Head and neck 3 (cancers) Flashcards
Presentation of oral cavity carcinoma
Non healing ulcers
Exophytic lesions in the mouth
Local pain, referred otalgia and loose teeth or poor fitting dentures
Later presentation of oral cavity carcinoma
Spread to lymph nodes
Affects speech, swallowing, taste and appearance
Treatment of oral cavity carcinoma
Surgery to primary site +- neck
Adjuvant post operative radio for pts at high risk of recurrence based on staging and histology
Presentation of oropharyngeal cancer
obvious lesion - enlarged or ulcerated tonsil
local pain or referred otalgia
dysphagia or a sensation of a mass in the throat
asymptomatic with a mass in the neck
treatment of oropharyngeal cancer
planned combined surgery with adjuvant radiation
radiation or chemoradiation with surgery for salvage
Presentation of laryngeal cancer
Presentation and spread of tumour depends on site
Presentation of glottic cancer
Early presentation
Change in voice: constant gruff coice, progressive
Later invade supra glottis or sub glottis
-Airway obstruction
-Pain
-Dysphagia
-Spread to regional lymph nodes
Presentation of supra glottis cancer
Late presentation
Local pain
Referred otalgia
Change in voice
Otalgia
Dysphagia
Frequently spread to lymph nodes
Treatment of early laryngeal cancer T1/2
Transoral LAser resection
Radiation
Partial laryngectomy
Treatment of advanced laryngeal cancer T3/4
Total laryngectomy +/- postoperative radiation
Primary radiation with surgery for salvage
Concurrent chemoradiation with surgery for salvage
Difference between laryngectomy and tracheostomy
LAryngectomy- trachea brought to skin and no airway above stoma. Does not need a tube. May have moisture exchange device or speaking valve
TRacheostomy- always needs a tube
Presentation of hypo pharynx cancer
Presentation - usually late
foreign body sensation in the throat
increasing dysphagia with weight loss
hoarseness and stridor. otalgia
spread to lymph nodes common
Treatment of hypopharynx cancer
Early- radiation
Advanced- similar to advanced laryngeal cancer
Factors that affect treatment
TNM
nutrition
airway
Mental state
Speech
Swallowing
Sobriety
What procedure of cancer has spread to lymph nodes
Neck dissection: surgical procedure to remove lymph nodes in neck +- other structures e.g. SCM IJV
Types of thyroid cancer
Papillary and follicular cancer
Anaplastic
Medullary thyroid cancer Lymphoma
What is MENI
Syndrome that occurs in some thyroid cancers
Includes pancreas, pituitary, parathyroid
what is MENII
-a parathyroid, medullary thyroid (MTC), phaeo
-b: MTC, phaeo, mucosal neuromas, Marfanoid
-Familial medullary thyroid cancer
Risk factor for thyroid cancer
Previous radiation exposure
Thyrioditis
How does thyroid cancer present
Present with neck lump in thyroid area
May have airway compromise due to invasion of trachea or recurrent laryngeal nerves causing vocal cord palsy
Investigations for thyroid cancer
Drawback of FNA
USS +- FNA
FNA can’t distinguish follicular adenoma from follicular carcinoma so if FNA says follicular, then need diagnostic hemithyroidectomy
Papillary and follicular cancer treatment
Total thyroidectomy
Central compartment neck dissection
+- radioiodine
Tumour marker for papillary and follicular cancer
Thyroglobulin
Treatment for medullary cancer
Surgery. NO iodine.
