Other tumours

Here are two more tumours you might meet.

OTHER TUMOURS If a patient has a slowly progressive SWELLING OF HIS CHEEK, or JAW PAIN which is not removed by tooth extraction, or a foul BLOODSTAINED DISCHARGE FROM HIS NOSE, suspect CARCINOMA OF HIS MAXILLARY ANTRUM. Look for swelling of his palate, epiphora (due to obstruction of the lachrymal duct), and enlarged lymph nodes behind the angle of his jaw. X-rays may show an increase in the size of his antrum, and later erosion of its walls. Biopsy any polypi and send them for histology. Do an antral washout, and send any material you get for histology. If necessary do a diagnostic Caldwell[nd]Luc operation (25.9). A total excision of his maxilla, with or without radiotherapy, will usually cure it. The 5 year survival rate is 30 to 50%. If you cannot refer him for this, a Caldwell[nd]Luc operation may possibly give him symptomatic relief.

If he is a middle-aged smoker, and is HOARSE for 2 weeks or longer, he has a CARCINOMA OF HIS GLOTTIS (vocal cords) until proved otherwise. This carcinoma causes voice changes early, so that he presents early. He has a 95% chance of 5 year survival with radiotherapy, so refer him.

HOARSENESS IN A MIDDLE-AGED SMOKER IS CARCINOMA OF HIS GLOTTIS UNTIL PROVED OTHERWISE. 33 Terminal care