20 Head and Neck Cancers Flashcards

1
Q

What is the arterial supply to and venous drainage from the thyroid gland?

A

Arterial supply:

  • External carotid artery- extracranial branches- Superior thyroid artery
  • Thyrocervical trunk- Inferior thyroid artery

Venous drainage:

Thyroid venous plexus drains into:

  • Superior and middle thyroid vein
    • Internal jugular
  • Inferior thyroid vein
    • Brachiocephalic vein
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2
Q

What is the course of the recurrent laryngeal nerves? (left and right)

A

From the vagus nerve goes down and back up into tracheooesophageal groove

Right

-Wraps around subclavian artery

Left

-Wraps around aortic arch

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3
Q

What is the relationship between the branches (external and internal) of the superior laryngeal nerve and the thyroid?

A
  • Internal branch pierces the thyroid
  • External supplies the larynx
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4
Q

What is the main type of cancer that occurs in the head and where in the head and neck might it be found?

A
  • Squamous Cell Carcinoma
  • Most common in oral cavity, larynx and oropharynx
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5
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
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6
Q

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

A

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

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7
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 (pain on swallowing)
  • Otalgia with normal ear (pharynx and larynx)
  • Mucosal ulceration e.g erythroplakia
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8
Q

How are head and neck cancers diagnosed?

A
  • Clinical examination and biopsy under ultrasound guidance
  • CT/MRI
  • Endoscopy for larynx biopsy
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9
Q

How do we stage head and neck cancers?

A

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

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10
Q

How are head and neck cancers often treated?

A
    • Early stage by surgery or radiotherapy. Lasers or radical neck dissection
    • Late stage surgery and adjuvant chemotherapy
    • Incurable late stage then palliative

MDT required as many functions of head and neck

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11
Q

What is a radical neck dissection? (what’s removed) (5)

A

Removal of:

  1. tumour
    • all ipsilateral lymph nodes
  2. spinal accessory nerve
  3. IJV
  4. SCM
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12
Q

What are some different specialities that may be on an MDT team to plan for a radical neck dissection?

A
  • Radiologist
  • Pathologist
  • Oncologist
  • Dietician
  • Plastic surgeon
  • Speech and Language therapist
  • Head and neck surgeon
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13
Q

What might be in a palliative care plans for a patient with an incurable laryngeal cancer?

A

Support with feeding, swallowing, pain, voice rehab

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14
Q

How does an oral cavity (lips and tongue) cancer often present, what are the risk factors and how do we investigate this further?

A

Usually squamous cell carcinoma

Presentation:

  • Unexplained lump or non-healing lesion e.g leukoplakia (thick, white or grayish patches form)

–>Side of tongue and lip

  • Pain or problems swallowing

Risk factors:

alcohol, HPV, long term sunlight (lip)

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15
Q

How does a pharyngeal cancer often present and how do we investigate this further?

A
  • Lump in neck
  • Hearing loss or otalgia
  • Change in voice
  • Weight loss
  • Bad breath
  • Difficulty or pain swallowing

- Risks: hardwood, EBV, HPV, drinking, smoking, betel nut, high salt diet

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16
Q

How does a laryngeal cancer often present and how do we investigate this further?

A
  • Dysphonia (voice disorder)
  • Dysphagia
  • Otalgia
  • Neck lump
  • Cough

If advanced need to do laryngectomy to breathe out of neck. If small surgery and radio

17
Q

What is the difference between a tracheostomy and a laryngectomy?

A

Larynx is completely removed in laryngectomy so trachea on anterior neck

18
Q

How does thyroid cancer often present?

A
  • Neck lump (goitre or lymphadenopathy)
  • Compressive symptoms, e.g dysphagia
  • Voice change
  • Thyroid function often unaffected
19
Q

How do we investigate a suspected thyroid cancer?

A

Triple assessment

  • Clinical full history and examination
  • Imaging by ultrasound as superficial
  • Biopsy under ultrasound by aspiration for cytology
20
Q

What is the most common malignancy in the head and neck? What is the most common malignancy in the thyroid?

A

- H and N: SCC

- Thyroid: see image PFAM

21
Q

If cancer of the thyroid is confirmed by biopsy what is the next step? What nerve is potentially at risk of damage from a thyroidectomy?

A
  • Thyroidectomy followed by radioactive iodine and radio/chemo
  • Can damage superior and recurrent laryngeal nerve
22
Q

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

A
23
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
24
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
25
Q

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

A
  • Unpaired artery from brachiocephalic trunk that supplies the thyroid gland that happens in 10% of people
  • Supplies the isthmus and anterior surface
26
Q

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

A

C5 to T1

27
Q

What is the likely diagnosis of this patients neck lump?

A

Thyroglossal cyst

28
Q

What nerves contribute to the cervical plexus and where is it located?

A
  • Anterior rami of C1 to C4
  • Line on scalenus medius and levator scapulae deep to SCM
  • Sensory branches emerge from posterior border of SCM
  • Found in posterior triangle
29
Q

Where do the sensory branches of the cervical plexus supply?

A
  • Skin of neck
  • Part of scalp and ear
  • Superior thorax (C2 to C4)

Yellow nerves on image

30
Q

What is the ansa cervicalis?

A
  • Motor branch loop from the cervical plexus that supplies the infrahyoids. C1 to C3
  • Acts to depress the hyoid
  • Sits on top of IJV
31
Q

What other motor branch comes from the cervical plexus apart from the ansa cervicalis?

A
  • Phrenic nerve C3, C4, C5
32
Q

What is a cervical plexus block?

A
  • When doing any neck surgery, e.g lymph node dissection or thyroidectomy, can anaesthatise the nerves

- Nerve point: midway posterior SCM

  • This is the point where all of the sensory nerves enter the skin
33
Q

What nerve innervates the mucosa lining the infraglottis and supraglottis?

A

Infra: recurrent laryngeal

Supra: external branch of superior laryngeal

34
Q

A man presents with pain in his throat which after investigation turns out to be due to a tumour in his piriform fossa, what nerve conveys this pain?

A

Vagus as responsible for sensory information of the laryngopharynx