Tumours of the nose, sinuses, pharynx, tonsils and larynx
How the linings of the nose, sinuses, pharynx and larynx give rise to papillomas and carcinomas: EBV in nasopharyngeal carcinoma, HPV and p16 in tonsil cancer, and why glottic cancers cause early hoarseness while supraglottic ones reach nodes early.
By the end, you can
- Describe the linings, lymphoid tissue and lymphatic drainage of the nose, pharynx and larynx, and relate them to where tumours arise and spread.
- Describe sinonasal papillomas and carcinomas, and explain why sinus tumours present late.
- Explain the roles of Epstein–Barr virus in nasopharyngeal carcinoma and of HPV in oropharyngeal carcinoma, including why p16 is a marker.
- Compare glottic, supraglottic and subglottic laryngeal carcinoma, and relate each to its symptoms and node spread.
- Explain why staging of head and neck carcinoma is site-specific and why HPV status changes it.
- Recognise the classic appearances, site and HPV classification and tests of upper airway tumours, including vocal fold nodules and papillomas, and explain how surgery, radiotherapy, chemoradiotherapy and antibody treatments act on them.
What it is
Tumours of the upper airway arise from the linings of the nasal cavity and sinuses, the nasopharynx, the oropharynx (tonsils and base of tongue) and the larynx. Most malignant ones are squamous cell carcinomas, divided by cause into tobacco- and alcohol-related, HPV-associated (oropharynx) and EBV-associated (nasopharynx) tumours; benign tumours include sinonasal and laryngeal papillomas.
4 types to tell apart
- Sinonasal tumours
- Inverted, exophytic and oncocytic sinonasal papillomas; squamous cell carcinoma and intestinal-type adenocarcinoma (wood dust) of the nose and sinuses.
- Nasopharyngeal carcinoma
- Mostly non-keratinising and EBV-associated; common in southern China and Southeast Asia; often presents with neck nodes.
- Oropharyngeal carcinoma
- HPV-associated (p16-positive, non-keratinising, tonsil and tongue base) or HPV-independent (tobacco and alcohol, keratinising).
- Laryngeal tumours
- Papillomatosis from HPV types 6 and 11; squamous cell carcinoma, whose behaviour depends on the supraglottic, glottic or subglottic subsite.
US spelling: tumours → tumors.
Normal function
Linings, lymphoid tissue and lymphatics of the upper airway
The nasal cavity and sinuses, such as the and , are lined by ciliated respiratory epithelium (in the nose often called Schneiderian mucosa), with olfactory epithelium in the roof. The behind the nose carries the and the , with a deep pocket, the pharyngeal recess, behind each.
The is lined by non-keratinised squamous epithelium and holds the palatine tonsils and the lingual tonsil on the base of the tongue. Their deep crypts are lined by a thin, sponge-like reticulated epithelium full of lymphocytes, with a patchy basement membrane, so antigens and viruses reach its basal cells easily.
The larynx has three subsites: the supraglottis (the , aryepiglottic folds and false cords), the glottis (the true vocal folds, covered by stratified squamous epithelium) and the subglottis down to the . Lymphatics are plentiful above the vocal folds and sparse within them. The nasopharynx drains to retropharyngeal and upper and posterior neck nodes, often on both sides.
Underlying change · Step 1 of 5
Nose and sinuses: papillomas and silent carcinomas
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 2 of 5
Nasopharyngeal carcinoma and Epstein–Barr virus
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 3 of 5
Tonsil and tongue base: HPV-associated or HPV-independent
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 4 of 5
Larynx: papillomatosis and carcinoma by subsite
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 5 of 5
Neck nodes, site-specific staging and the effects on the body
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .