20 - Head and Neck Cancers Flashcards
What is the blood supply to the thyroid gland?
- Superior artery from ECA
- Inferior artery from thyrocervical trunk
- There is a superior, middle and inferior vein that drain back to internal jugular and brachiocephalic (inferior). Form a venous plexus
What is the course of the recurrent laryngeal nerve?
- From the vagus nerve goes down and back up into tracheooesophageal groove
- Left on arch of aorta and right on subclavian artery
What is the relationship between the superior laryngeal nerve and the thyroid?
Internal branch pierces the thyroid whilst the external supplies the larynx
What surrounds the trachea?
- Pretracheal fascia
- Infrahyoids lie anteriorly to it
What is the main type of cancer that occurs in the head and neck?
- Squamous Cell Carcinoma (apart from thyroid cancers)
- Most common in oral cavity, larynx and oropharynx
What are the risk factors for head and neck cancers?
- 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
What is happening to the incidence of head and neck cancers and why?
Rising, particulary in 30-40 year old due to HPV, even though smoking has decreased
What is the most common presentation of a head and neck cancer and some other symptoms a patient might present with?
Asymptomatic neck lump (cervical lymphadenopathy)
Also:
- Hoarseness of voice
- Dysphagia
- Odynophagia
- Otalgia with normal ear (pharynx and larynx)
- Mucosal ulceration e.g erythroplakia
How are head and neck cancers diagnosed?
- Clinical examination and biopsy under ultrasound guidance
- CT/MRI
- Endoscopy for larynx biopsy
How do we stage head and neck cancers?
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 are head and neck cancers often treated?
- Early stage by surgery or radiotherapy. Lasers or radical neck dissection
- 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
What is a radical neck dissection?
Removal of tumour, all ipsilateral lymph nodes, spinal accessory nerve, IJV and SCM
What are some different specialities that may be on an MDT team to plan for a radical neck dissection?
- Radiologist
- Pathologist
- Oncologist
- Dietician
- Plastic surgeon
- S and L therapist
- Head and neck surgeon
What are palliative care plans for a patient with an incurable laryngeal cancer?
Support with feeding, swallowing, pain, voice rehab
How does an oral cavity (lips and tongue) cancer often present and how do we investigate this further?
- 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)