ENT Malignancies

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

ENT malignancies refer to cancers affecting the ear, nose, throat, and associated structures, including the larynx, pharynx, nasal cavity, paranasal sinuses, and salivary glands.

Aetiology

  • Squamous cell carcinoma (SCC): the most common histological type, arising from mucosal surfaces.
  • Adenocarcinoma: occurs in salivary glands and nasal cavity.
  • Lymphomas: can involve the Waldeyer’s ring (tonsils, nasopharynx).
  • Melanoma: can affect the nasal cavity and paranasal sinuses.

Pathophysiology

  • Chronic exposure to carcinogens (e.g., tobacco, alcohol, HPV infection) leads to DNA mutations and uncontrolled cell proliferation.
  • Invasion of surrounding tissues and potential for metastasis, particularly to cervical lymph nodes.

Risk Factors

  • Smoking and tobacco use.
  • Excessive alcohol consumption.
  • Human papillomavirus (HPV) infection (especially in oropharyngeal cancers).
  • Epstein-Barr virus (EBV) association with nasopharyngeal carcinoma.
  • Occupational exposure to wood dust and chemicals.
  • Radiation exposure.

Signs and Symptoms

  • Persistent hoarseness: suggestive of laryngeal cancer.
  • Dysphagia: difficulty swallowing, often in pharyngeal or oesophageal involvement.
  • Unilateral nasal obstruction or epistaxis: seen in sinonasal malignancies.
  • Non healing oral ulcer: may indicate oral cavity cancer.
  • Cervical lymphadenopathy: may be the first sign of metastasis.
  • Otalgia: referred pain due to oropharyngeal or laryngeal cancer.

Investigations

  • Flexible nasoendoscopy: first line examination for visualising upper aerodigestive tract lesions.
  • Biopsy: histopathological confirmation of malignancy.
  • CT/MRI scan: assesses tumour extent and lymph node involvement.
  • PET-CT scan: for staging and detecting distant metastases.
  • HPV and EBV testing: indicated in oropharyngeal and nasopharyngeal cancers.

Management

2ww ENT referral

1. Surgical Treatment:

  • Local excision: for early stage tumours.
  • Neck dissection: for metastatic lymph node involvement.
  • Laryngectomy/pharyngectomy: for advanced disease.

2. Radiotherapy:

  • Definitive treatment in early stage or adjunct to surgery in advanced disease.

3. Chemotherapy:

  • Used in combination with radiotherapy for locally advanced disease.
  • Indicated for metastatic or inoperable cases.

4. Targeted and Immunotherapy:

  • EGFR inhibitors (e.g., cetuximab): used in SCC of the head and neck.
  • PD-1 inhibitors (e.g., pembrolizumab, nivolumab): for recurrent/metastatic disease.

5. Referral:

  • ENT specialist: for diagnostic assessment and treatment planning.
  • Oncology: for radiotherapy and systemic therapy consideration.
  • Palliative care: for advanced or incurable cases.
Ear, nose and throat, ENTmypanotesENT Malignancies