Mr. Codero’s major risk factor for developing head and neck cancer is: Mr. Coder

Question

Mr. Codero’s major risk factor for developing head and neck cancer is:

Mr. Codero’s major risk factor for developing head and neck cancer is:

Smokes 2 ppd

Daily consumption of alcohol

HPV positive

All of the above

Sam Codero is a 58-year-old man who presents to his dentist for a routine cleaning. During examination, his dentist notices a small tongue mass and Mr. Codero admits to associated pain. His dentist refers him to an ear, nose and throat (ENT) specialist who decides to biopsy the area.

Patient Summary: The biopsy revealed a stage IV T2 N2b HPV (human papilloma virus) positive, squamous cell carcinoma of the right anterior tongue.

History: Onset of disease: Odynophagia x 5-6 months. Medical history: HTN, which he states is well-controlled. Patient describes noticing a “pimple” on his tongue approximately 5 to 6 months ago. He noticed this mass seemed to slowly get worse and he began having significant pain with eating. He states this is especially true with spicy or acidic foods like salsa, hot sauce or orange juice. He has noted weight loss of approximately 45 pounds over 5 to 6 months. Medications at home: Metoprolol. Tobacco use: Yes, 2ppd; wife also smokes. Alcohol use: Yes, 1-2 drinks most nights of the week. Family history – mother died of liver cancer at 58 years.

Social History: Married, wife age 52, son, age 18; two other sons are away at college – ages 19 and 22. Years education: some college. Occupation: contractor. Hours of work: variable but usually 5-6 days per week – starts as early as 6:30am and works often until after 6pm. Ethnicity: Puerto Rican (Hispanic). Religious affiliation: Catholic.

Explanation / Answer

Mr. Codero's major risk factor for developing cancer is the use of tobacco and alcohol.Human Pappiloma virus (HPV) infection is another important risk factor for head and neck infections.Mr. Codero'ss biopsy revealed Stage IV squamous cell carcinoma and is positive for HPV infection.HPV 16 and HPV 18 are most commonly associated with cancer of the head and neck.

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