ENT - Neck Lumps Flashcards

1
Q

Sarah Cole, a 22 year old with a lump in her neck.

What questions might you ask in a neck lump history?

A
  • SOCRATES
  • Change in size
  • Associated features - Pain, redness, discharge
  • Lumps elsewhere
  • Preceding symptoms - Particularly coryzal, tonsillitis, pharyngitis
  • Recent travel - particularly where TB is endemic
  • Contact with TB patients
  • Occupation? e.g. petrochemical wood industry
  • Animals - cat scratch?
  • Radiation exposure?
  • HIV status?
  • Dental problems?
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2
Q

Sarah Cole, a 22 year old with a lump in her neck.

What ‘red-flag’ symtpoms should you ask about?

A

Persistence of throat / neck symptoms may indicate malignancy

  • Weight loss
  • Fevers
  • Night sweats
  • Persistent sore throat
  • Hoarseness
  • Dysphagia
  • Odynophagia
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3
Q

What investigations might you do for a neck lump?

A

1st line:

  • CT
  • Ultrasound
  • FNAC - fine needle aspiration cytology

2nd line:

  • MRI
  • Excision biopsy - avoid in some pathologies e.g. excision of a metastatic lymph node has a detrimental effect on outcome
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4
Q

What differentials might be considered for a neck lump?

A

Congenital:

  • Dermoids - derived from stem cells, midline, common above hyoid, contain calcium + fat
  • Thyroglossal cyst - anterior triangle, below hyoid, derived from remnants of thyroglossal duct
  • Haemangioma - benign vascular tumour, red/blue lesion
  • Cystic hygroma / lymphangioma - lymphatic malformation consisting of 1 or more cysts

Infectious:

  • Lymphadenopathy - bacterial (e.g. strep or staph), viral (e.g. EBV or cytomegalovirus), TB
  • Abscess

Inflammatory:

  • Sarcoidosis
  • Kawasaki disease - rare vasculitits seen in children
  • Castleman’s syndrome

Neoplastic - benign:

  • Lipoma
  • Sebaceous cyst

Neoplastic - malignant:

  • Metastatic SCC
  • Lymphoma

Vascular:

  • Carotid body tumour
  • Carotid artery aneurysm

Thyroid:

  • Nodule
  • Goitre
  • Thyroiditis
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5
Q

Name 4 risk factors for squamous cell carcinoma (SCC) of the head & neck?

A
  1. Smoking (up to 16 fold)
  2. Alcohol (up to 5 fold)
  3. Human papilloma virus (HPV) - responsible for head/neck Ca in younger pts i.e.e 20-40s
    • Epstein Barr virus has been implicat in nasopharyngeal Ca
  4. Betel nut chewing - chewed commonly in the Indian subcontinent, parts of Asia and around the Pacific (carcinogenic)
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6
Q

Outline the 3 basic steps of head & neck Ca management.

A
  1. Panendoscopy - examination of upper aerodigestive tract (pharynx, larynx, upper trachea and oesophagus) under anaesthetic
    1. Purpose = find primary site + biopsy for histological diagnosis
    2. 5-10% of cases no primary is ever identified
  2. CT skull base to diaphragm - assess extent of primary tumour and any regional or distant mets
  3. MDT meeting
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7
Q

Geoffrey Watson, a 68 year old with a history of hoarseness.

What history questions might you ask this man?

A

Red-flag screen:

  • Weight loss
  • Night sweats
  • Fever

Specific:

  • Dysphagia - of solids/liquids?
  • Odynophagia (pain on swallowing)
  • Heartburn / indigestion - GORD can cause inflammation of larynx and dysphonia
  • Postnasal drip - can cause dysphonia through excessive throat clearing

Systemic:

  • Noticed any lumps in neck or elsewhere
  • Tiredness / fatigue
  • Nausea
  • SoB
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8
Q

What is included in the NICE guidelines for urgent referral due to concern of head & neck cancer?

A
  • Hoarseness > 6 weeks
  • Oral swellings > 3 weeks
  • Dysphagia > 3 weeks
  • Unilateral nasal obstruction (particularly when associated with purulent discharge)
  • Unresolving neck masses > 3 weeks
  • Cranial neuropathies
  • Orbital masses
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9
Q

What are some symptoms associated with a thyroid lymp that make you concerned about thyroid malignancy?

A
  • Thyroid nodule in a child
  • A rapidly enlarging painless thyroid mass
  • Stridor
  • Enlarged cervical lymph nodes
  • Unexplained hoarseness
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10
Q

What is the most common site of head and neck squamous carcinoma in adults?

  • Hypopharynx
  • Larynx
  • External auditory canal
  • Nasopharynx
  • Oral cavity
A

Oral cavity

  • Oral cavity carcinoma = commonest type of mucosal carcinoma
  • Most often a SCC but can also by lymphoma, salivary gland tumour and melanoma
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