cancers Flashcards
What’s the most common head neck cancer? (cell type)
Squamous cell carcinoma (>90% cases) – cancers of aerodigestive tract all have squamous cell epithelia
How do thyroid cancers and many head and neck cancers present?
Asymptomatic neck lump is commonly the first presenting sign
Not surprising therefore that cervical lymphadenopathy due to cervical lymph node metastases (i.e. a neck lump) is a common initial presenting sign with HNC.
Are head and neck cancers common?
Relatively uncommon compared to other types of cancers
Where do most head and neck cancers begin?
Most begin in the squamous mucosal surfaces lining the H&N structures
Where do the largest proportion of head and neck cancers occur?
List the most common risk factors associated with head and neck cancers (HNC) and thyroid cancers.
Men or women?
* Heavy alcohol use
* Heavy tobacco use (including chewing tobacco)
* Greater risk is using both
* Chewing of betas nut (paan)
MEN more than women
* Prolonged occupational/environmental exposure to certain inhalants eg. Hardwood
* Long term exposure to sunlight or sun beds (cancer affecting lips)
which viruses is a risk factor for HNC?
what cancers do they specificlly cause?
o Epstein-Barr – particularly for nasopharyngeal cancers
o HPV – OROPHARYNGEAL CANCERS IN YOUNGER PATIENTS
what r Premalignant squamous lesions of oral cavity?
Premalignant squamous lesions of the oral cavity are areas of altered epithelium that are at an increased risk for progression to squamous cell carcinoma (SCC)
name these Premalignant squamous lesions of the oral cavity:
explain appearence of the second pic
leukoplakia:
erythroplakia
If you have leukoplakia there’s a small risk that it could progress to mouth cancer over time. This is why it’s very important to see your dentist or GP if you have a white patch in your mouth
Erythroplakia is characterized by a smooth, velvety clinical presentation with a homogeneous surface, without ulceration.
where else can leukoplacia occur?
decribe the appearence?
You can also get patches on the floor or roof of your mouth.
- aren’t painful
- are an irregular shape
- are slightly raised
- may be slightly red within the patch
- can’t be rubbed or scraped away (patches that can be removed could be oral thrush)
CLINICAL MANIFESTATIONS
investigations for diagnosis and severity of a HNC or thyroid cancer
* Thorough clinical examination
* Imaging (CT/MRI)
Evaluates extent of the primary cancer and involvement of other structures/lymph nodes so include chest
* Endoscopic investigation – necessary for head and neck cancers involving the nasal cavity, pharynx and larynx
Allows direct visualisation of the cancer and enables biopsy
* Biopsy
Neck lump – fine needle aspiration for cytology or core biopsy under ultrasound guidance
* May be PET
Radiolabelled glucose to find where cancer is if lymph node metastasis is the presentatio
chemotherpay vs radiotherapy
staging and prognosis of Head and neck cancer (SCC)
the larger the number & the larger the tumour the worse the prognosis
when is SCC likely incurable?
For patients who have distant metastases, typically in the lungs
managment of early stage cancer and advanced
* Early stage cancers
- Surgery
- Radiotherapy
* More advanced cancers
- Surgery
- Adjuvant chemoradiotherapy
Surgical approaches depends on cancer type & extent of disease spread. name some
* Microsurgical techniques
* Lasers
* Radical neck dissection – all ipsilateral lymph nodes, spinal accessory nerve, IJV, SCM are removed
Lip/oral cavity
presentation, investigations, treatment
pharynx
presentation, investigations, treatment
larynx
presentation, investigations, treatment
investigations for thyroid cancer
TRIPPLE ASSESMENT
Staging and prognosis of thyroid Cancers
N1a - Tends to affect local lymph nodes around the thyroid gland
N1b – spread to regional lymph nodes around IVC, in suprasternal notch or around mediastinum
Good prognosis even if it has metastasised to nodes
presentation of thyroid cancers?
most common type of thyroid cancer?
what r the 4 different types?
Types:
– Papillary adenoCa(80%)
– Follicular AdenoCa (10%)
– MedullaryCa(5%)
– Anaplastic Ca (5%)
treatment of thyroid cancer?
- Thyroidectomy (hemi or total dependant on type of Ca- most are total)
- Radioactive Iodine
- Radiothearphy/Chemothearphy
complications of Thyroid Surgery
- Hoarseness (due to reccurent laryngeal N. damage)
- Hypocalcemia (removal of parathyroid glands)
transection of recurrent and superior laryngeal nerves, during ligation of inferior thyroid and superior thyroid
causes of Recurrent Laryngeal Nerve Palsy?
- Idiopathic
- Laryngeal cancer
- Thyroid disease (benign or malignant)
- Trauma (including iatrogenic – ie. thyroidectomy)
- Cervical lymphadenopathy
- Oesophageal cancer
- Apical lung cancer
- Aortic aneurysm
- Neuropathic (diabetes)
unexplained otalgia can sometimes also be a red flag indicating pharyngeal or laryngeal cancer.
explain why?
contribution of the vagus nerve to the sensory innervation of the ear (in addition to providing sensory innervation of the laryngopharynx and larynx)
what is Beahears triangle ?
