cancer of the nasopharynx typically does not cause early symptoms. However on occasion it may cause unilateral serous otitis media due to obstruction of the eustachian tube unilateral or bilateral nasal obstruction or epistaxis. Advanced nasopharyngeal carcinoma causes neuropathies of the cranial nerves. Carcinomas of the oral cavity present as nonhealing ulcers changes in the fit of dentures or painful lesions. Tumors of the tongue base or oropharynx can cause decreased tongue mobility and alterations in speech. Cancers of the oropharynx or hypopharynx rarely cause early symptoms but they may cause sore throat and or otalgia. Hoarseness may be an early symptom of laryngeal cancer and persistent hoarseness requires referral to a specialist for indirect laryngoscopy and or radiographic studies. If a head and neck lesion treated initially with antibiotics does not resolve in a short period further workup is indicated to simply continue the antibiotic treatment may be to lose the chance of early diagnosis of a malignancy. Advanced head and neck cancers in any location can cause severe pain otalgia airway obstruction cranial neuropathies trismus odynophagia dysphagia decreased tongue mobility fistulas skin involvement and massive cervical lymphadenopathy which may be unilateral or bilateral. Some patients have enlarged lymph nodes even though no primary lesion can be detected by endoscopy or biopsy these patients are considered to have carcinoma of unknown primary Fig. 84-1 . If .