Head and Neck Malignancy

Question 1

Anatomical divisions of pharynx and larynx

Answer 1

• Oral cavity
• Lips to anterior tonsil pillar
• Oropharynx
• Anterior tonsil pillar to postrior
pharyngeal wall/apex of vallecular • Nasopharynx
• Above hard palate, posterior to choanae
• Hypopharynx

• Larynx
• Protectsrespiratorytractform digestive tract
• Voice production

Question 2

Structures forming the boundaries of posterior triangle

Answer 2

anteriorly: posterior border of sternocleidomastoid
posteriorly: anti border of trapezius
base: Intermediate 1/3rd of clavicle
Apex: on superior nucal line where tragedies meets Sternocleidomasttoid

Question 3

Red flags for head and neck malignancy

Answer 3

Unilateral symptoms in ENT are malignant until proven otherwise.

If a a patient presents with an oral cavity/nasal/or laryngeal mass
EXAMINE FOR LYMPHADENOPATHY
• If the patient presents with a persistent lymph node in the neck EXAMINE THE AREAS DRAINED BY THESE NODES

Question 4

Risk factors for Head & Neck Ca

Answer 4

• Smoker
• ETOH
• Betel nut
• Family History
Risk factors
for Head & Neck Ca
• Beware the 40 year old!
• HPV related tonsil ca on the increase in relatively young patients

Question 5

Symptoms of Oropharyngeal Ca

Answer 5

• Persistent unilateral unexplained pain • Ear
• Neck
• Mouth
• Persistent unexplained neck lump • LN
• SMG
• Parotid
• Persistent ulcer/mass • Oral
• Tonsil

Question 6

Symptoms of laryngeal cancer

Answer 6

• Persistent hoarse voice
• Otalgia
• Dysphagia
• Wt loss
Laryngeal
• Background and risk factors
• Examine with nasoendoscopy or laryngoscopy with 70 degree scope in clinic

Question 7

Curative Treatment Options for Laryngeal Ca

Answer 7

• Local excision
• Small volume disease • Radiotherapy
• Majority of patients
• Laryngectomy +/- neck dissection • Advanced disease

Question 8

Airway Management & Airway Obstruction describe A-E assessment

Answer 8

• A
• ?Talking ?Full sentences
• Quality of voice
• Ability to cough
• Stridor vs stertor
• Sats
• RR
• B
• examine chest
• C
• Tachycardia
• BP

Question 9

Management of Acute Airway obstrauction

Answer 9

• O2
• Adrenaline nebulisers
• IV access
• IV steroid
• Anaesthetist & ENT surgeon
• Intubation
• Surgical airway
• Cricothyroidotomy
• Emergency tracheostomy

Question 10

Symptoms of nasal malignancy

Answer 10

• Unilateral nasal blockage/mass
• May present with unilateral glue ear in an adult
• Diplopia late sign
• Smoking and elderly are at risk/dye industry/hardwood industry
• No examination of the nose is complete without examining the ear and visa versa!

Question 11

How should a neck lump be investigated

Answer 11

Neck Lumps : Thyroid • Vast majority are benign
• Midline lump that moves on swallowing
• Assess voice (hoarseness, nasoendoscopy) • USS
• FNA
• TSH
• Autoantibody screen

Question 12

Neck lumps : Lymphoma - NonHodgkins presentation

Answer 12

NonHodgkins
• Waldeyersring
• 30% Extra nodal presentation • Bsymptomsin30-40%

Question 13

Neck lumps : Lymphoma - Hodgkins presentation

Answer 13

• Adenopathy neck/supra- clavicular 80%
• armpit/groin
• Hepato-splenomegaly • pruritis
• Reed-Sternbergcells • EBV
• HIV

Question 14

Thyroid lumps and goitres: causes of discrete lumps

Answer 14

• Benign • Cyst
• adenoma
• Malignant • papillary
• Follicular
• Medullary • Lymphoma • Anaplastic

Question 15

Thyroid lumps and goitres: causes of diffuse goiters

Answer 15

• Hashimotos

* Graves