Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Head and Neck > 11.1.1 The Thyroid and Head & Neck Cancers > Flashcards

11.1.1 The Thyroid and Head & Neck Cancers Flashcards

1
Q

What is the course of the recurrent laryngeal nerve?

A
  1. Vagus starts at medulla
  2. Enters jugular foramen
  3. Continues within carotid sheath down entire length, two branches given off
  4. Recurrent laryngeal branches off, Left loops around the arch of the aorta Right loops around subclavian
  5. Tracks back up in the tracheooesophageal groove
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the relationship between the superior laryngeal nerve and the thyroid?

A

External branch pierces the thyroid, internal provides sensory innervation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the predominant type of cancer that occurs in the head and neck?

A

Squamous cell carcinoma (not in thyroid cancers)

Common in oral cavity, larynx and oropharynx

Less common in nasopharynx and laryngopharynx (hypopharynx)

Rare- salivary glands, nasal cavity and sinuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the risk factors for head and neck cancers?

A
  • Male, older age (60-70), smoking, alcohol, betal nut chewing
  • Occupation e.g exposure to hardwood
  • Pre-malignant changes e.g. white patches (leucoplakia) or red patches (erythroplakia) seen on tongue
  • HPV virus in oropharyngeal cancers
  • EBV in nasopharyngeal
  • Exposure to sunlight in lip cancers
  • Thyroid cancer are previous radiation exposure/ family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is happening to the incidence of head and neck cancers and why?

A

Rising, particulary in 30-40 year olds due to HPV, even though smoking has decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common presentation of a head and neck cancer and some other symptoms a patient might present with?

A

Asymptomatic neck lump (cervical lymphadenopathy)
Also:
- Hoarseness of voice
- Dysphagia
- Odynophagia
- Otalgia with normal ear (pharynx and larynx)
- Mucosal ulceration e.g erythroplakia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are head and neck cancers diagnosed?

A
  • Clinical examination and biopsy with ultrasound
  • CT/MRI
  • Endoscopy for larynx biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do we stage head and neck cancers?

A

TNM Stage 1-4 then treat
T: size of tumour and location
N: degree of lymph node involvement
M: presence of distant metastases

Distant metastases (particularly in lung) have poor prognosis and often incurable. Need to stage to choose appropriate treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are head and neck cancers often treated that are caught early?

A

Early stage by surgery or radiotherapy. Lasers or radical neck dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do we treat H&N cancers that have advanced?

A
  • Late stage surgery and adjuvant chemotherapy
  • Incurable late stage then palliative
  • Need MDT approach as lots of functions, e.g swallowing and talking, lost when surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a radical neck dissection?

A

Can use lasers
Remove:
Tumour
All ipsilateral lymph nodes
Spinal accessory nerve
IJV
SCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What specialities may be needed in MDT for a radical neck dissection?

A
  • Radiologist
  • Pathologist
  • Oncologist
  • Dietician
  • Plastic surgeon
  • S and L therapist
  • Head and neck surgeon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What palliatve care can be given for incurable laryngeal cancer?

A

Support with:
- Feeding
- Swallowing
- Pain
- Phonation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does an oral cavity (lips and tongue) cancer often present?

A
  • Usually SCC
  • Unexplained lump or non-healing lesion e.g leukoplakia
  • Side of tongue and lip
  • Pain or problems swallowing
  • Risk factors: alcohol, HPV, long term sunlight (lip)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we investigate oral cancer?

A
  • Biopsy
  • CT +/- MRI-if bone involvement is suspected (include chest)
  • PET
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does a pharyngeal cancer often present?

A
  • Lump in neck
  • Hearing loss or otalgia
  • Change in voice
  • Weight loss
  • Halitosis
  • Dysphagia
17
Q

How do we investigate pharyngeal cancer?

A
  • Image with CT +/- MRI (INCLUDE CHEST 10% chance of picking up another cancer)
  • PET
  • Biopsy
18
Q

How can we treat cancer of the pharynx?

A

Small tumour- removal
Medium tumour- radiotherapy
Large- if no response to radiotherapy may need extensive surgery e.g. pharyngectomy, mandibular split or robotic procedure

19
Q

How do patients with pharyngeal cancer feed?

A

Gastrostomy tubes bypass the need for swallowing completely, tend to be in for ~6 months

20
Q

How does a laryngeal cancer often present?

A
  • Dysphonia
  • Dysphagia (as the larynx has been damaged)
  • Otalgia
  • Neck lump
  • Cough
21
Q

How do we investigate laryngeal cancer?

A
  • CT (include chest)
  • May need PET
  • Biopsy
22
Q

What may be necessary to help patients with laryngeal cancer to breathe?

A

Laryngectomy to breathe out of neck

23
Q

What is a laryngectomy?

A

Larynx completely removed, trachea stitched to anterior neck and opens directly in neck

Patient breathes through holy in neck and swallows through mouth (may be able to eat and breathe at same time?)

24
Q

What is a tracheotomy?

A

Small hole made in trachea, tube is inserted to help breathing, larynx is not damaged

More common than laryngectomy, done secondary to cricothyrotomy to secure a more permanent temporary airway, e.g. if patient is in ICU and needs help breathing

25
Q

What are some structures that run through the posterior triangle of the neck?

A
  • Inferior belly of omohyoid
  • Subclavian vein in front of anterior scalene, artery behind
  • Scalenes form the floor
26
Q

What are some important nerves that are related to the scalene muscles?

A
  • Phrenic nerve runs on anterior surface of anterior scalene
  • Brachial plexus passes between anterior and middle scalenes
27
Q

At what level in the neck does the thyroid gland sit?

A
  • C5 to T1
  • Between 2nd and 5th tracheal ring usually
  • Below thyroid and cricoid cartilage
28
Q

What surrounds the thyroid?

A
  • Pretracheal fascia
  • Infrahyoids lie anteriorly to it
29
Q

When should we be concerned about thyroid lumps?

A

Young, less than 20
Old, >70 years old

30
Q

What is the blood supply to the thyroid gland?

A
  • Superior artery- first branch of ECA
  • Inferior artery from thyrocervical trunk (branch of subclavian)

Superior and middle vein drain into IJV then into brachiocephalic

Inferior vein drains into brachiocephalic

Forms a venous plexus

31
Q

How does thyroid cancer often present?

A
  • Lump in neck
  • Compressive symptoms (swallowing, feeling like they are being strangled)
  • Voice change
  • Thyroid status rarely affected
32
Q

What are some thyroid cancer risk factors?

A

Family history
Radiation exposure, e.g. chernobyl increased thyroid cancer, will peak in 2030

33
Q

How do we investigate a suspected thyroid cancer?

A

Triple Assessment
- Full history and examination
- Imaging (ultrasound)
- Biopsy to test suspicious lumps in the form of Fine Needle Aspiration Cytology (FNAC)

34
Q

What is the most common malignacy in the head, neck and thyroid?

A

Head and neck
Squamous cell carcinoma

Thyroid
PFAM

35
Q

How do you treat thyroid cancer?

A
  • Thyroidectomy (hemi or total, dependent on type of Ca- most are total)
  • Radioactive iodine to kill any remaining cancer cells
  • Radiotherapy and chemotherapy to ensure all cancer cells are dead
  • Can cause damage to superior and recurrent laryngeal nerves
  • Can cause removal of parathyroid glands

Patient will need lifelong thyroxine if total thyroidectomy

36
Q

What can go wrong in thyroid surgery?

A
  • Recurrent laryngeal nerve damage
  • Removal of parathyroids, hypoparathyroidism
  • Hypocalcaemia
  • Hypothyroidism
  • Release of thyroid hormones, Thyroid storm- hyperthyroidism
  • May hit thyroid IMA if not known about can lead to extensive bleeding
37
Q

What are some differential diagnoses for a recurrent laryngeal nerve palsy?

A
38
Q

What is a thyroid ima and why can it cause issues?

A

1% of the population
Comes off the isthmus of the thyroid

Can be a source of bleeding in tracheotomy

Head and Neck (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions