HEAD AND NECK TUMOURS Flashcards

Question

Role/Use of the Fenestrations on Tracheostomy Tube?

Answer 1

**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**

Answer 2

1. Acinic cell carcinoma 2. Adenoid Cystic 3. Mucoepidermoid

Answer 3

**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**

Answer 4

* 80% of parotid gland tumors are _benign_ * 80% are _pleomorphic adenomas_ * 80% are found in the _superficial lobe_ of the parotid gland

Answer 5

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%.

Answer 6

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**

Answer 7

**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.

Answer 8

**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**

Answer 9

Patients with **Follicular Thyroid Cancer** are more likely to develop lung and bone metastases than are patients with **Papillary Thyroid Cancer**

Answer 10

**Hurtle Cell (Follicular Oncocytic)** + Adjuvant Radioactive Iodine

Answer 11

* 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*

Answer 12

**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.)

Answer 13

* Haematological: **Calcitonin/CEA** levels * Radiological with US, MRI, CT scanning *Thyroglobulin for Papillary/Follicular*

Answer 14

**Anaplastic Thyroid Cancer**: most severely de-differentiated tumors accounting for <2% of thyroid cancers. They carry a very _poor prognosis_.

Answer 15

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

Answer 16

**HYPERCALCAEMIA OF MALIGNANCY**: Parathyroid hormone-related peptide (PTH-rP) secreted from tumours **Diagnosed by HIGH calcium levels with LOW PTH**

Answer 17

**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

Answer 18

**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

Answer 19

**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_

Answer 20

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**

Answer 21

**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**