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ENT Tumours Flashcards

1
Q

what are the causes of HNSCC?

A
  • Cigarette smoking
  • Alcohol consumption
  • Vitamin A & C Deficiency
  • Nitrosamines in salted fish
  • HPV
  • GORD
  • Deprivation
  • Hot drinks
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2
Q

what is HSNCC?

A

Squamous cell carcinomas of the head and neck

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3
Q

where do HSNCC arise from?

A

• Develop form lining of aerodigestive tract oral cavity, orophargynx, hypopharynx, larynx and trachea

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4
Q

how does HPV cause HSNCC?

A

produces proteins E6 and E7 which disrupt p53 and Rb pathways, leading to cellular immortality

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5
Q

what are the throat clinical features of HSNCC?

A 
Neck pain/lump
Hoarse voice >6wks
Sore throat >6wks
Speech change 
Dysphagia
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6
Q

what are the mouth clinical features of HSNCC?

A
  • Mouth bleeding
  • Mouth numbness
  • Sore tongue
  • Painless ulcers
  • Patches in mouth
  • Lumps (lip, mouth, gum)
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7
Q

what are the ear clinical features of HSNCC?

A

Earache/effusion

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8
Q

what are the referral guidelines for HSNCC?

A

o A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:
o persistent unexplained hoarseness or
o An unexplained lump in the neck.

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9
Q

what are the clinical features of HSNCC of the oral cavity and tongue?

A

persistent painful ulcers, white or red patches on tongue, gums or mucosa, otalgia, odynophagia, lymphadenopathy

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10
Q

what is the management of HSNCC of the oral cavity and tongue?

A

surgery/radiotherapy

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11
Q

what is the epidemiology factors of oropharyngeal carcinomas?

A

Male: female, 5:1

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12
Q

what are the risk factors of oropharyngeal cancer?

A

pipe smoking, or chewing tobacco, HPV

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13
Q

what type of cancer is oropharyngeal cancer?

A

squamous cell

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14
Q

what are the clinical features of oropharyngeal cancer?

A

older patient, smoker with sore throat, sensation of lump, referred, otalgia

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15
Q

how is oropharyngeal carcinomas diagnosed?

A

MRI

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16
Q

how are oropharyngeal carcinomas managed?

A

surgery, radiotherapy

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17
Q

what are the clinical features of hypopharyngeal carcinoma?

A

lump in throat, dysphagia, odynophagia, pain referred to ear, hoarse voice

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18
Q

what are the premalignant conditions to hypopharyngeal tumour?

A

leucoplakia, Patterson-kelly-brown syndrome

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19
Q

what is the management of hypopharyngeal carcinoma?

A

radiotherapy, surgery

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20
Q

what type of tumour is hypopharyngeal tumours?

A

squamous cell

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21
Q

what are the clinical features of laryngeal carciomas?

A

Typical Patient: older, progressive hoarseness, then stridor, difficulty or pain on swallowing +/- haemoptysis +/- ear pain (if pharynx involved)
Younger Patient: HPV +ve

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22
Q

where do laryngeal cancers occur?

A

supraglottic, glottic or subglottic

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23
Q

how are laryngeal cancers diagnosed?

A

laryngoscopy + biopsy, HPV status, MRI Staging

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24
Q

how are laryngeal cancers managed?

A

o Radical radiotherapy for small tumours

o Larger tumours – partial/total laryngectomy +/- block dissection of neck glands

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25
what is stertor?
caused by obstruction of airway above the level of the larynx, low pitched snoring or snuffle sound
26
what is stridor?
due to airflow changes, narrowed or obstructed airway path, high pitched sound, inspiratory (higher in airway), expiratory, biphasic
27
what is wheeze?
continuous, coarse, whistling sound, polyphonic sound
28
what is hoarseness?
A voice change really = dysphonia” i.e. abnormal voice
29
what is aphonia?
A complete loss of voice
30
what is nasopharyngeal carcinoma?
squamous cell carcinoma
31
what are the causes of nasopharyngeal carcinoma?
* Combination of viral, environmental, genetics * Epstein Barr virus * Also volatile nitrosamines in food
32
what are the clinical features of nasopharyngeal carcinoma?
* Blocked or stuffy nose * Nosebleeds * Neck lump (cervical lymphadenopathy) * Hearing loss (in one ear) – otalgia, unilateral serous otitis media * Cranial nerve palsy
33
what is the histology of nasopharyngeal carcinoma?
solid lesions (look like eyeballs)
34
how does EBV cause nasopharyngeal tumours?
Infects epithelial cells of oropharynx and B cells | hi-jacks and mimics helper T cells responses leading to proliferation and survival of B cells
35
how are nasopharyngeal carcinomas mediated cellularly?
* Mediated largely by latent membrane protein 1 (LMP-1) | * Encodes EBNA-2 activating cyclin D and promoting transition from G0 to G1
36
how are nasopharyngeal carcinomas diagnosed?
endoscopic biopsy, combined CT and MRI
37
how are nasopharyngeal carcinomas managed?
radiotherapy, chemotherapy, surgery
38
what are examples of benign nasal tumours?
squamous papillomas, Schneiderian papilloma, angiofibromas
39
what are examples of malignant nasal tumours?
most commonly squamous cell carcinoma | primary adenocarcinoma, nasopharyngeal carcinoma, neuroblastoma, lymphoma
40
what is an important part of nasal tumour history?
occupation – carpenter
41
what are the causes of squamous papilloma's in the head and neck?
* HPV exposure – types 6 and 11 | * Risk Factors – female, smoking, alcohol
42
what is the pathophysiology of squamous papilloma's in the head and neck?
* Generally benign papilloma * Nipple like (grows exophytical projecting outward) * Red or pink in colour – too much production of keratin
43
where do squamous papillomas occur?
Arises from squamous epithelium of skin, lip, oral cavity, tongue, pharynx, larynx, esophagus
44
what are the clinical features of squamous papillomas?
* Hoarseness * Cough * Palpable lymphnodes * Referred pain to ear * Stridor
45
what is the management of squamous papillomas?
* Radiotherapy * Laser resection * Endoscopic resection * Laryngectomy and neck dissection
46
what is a pharyngeal pouch?
Acquired diverticulum of mucosa through the muscles layers of the wall of the pharynx
47
where do pharyngeal pouches occur?
between thyropharynheus and the cricopharyngeus
48
what are the clinical features of pharyngeal pouches?
dysphagia, cough, regurgitation, weight loss, hoarse voice, aspiration pneumonia, halitosis, lung abscess Boyces sign patients > 50
49
how are pharyngeal pouches classification?
Lakey classification
50
what are paragangliomas?
• Tumours arising from clusters of neuroendocrine cells
51
what are the causes of paragangliomas?
* MEN2 (autosomal dominant) | * NF 1
52
what are the types of head and neck paragangliomas?
Chromaffin +ve | Non-Chromaffin
53
what are examples of chromaffin +ve paragangliomas?
Usually adrenal or paravertebral
54
what are examples of non-chromaffin paragangliomas?
carotid bodies, aortic bodies, jugulotympanic ganglion, ganglia nodosum of vagus and clusters and oral cavity nose, nasopharynx, larynx + orbit
55
what is the pathophysiology of chromaffin +ve paragangliomas?
sympathetic nervous system and secrete adrenaline and noradrenaline
56
what is the histology of paragangliomas?
nested cell appearance, oval cells
57
what are the clinical features of paraganglioms?
* Most asymptomatic * Painless mass * Occur 1-3% procedure excess catechol to be symptomatic * Occur after hard physical activity, stress, injury, childbirth, going under anaesthesia, eating foods high in tyramine
58
how are paragangliomas diagnosed?
* 24 hr urine test * Blood catecholamine * CT and MRI san * Genetic tests
59
how are paragangliomas managed?
surgery, embolization, radiotherapy
60
what is a pleomorphic adenoma?
most common salivary gland tumours
61
what are the causes of pleomorphic adenomas?
* Genetic – rearrangement of chromosome band 8q12, 12q13-15 * Sporadic * PLAG 1 and HMGA2 gene translocation * Simian virus * MUC1 gene
62
what is the structure of pleomorphic adenomas?
epithelial, myoepithelial, stromal (mesenchymal)
63
what type of cancer are pleomorphic adenomas?
Benign neoplastic proliferation of parenchymal glandular cells
64
what are the clinical features of pleomorphic adenomas?
* Slow growing * Painless * If parotid + large – facial nerve weakness * Dysphagia, dyspnoea, hoarseness, difficulty in chewing, epitasis
65
how are pleomorphic adenomas diagnosed?
Excision biopsy, FNA, CT or MRI
66
how are pleomorphic adenomas managed?
surgical resection, difficult to excise (recurrence)
67
what are the complications of pleomorphic adenomas?
malignant transformation
68
what are warthins tumours?
second most common salivary gland tumour
69
what are the causes of warthins tumours?
unknown, strong association with smoking, radiation exposure? Autoimmune disorder?
70
what type of tumour is Warthins tumour?
Benign cystic tumour
71
where do Warthins tumours occur?
tail of parotid gland
72
what is the histology of Warthins Tumour?
Contains abundant lymphocytes and germinal centres | papillary folds composed of a double layer of ocnocystic cells
73
what are the clinical features of Warthins tumours?
* bilateral * firm, painless lump * swelling * facial nerve palsy
74
how are Warthins tumours diagnosed?
* xray * CT, MRI, US * Gland biopsy
75
how ware Warthin tumours managed?
surgical removal, non recurrent
76
what are the causes of adenoid cystic tumour?
* Unknown * Genetic – chromosomal translocation t(6:9)q22-23 * Environmental – too much protein
77
what are adenoid tumours derived from?
reserve epithelial cells of the intercalated ducts
78
where do adenoid cystic tumours occur?
Most commonly salivary gland – also breast, lacrimal, parotid, lung, brain, trachea, paranasal
79
what are the histopathology's of adenoid cystic tumours?
cribriform, tubular, solid
80
what are the clinical features of adenoid cystic tumours?
* Painless slow growing mass * Facial nerve paralysis * Proptosis (lacrimal glands) * Difficulty breathing, hoarseness (larynx)
81
what is the management of adenoid cystic tumours?
* Surgical removal with clear margin * Radiotherapy * Chemo – if metastatic
82
what is the complications of adenoid cystic tumours?
distant mets

ENT (13 decks)

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