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Head And Neck > 11.1 Thyroid And Head And Neck Cancers > Flashcards

11.1 Thyroid And Head And Neck Cancers Flashcards

1
Q

What is often the first presenting sign of thyroid cancers and HNC?

A

Asymptomatic neck lump - cervical lymphadenopathy due to cervical lymph node Metastases

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2
Q

What type of cancer are most HNC?

A

Squamous cell carcinomas

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3
Q

Where do the largest proportion of HNC occur?

A

Oral cavity
Larynx
Oropharynx

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4
Q

What are the main risk factors for HNC?

A

Heavy alcohol use
Tobacco
Increased age (60-70years)
Male Epstein-Barr virus infection (nasopharyngeal cancers)
Chewing of Betal nuts
Exposure to inhalants (hardwood)
Long term exposure to sun light or sun beds / radiation exposure
Family history
Human Papilloma Virus
Dental hygiene
Premalignant changes (leucoplakia/eryhtroplakia)

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5
Q

How to HNC commonly clinically manifest?

A 
Unexplained painful lesion
Mucosal ulceration or lesion within the oral cavity 
Unexplained hoarseness of voice
Dysphagia / Odynophagia 
Otalgia in an otherwise normal ear
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6
Q

How are HNC usually staged and diagnosed?

A

Clinical examination
biopsy of the lesion (or neck lump)
imaging (e.g. CT/MRI)
Endoscopic investigation will be necessary for head and neck cancers involving the nasal cavity, pharynx and larynx

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7
Q

Why is imaging of HNC necessary?

A

Evaluates the extent of the primary cancer, involvement of other structures and lymph nodes

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8
Q

How is a neck lump biopsied?

A

Fine needle aspiration for cytology
Core biopsy
- always done under USS guidance

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9
Q

Why is staging of the HNC important?

A

Determines appropriate treatment

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10
Q

How are early stage HNC usually treated?

A

Surgery and radiotherapy

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11
Q

How are more advanced HNC usually treated?

A

Surgery

Adjuvant chemotherapy

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12
Q

Why is it important to have a multidisciplinary team supporting treatment of a patient with HNC?

A

Given the complexity of structures within the head and neck regions, treatments for most types of HNC will have some permanent and often significant implications on the anatomical structures essential for eating/drinking, speaking and breathing. Patients with HNC therefore require expert support from a variety of professional disciplines throughout their treatment.

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13
Q

What health care professionals are commonly involved in the treatment of HNC?

A 
radiologists
pathologists
specialist head and neck cancer surgeons
oncologists
dieticians 
speech and language therapists
Plastic surgeons
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14
Q

What is the blood supply to the thyroid?

A

Superior thyroid artery - 1st branch of the external carotid artery
Inferior thyroid artery - arises from the thyrocervial trunk (a branch of the subclavian artery)

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15
Q

Describe the venous drainage of the thyroid

A

Superior, middle and inferior thyroid veins. Form a venous plexus around the thyroid gland.
Superior and middle veins drain into respective internal jugular veins. Inferior drain into the brachiocephalic vein

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16
Q

Why is the thyroid highly vascularises due?

A

As it is an important endocrine structure that secretes hormones directly into the circulation

17
Q

Who is the secretory function of the thyroid gland regulated?

A

By the pituitary gland

18
Q

How is the thyroid gland innervated?

A

Via the sympathetic trunk

19
Q

What anatomical structure is closely associated with the thyroid gland?

A

The recurrent laryngeal nerve - lies in close proximity to the thyroid. Care must be taken not to damage them during thyroid surgery

20
Q

Describe the pathway of the recurrent laryngeal nerve and how it relates to the thyroid gland

A

Branch from the vagus nerve within the chest and ascend up the neck to innervate the larynx.
Right RLN hooks under the right subclavian artery
Left RLN hooks under the arch of the aorta.
RLN then travels up the neck in a groove between the trachea and the oesophagus called the tracheoesophageal groove. Passes under the thyroid gland to innervate the larynx

21
Q

What is Leukoplakia?

A

Formation of thickened white patches on mucous membranes, particularly of the mouth and vulva

22
Q

What is erythroplakia?

A

An erythematous area on a mucous membrane

23
Q

What are risk factors for thyroid cancer specifically?

A
  • Irradiation exposure (including radioactive iodine & radiation leaks)
  • Family history and certain inherited conditions (e.g. FAP)
24
Q

What staging criteria is used for HNC?

A

TNM staging

25
Q

What determines the management of a patient with HNC?

A
  1. Assessment - patients fitness for intervention, clinical staging, radiological staging
  2. Biopsy
  3. Discuss at multidisciplinary team meeting - curative or palliative intervention
  4. Management with patient involvement
26
Q

How are cancers of the lip and oral cavity treated?

A

– Small tumours excise and repair the defect
– Radiotherapy (bad morbidity)
– Larger tumours that do not respond to RT may need extensive surgery (hemiglossectomy or total glossectomy)

27
Q

What are common resenting symptoms of a cancer of the larynx?

A 
– Dyphonia (voice change)- main feature 
– Dyphagia 
– Referred otalgia 
– Globus 
– Neck lump 
– Weight loss 
– Cachexia
28
Q

What is a laryngetomy?

A

Surgical removal of the larynx, separating the airway from the mouth,nose and oesophagus. Done for large tumours of the larynx that do not respond to radiotherapy. Patient breathes through an opening in the neck known as a stoma

29
Q

Where is the thyroid gland?

A

Anterior neck, spans the C5 to T1 vertebrae. Lobes of thyroid are wrapped around the cricoid cartilage and superior rings of the trachea.
Can be retrosternal

30
Q

What is the most common type of thyroid cancer?

A

Papillary adenocarcinoma

31
Q

What can cause recurrent laryngeal nerve palsy?

A
  • Idiopathic
  • Laryngeal cancer
  • Thyroid disease (benign or malignant)
  • Trauma (including iatrogenic – ie. thyroidectomy)
  • Cervical lymphadenopathy
  • Oesophageal cancer
  • Apical lung cancer
  • Aortic aneurysm
  • Neuropathic (diabetes)
32
Q

What is the visceral compartment of the neck?

A

Compartment of the neck enclosed by the pre-tracheal fascia, with contributions from the buccopharyngeal fascia posteriorly. Contains the thyroid gland, trachea and oesophagus. Lies behind the muscular part of the pretracheal layer (contains the infrahyoid muscles).

33
Q

What are the 4 types of thyroid cancers?

A

Papillary adenocarcinoma
Follicular adenocarcinoma
Medullary carcinoma
Anaplastic carcinoma

34
Q

How might a thyroid cancer present?

A
  • enlarged thyroid gland or lump in the thyroid gland
  • usually thyroid function is unaffected (so TFTs would be normal- and will not report symptoms or signts relating to hyper or hypothyroidism.)
    Dysphagia
    Voice change
35
Q

How is thyroid cancer treated?

A 
• Thyroidectomy (hemi
or total dependant on
type of Ca- most are
total) 
• Radioactive Iodine 
• Radiothearphy/Chemotherapy

Head And Neck (13 decks)

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