ENT Malignancies

Definition | Nasopharyngeal Cancer | Oropharyngeal Cancer | Laryngeal Cancer | Paranasal Sinus and Nasal Cavity Cancer | Salivary Gland Cancer | References

Definition

ENT (Ear, Nose, and Throat) malignancies are cancers that develop in the structures of the head and neck, including the nasopharynx, oropharynx, larynx, paranasal sinuses, nasal cavity, and salivary glands. These cancers can vary in their clinical presentation, aetiology, and management.

Nasopharyngeal Cancer

Definition: Nasopharyngeal cancer is a malignant tumour that arises in the nasopharynx, the upper part of the throat behind the nose.

Aetiology: Associated with Epstein-Barr virus (EBV) infection, genetic predisposition, dietary factors (e.g., consumption of salted fish), smoking.

Pathophysiology: Malignant transformation of epithelial cells in the nasopharynx, often linked to EBV infection.

Risk Factors: EBV infection, family history of nasopharyngeal cancer, smoking, diet high in salted fish.

Signs and Symptoms: Nasal obstruction, epistaxis (nosebleeds), hearing loss, neck mass (due to lymph node metastasis), headache.

Investigations: Nasopharyngoscopy, biopsy, imaging studies (CT or MRI), EBV serology.

Management:

• Radiotherapy (primary treatment)
• Chemotherapy (concurrent with radiotherapy or for advanced disease)
• Surgical intervention in selected cases
• Regular follow-up and monitoring for recurrence
• Referral to oncology and ENT specialists for comprehensive care

Oropharyngeal Cancer

Definition: Oropharyngeal cancer is a malignant tumour that arises in the oropharynx, the middle part of the throat that includes the base of the tongue, tonsils, soft palate, and walls of the pharynx.

Aetiology: Human papillomavirus (HPV) infection, smoking, heavy alcohol use.

Pathophysiology: Malignant transformation of epithelial cells in the oropharynx, often linked to HPV infection.

Risk Factors: HPV infection, smoking, heavy alcohol use, multiple sexual partners.

Signs and Symptoms: Sore throat, dysphagia (difficulty swallowing), odynophagia (painful swallowing), ear pain, neck mass.

Investigations: Physical examination, biopsy, imaging studies (CT or MRI), HPV testing.

Management:

• Surgery (e.g., transoral robotic surgery, TORS)
• Radiotherapy
• Chemotherapy (especially for advanced or metastatic disease)
• Immunotherapy for HPV-positive tumours
• Regular follow-up and monitoring for recurrence
• Referral to oncology and ENT specialists for comprehensive care

Laryngeal Cancer

Definition: Laryngeal cancer is a malignant tumour that arises in the larynx, also known as the voice box.

Aetiology: Smoking, heavy alcohol use, HPV infection.

Pathophysiology: Malignant transformation of epithelial cells in the larynx.

Risk Factors: Smoking, heavy alcohol use, HPV infection, exposure to asbestos and other occupational hazards.

Signs and Symptoms: Hoarseness, voice changes, sore throat, persistent cough, dysphagia, ear pain, weight loss.

Investigations: Laryngoscopy, biopsy, imaging studies (CT, MRI, PET scan), HPV testing.

Management:

• Surgery (e.g., partial or total laryngectomy)
• Radiotherapy
• Chemotherapy (especially for advanced or metastatic disease)
• Voice rehabilitation post-surgery
• Regular follow-up and monitoring for recurrence
• Referral to oncology and ENT specialists for comprehensive care

Paranasal Sinus and Nasal Cavity Cancer

Definition: Paranasal sinus and nasal cavity cancer is a malignant tumour that arises in the sinuses and nasal cavity.

Aetiology: Occupational exposure to dust and chemicals (e.g., wood dust, nickel, chromium), smoking, HPV infection.

Pathophysiology: Malignant transformation of epithelial cells in the paranasal sinuses or nasal cavity.

Risk Factors: Occupational exposures, smoking, HPV infection.

Signs and Symptoms: Nasal obstruction, epistaxis, facial pain or pressure, swelling, vision changes, dental problems.

Investigations: Nasal endoscopy, biopsy, imaging studies (CT, MRI), HPV testing.

Management:

• Surgery (e.g., endoscopic sinus surgery)
• Radiotherapy
• Chemotherapy (especially for advanced or metastatic disease)
• Regular follow-up and monitoring for recurrence
• Referral to oncology and ENT specialists for comprehensive care

Salivary Gland Cancer

Definition: Salivary gland cancer is a malignant tumour that arises in the salivary glands, including the parotid, submandibular, and sublingual glands.

Aetiology: Radiation exposure, genetic predisposition, smoking, occupational exposures.

Pathophysiology: Malignant transformation of epithelial cells in the salivary glands.

Risk Factors: Radiation exposure, family history of salivary gland cancer, smoking, certain occupational exposures (e.g., rubber manufacturing).

Signs and Symptoms: Lump or swelling in the jaw, neck, or mouth, pain, facial nerve palsy, difficulty swallowing.

Investigations: Physical examination, imaging studies (CT, MRI, PET scan), biopsy, fine needle aspiration (FNA).

Management:

• Surgery (e.g., parotidectomy)
• Radiotherapy
• Chemotherapy (for advanced or metastatic disease)
• Rehabilitation for facial nerve function if affected
• Regular follow-up and monitoring for recurrence
• Referral to oncology and ENT specialists for comprehensive care

References

1. NICE. (2024). Head and Neck Cancers: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Head and Neck Cancer. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). ENT Malignancies: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). (2021). Clinical Practice Guideline: Head and Neck Cancers. Retrieved from AAO-HNS

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