Site and spread

The oral cavity is the most common site where SCC develops, followed by the larynx, oropharynx and hypopharynx in descending frequency. Within the oral cavity, tumours arise from the anterior two-thirds of the tongue, floor of the mouth, the gums, hard palate and buccal mucosa (the mucosa over the inner lining of the cheek). Larynx tumours are subdivided into those at the glottis (the level of the vocal cords), supraglottis (above the vocal cords) and subglottis (below the level of the vocal cords). The oropharynx includes the tonsils, soft palate and the base of the tongue, and the hypopharynx consists of the pyriform fossae down to the beginning of the oesophagus. Head and neck tumours also arise in the nose and sinuses and nasopharynx. Skin cancers that arise in the head and neck are not normally classed as head and neck tumours. As with most tumours, head and neck cancer can invade local structures, spread to regional lymph nodes and systemically to the rest of the body (Figure 30.1). Tumours tend to spread to regional neck nodes along relatively predictable pathways - the location of these nodes can often help to identify the location of the primary tumour.

Common modes of presentation (‘red flag’ symptoms) that warrant urgent referral to an ENT surgeon include the following:

•  Hoarseness (persisting for more than 3 weeks)

•  Dysphagia

•  Odynophagia

•  Unexplained otalgia

•  Neck lump

•  Non-healing ulcers of the oral cavity or oropharynx for more than 3 weeks

•  White or red patches in the mouth or oropharynx for more than 3 weeks

•  Stridor

•  Facial or cheek swelling.

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