1.07 - H&N Cancer Flashcards
What percentage of brain tumours are benign?
50%
What causes the signs and symptoms associated with brain tumours?
- local brain invasion
- increased intracranial pressure
- compression of adjacent structures
What is the location and function of oligodendrocytes?
Location: CNS
Function: myelination of axons and electrical insulation.
What is the location and function of Schwann cells?
Location: PNS
Function: myelination of axons and electrical insulation.
What is the location and function of astrocytes?
Location: CNS
Function: Repair processes and establishing the blood brain barrier.
What is the location and function of ependymal cells?
Location: CNS
Function: Single-layered columnar and cuboidal cells that line the ventricles and the central canal.
What is the location and function of microglial cells?
Location: CNS
Function: Protective and phagocytic immune-based function.
What is the location and function of satellite cells?
Location: PNS
Function: Cover the PNS ganglia for support.
Location of brain mass and respective deficit / symptom.
Temporal lobe.
- Wernicke’s aphasia
- homonymous superior quadranopsia
- mild contralateral facial weakness
Location of brain mass and respective deficit / symptom.
Frontal lobe.
- drowsiness
- decreased attention
- seizures
- altered judgement
Location of brain mass and respective deficit / symptom.
Parietal lobe.
- impaired position sense
- focal sensory and motor seizures
- homonymous hemianopsia
Location of brain mass and respective deficit / symptom.
Cerebellum.
- ataxia
- nystagmus
- ipsilateral incoordination of arm and leg movements with intention tremor
Location of brain mass and respective deficit / symptom.
Brainstem.
- facial weakness
- dysphagia
- cranial nerve palsy
Most frequently occurring primary brain tumours.
Gliomas.
Risk factors for brain tumours.
- 50-55 years old
- male > female
- synthetic rubber
- vinyl chloride
Signs and symptoms of gliomas.
- headaches
- seizures
- memory loss
- motor weakness
- visual symptoms
- language deficit
- cognitive / personality change
Headache features of gliomas.
- headache on exertion
- headache onset at night or early morning
- headache with neurological signs
- valsalva worsening (ie. coughing, sneezing, bending over)
Examination of gliomas.
- mental status
- cranial nerve exam
- motor system exam
- reflexes
- sensation
Gold standard imaging for gliomas.
Gadolinium-enhanced MRI.
Management of gliomas.
- maximal surgical resection
- adjuvent chemotherapy
- post-operative radiation
Prognostic factors for CNS tumours.
- age
- tumour grade
- extent of surgical resection
- molecular alterations
- KPS score
Most common type of oral cancer.
- squamous cell carcinoma
Risk factors for oral cavity cancer (OCC).
- tobacco
- alcohol use
- sun exposure
- betel nut chewing
- previous radiation exposure
- poor oral hygiene
Premalignant conditions of the oral cavity.
- leukoplakia: white, well-defined keratotic pathces)
- erythroplakia: red mucosal plaques
Both are caused by chronic inflammation.
Prevention of oral cavity cancer.
- avoidance of tobacco
- alcohol avoidance
- good oral hygiene
- regular dental appointments
- HPV vaccination
Symptoms of oral cavity cancer.
- painful oral lesion / mass
- oral cavity bleeding
- loose teeth
- dysphagia
- halitosis
- numbness of lower teeth
- referred otalgia (CNVc)
Signs of oral cavity cancer.
- asymmetry on tongue extension
- trismus
- halitosis
- numbness of lower teeth
Imaging of oral cavity cancer.
- biopsy on initial presentation
- CT / MRI
Treatment of oral cavity cancer.
- surgical resection
- radiation therapy
- chemotherapy
- targeted therapy
- immunotherapy
Prognostic factors for oral cavity cancer.
- depth of tumour invasion
- close surgical margins
- positive cervical nodes
- extracapsular spread
Layers of the eye.
1) sclera - white outer part visible to the eye.
2) uvea - heavily pigmented and vascular, providing nutrients to the retina and lens.
3) retina - nerve fibres that sense light that are sent through the optic nerve to the brain.
Components of the uveal tract.
- Iris
- Ciliary body
- Choroid
Function of the iris.
Sphincter pupillae constrict the pupil in bright light (parasympathetic).
Dilator pupillae dilate the pupil in dark light (sympathetic).
Function of the ciliary body.
Ciliary smooth muscle fibres result in the accommodation reflex under parasympathetic control.
Contains epithelial cells that produce aqueous humour.
Most common primary intraocular malignancy.
Uveal melanoma
Risk factors for uveal melanoma.
- fair skin
- BRCA1 mutation
- family history
- ## UV light exposure
Risk factors that dispose pre-existing iris nevi into developing malignancy.
ABCDEF risk factors:
Age at presentation ≤40 years
Blood (spontaneous hyphema)
Clock hour location (inferior quadrant)
Diffuse involvement of the entire iris
Ectropion uvaea
Feathery edges
Presentation of uveal melanoma.
- incidental finding on ophthalmic examination
- vision loss
- flashes / floaters
Imaging for uveal melanoma.
Optical coherence tomography (OCT).
Treatment of uveal melanoma.
- observation
- radiation
- laser therapy
- surgical resection
- thermotherapy
Risk factors for thyroid cancer.
- radiation exposure
- female sex
- FAP
- chronic TSH elevation
- goitre
Prevention of thyroid cancer.
Diet with adequate amounts of iodine.
Signs and symptoms of thyroid cancer.
- painless swelling in neck
- goitre / tight collar
- persistant cough
- dysphagia
- difficulty breathing
- hoarseness of voice
Diagnostic workup of thyroid nodule.
- neck ultrasound
- fine need aspiration
Most common type of thyroid cancer.
- papillary carcinoma (80%)
- follicular carcinoma
- anaplastic carcinoma (<1%)
Anaplastic carcinoma is the most aggressive type and is fast growing with early spread.
What is the difference in matastatic spread between papillary carcinoma vs follicular carcinoma.
Papillary carcinoma: lymphatic metastasis.
Follicular carcinoma: haematogenous metastasis.
