HEAD AND NECK TUMOURS Flashcards
Red Flag Presentations for Mucousal Tumours?
- Dysphagia (difficulty swallowing)
- Dysarthria (Difficulty speaking)
- Dysphonia (hoarse voice)
- Odynophagia (pain swallowing)
- Referred Otalgia
- Globus (sensation of mass in throat)
Most Common Tumour type in Head /Neck Mucosa?
The most common tumour type in head and neck mucosa is Squamous Cell Cancer (SCC)
These can arise:
- de novo
- from premalignant lesions: leukoplakia or erythroplakia
Difficulty Swallowing?
Dysphagia
Difficulty Speaking?`
Dysarthria
Hoarse Voice?
Dysphonia
Pain Swallowing?
Odynophagia
Sensation of Mass in Throat?
Globus
Cause/Presentation/Treatment of Oral Cavity Mucosal Tumour?
_
Cause/Presentation/Treatment of Oropharygeal Mucosal Tumour?
_
Cause/Presentation/Treatment of Nasopharygngeal Mucosal Tumour?
_
Cause/Presentation/Treatment of Hypopharyngeal Mucosal Tumour?
_
The larynx is bordered by:
- ___________ superiorly
- ___________ inferiorly
- ________________ laterally and posteriorly.
The larynx is bordered by:
- oropharynx superiorly
- trachea inferiorly
- hypopharynx laterally and posteriorly.
The larynx is the most complex of the mucosal lined structures of the head and neck.
Presentation/Treatment of various stages of Laryngeal Mucosal Tumour?
_
Odynophagia + Dysphagia + visible mouth lesion?
Cause?
Oral Cavity Tumor
Causative agents include tobacco and occasionally Human papilloma virus (HPV)
Painless neck mass due to cervical lymphadenopathy, odynophagia?
Cause?
Oropharyngeal Cancer
Causative agents: 70% Human papilloma virus (HPV) and less frequently tobacco smoking.
Painless neck mass due to cervical lymphadenopathy as well as nasal obstruction and epistaxis?
Subtypes/Causes?
Nasopharyngeal Tumour
Causes
Non-Keratinising Squamous Cell Carcinoma (NKSCC):
- Epstein Barr Virus (EBV)
- Genetic (HLA I&II)
- Nitrosamines - food preservative used in salted fish
Keratinising Squamous Cell Carcinoma (KSCC): Smoking and alcohol exposure
Dysphagia and weight loss?
Cause?
Hypopharyngeal Mucosal Tumour
Risk factors: Smoking and a co-factor is alcohol
Dysphonia, dysphagia, weight loss in advanced tumours?
Cause/Treatment of various stages?
Larynx Tumour
____________________: Removal of the larynx and separation of the airway from the mouth nose and esophagus.
- Consequences?
- Indications
- Complications?
Laryngectomy: Removal of the larynx and separation of the airway from the mouth nose and esophagus.
- After this procedure a patient will be an obligate neck breather(cannot be oxygenated or intubated from the nose/mouth)
- The patient will also have lost their vocal cords and will have lost the ability to phonate traditionally
Removal of the larynx and separation of the airway from the mouth nose and esophagus
Laryngectomy
Surgical formation of an opening into the trachea through the anterior neck especially to allow the passage of air
Tracheostomy
Indications for Tracheostomy?
- Long term ventilation (facilitates weaning)
- Upper airway obstruction e.g., tumour
- Airway protection in loss of laryngeal reflexes e.g., neurological disease
- Access for pulmonary toilet
- As part of another procedure e.g., Laryngectomy
Complications of Tracheostomy?
Role/Use of the Cuff on Tracheostomy Tube?
Role/Use of the Fenestrations on Tracheostomy Tube?
Role/Use of the Canuli on Tracheostomy Tube?
______________________
- Mass
- CN VII palsy or paralysis
- Pain, trismus (lockjaw), skin paraesthesia (burning/prickling)
Salivary Gland Malignancy (Acinic cell carcinoma, Adenoid Cystic, Mucoepidermoid)
- Mass
- CN VII palsy or paralysis
- Pain, trismus (lockjaw), skin paraesthesia (burning/prickling)
Lymphoma can present in salivary glands or in parotid lymph nodes
Most common salivary gland malignancies
- Acinic cell carcinoma
- Adenoid Cystic
- Mucoepidermoid
Acinic Cell Carcinoma
- Characteristics
- Most Common Salivary Gland
- Treatment
Adenoid Cystic
- Characteristics
- Demographic
- Most Common Salivary Gland
- Treatment
_
Mucoepidermoid
- Characteristics
- Demographic
- Most Common Salivary Gland
- Treatment
_
______________________ are the most common salivary gland mass
- Malignant?
- How do they present?
- Treatment?
Pleomorphic Adenomas are a benign condition and most common salivary gland mass.
- Present as a slow growing painless lump .
- Firm, mobile and well circumscribed.
- Surgically resected via parotidectomy
Characteristics of Parotid Gland Tumours?
- 80% of parotid gland tumors are benign
- 80% are pleomorphic adenomas
- 80% are found in the superficial lobe of the parotid gland
Concerns of Malignant Transformation of Pleomorphic Adenoma?
What are they called when they progress?
Pleomorphic adenomas present as a slow growing painless lump. On examination, they are firm, mobile and well-circumscribed
Malignancy Concerns
- Facial nerve is very rarely affected by pleomorphic adenomas. If present=> concern for a malignant process.
- Rapid enlargement of a tumour nodule should raise concern about the development of malignant change
- Risk of transformation is 10% over 15 years.
- When they transform to malignant tumours they are called Carcinoma Ex-pleo and have a poor prognosis with a 5-year survival of 40%.
Risk Factors/Clinical Presentation of Thyroid Malignancy?
Investigations for Thyroid Maliganancy?
Investigations:
- Clinical exam
- US is modality of choice and gives risk stratification U1 – U5 with U5 being malignant
- Haematology: Calcitonin/CEA for medullary, Thyroglobulin for Papillary
____________________________:
- Most Common type of thyroid maliganac (80%)
- It is well differentiated and carries a good prognosis
- several histological variants with varying degrees of
behavior from mild to more aggressive tumor types. - 11% of patients present with metastases outside the neck and mediastinum.
Investigations/Treatment/Indication for Thyroidectomy?
Papillary Thyroid Cancer:
- Most Common type of thyroid maliganac (80%)
- It is well differentiated and carries a good prognosis
- several histological variants with varying degrees of
behavior from mild to more aggressive tumor types. - 11% of patients present with metastases outside the neck and mediastinum.
When is a thyroidectomy indicated for Papillary Thyroid Cancer?
__________________________________:
- 10% of thyroid malignancies
- Considered a well differentiated cancer
- __________ at the time of surgery & frozen section cannot differentiate between benign and malignant
Metastasis?
Investigations/Treatment?
Follicular Thyroid Cancer:
- 10% of thyroid malignancies
- Considered a well-differentiated cancer (along with Papillary Thyroid Cancer)
- Thy 3 at time of surgery & frozen section cannot differentiate between benign follicular and follicular cancer
- 11% of patients with FTC have metastases beyond cervical/mediastinal area on initial presentation
Patients with FTC are more likely to develop lung and bone metastases than are patients with papillary thyroid cancer
Patients with ___________________________ are more likely to develop lung and bone metastases than are patients with ____________________
Patients with Follicular Thyroid Cancer are more likely to develop lung and bone metastases than are patients with Papillary Thyroid Cancer
More aggressive form of Follicular thyroid cancer that requires a total Thyroidectomy?
Hurtle Cell (Follicular Oncocytic)
+ Adjuvant Radioactive Iodine
Monitoring of Pappillary and Follicular Thyroid Cancer?
- Clinical History/Examination
- Neck US is effective for local recurrence in thyroid cancers
- Thyroglobulin is an accurate marker for disease recurrence.
Calcitonin/CEA for Medullary
________________________________:
- 1-3% of thyroid malignancies
- Nodule like Differentiated thyroid cancer
- History suggestive of Pheochromocytoma (__________+___________)
- Can be De Novo or assc. w/ Multiple Endocrine Neoplasia (Mutations?)
Investigations/Treatment?
Medullary Thyroid Cancer:
- 1-3% of thyroid malignancies.
- Nodule-like Differentiated thyroid cancer
- History suggestive of Pheochromocytoma (Flushing + Diarrhoea/loose stools)
De Novo
or
Multiple Endocrine Neoplasia
- RET mutation (More RET = more aggressive tumor)
- MEN 2a/2b, Familial Medullary (non M.E.N.)
Monitoring for Medullary Thyroid Cancer?
- Haematological: Calcitonin/CEA levels
- Radiological with US, MRI, CT scanning
Thyroglobulin for Papillary/Follicular
__________________________________: most severely de-differentiated tumors accounting for <2% of thyroid cancers. They carry a very poor prognosis.
Anaplastic Thyroid Cancer: most severely de-differentiated tumors accounting for <2% of thyroid cancers. They carry a very poor prognosis.
Types of Thyroid Malignancy?
Four Major Subtypes of Thyroid Cancers:
- Papillary (80%): Well Differentiated=> GOOD PROGNOSIS. Thyroglobulin Monitored
- Follicular (10%): Well Differentiated=> GOOD PROGNOSIS. Bone/Lung Metastiasis Likely. Thyroglobulin Monitored
- Medullary: Pheochromocytoma History. Calcitonin & CEA Monitored
- Anaplastic (2%)- Poorest Prognosis
Hyperparathyroidism Subtypes?
Most common cause of hypercalcemia in hospitalized patients?
Diagnosis?
HYPERCALCAEMIA OF MALIGNANCY: Parathyroid hormone-related peptide (PTH-rP) secreted from tumours
Diagnosed by HIGH calcium levels with LOW PTH
______________________: Slow-growing locally invasive malignant skin cancer arising from basal cells of the epidermis
- Frequency
- Risk Factors
- Surgical Margins/Indication for Radiotherapy?
BASAL CELL CARCINOMA (BCC): Slow-growing locally invasive malignant skin cancer arising from basal cells of the epidermis
Frequency: Most common cancer (7th Decade, Exposed Skin)
Predisposing Factors
- Exposure to UV radiation esp. in childhood
- Gorlin Syndrome
- Increasing age
- Males
- Fair skin types - Fitzpatrick I and II
- Immunosuppression
- Arsenic Exposure
_____________________________: Locally invasive, malignant tumor arising from the keratinising cells of the epidermis and has the potential to metastasize to other organs of the body
- Frequency
- Risk Factors
- Treatment?
Squamous Cell Cancers (SCC): Locally invasive, malignant tumour arising from the keratinising cells of the epidermis and has the potential to metastasize to other organs of the body
Frequency: 2nd Most Common Skin Cancer
Predisposing factors:
- Chronic UV light exposure in sun-damaged skin
- Fair skin
- Albinism
- Xeroderma pigmentosum
- Ionising radiation
- Arsenic exposure
- Chronic wounds/ scars/burns/ulcers/sinus tracts
- Bowen’s disease (intraepidermal SCC)
- Immunosuppression
___________: is a malignant tumour, which arises from cutaneous melanocyte
- Risk Factors?
- Subtypes?
- Treatment/Surgical Marins?
Melanoma: is a malignant tumour, which arises from cutaneous melanocyte.
Risk Factors:
- > 100 normal moles
- Atypical moles
- Family History of Melanoma
- Freckles
- Red hair or skin which burns in the sun
Treatment: by genotype of tumour (earliest cancers to benefit)
- BRAF v600 +: Vemurafenib
- Melanoma in Situ - 5mm margin
- Thickness ≥ 1mm - 2cm margin
- Thickness ≤ 1mm - 1cm margin
Incidence of oropharyngeal cancer is greatly increasing due to ______________
Incidence of oropharyngeal cancer is greatly increasing due to HPV-induced tumours
HPV-mediated oropharyngeal disease carries a close to 60% reduction in death risk when compared to smoking-induced oropharyngeal cancers
Factors influencing Squamous Cell Cancers (SCC) likeliness to metastasize?
Squamous Cell Cancers (SCC) (Locally invasive, malignant tumour arising from the keratinising cells of the epidermis)
- Site: Sun Exposed (Lips> Ears > Non-sun exposed sites >
Chronic ulcers, Radiation exposed sites) - Size: Tumours > 2cm - 3x more likely to metastasis
- Depth: Tumours deeper than 4mm or extending into/beyond the subcutaneous tissue (Clark IV)
- Patient immunosuppression
- Recurrent disease
ABCDE of Melanoma?
