Head & neck and thyroid cancer

Question 1

2WW referral for suspected laryngeal cancer

Answer 1

An unexplained neck lump or peristenet unexaplined hoarseness in someone aged 45 or above

Question 2

2ww oral cancer

Answer 2

Unexplained ulceration in the oral cavity lasting for more than 3 weeks, or
A persistent and unexplained lump in the neck

Question 3

2ww thyroid cancer

Answer 3

Patients with an unexplained thyroid lump should be referred under the suspected thyroid cancer pathway regardless of age

Question 4

Common clinical features of head and neck cancers include:

Answer 4

Dysphagia
Odynophagia
Dysphonia
ALARM symptoms (tiredness, unexplained weight loss, loss of appetite)
Lymphadenopathy
Airway compromise (stridor)
Bad breath (halitosis)
Focal neurology (VII cranial nerve palsy)

Question 5

Thyroid cancer most common type

Answer 5

Papillary

Question 6

Papillary cancer epidemiology

Answer 6

Most common (70%)
Tends to present 30-40 years of age.

Question 7

Features of Papillary cancer

Answer 7

Can spread locally compressing the trachea and also metastasises to bone and lung
Small tumours have an excellent prognosis

Question 8

Papillary thyroid cancer on microscopy

Answer 8

papillae among its cells
Orphan Annie-eye nuclear inclusions and psammoma bodies on light microscopy

Question 9

Follicular cancer features

Answer 9

Second most common
More common in areas of low iodine and in women >50y
Is more likely to metastasise (to lung and bones) than locally invade

Question 10

Features of Medullary cancer

Answer 10

Relatively uncommon
originates from the parafollicular cells that produce the hormone calcitonin so can occasionally present with hypocalcaemia and diarrhoea secondary to raised calcitonin
Associated with Multiple endocrine neoplasia (MEN) syndrome type 2A and B although 75% are sporadic.
Often metastasis to lymph nodes
Prognosis worse than papillary and follicular carcinoma
Disease activity can be monitored with calcitonin levels

Question 11

Features of Anaplastic cancer

Answer 11

least common form of all thyroid cancers
Present between 60-70 years
Extremely aggressive, patients present with rapidly growing masses
Invasion of the trachea, recurrent laryngeal nerve or other local structures by the time of presentation
Extremely poor prognosis – median survival: 8 months

Question 12

Features of Thyroid Lymphoma

Answer 12

Accounts for 10% of thyroid cancers
Almost always Non-Hodgkins lymphoma
Mainly occurs between 50-80 years old.
Highly associated with Hashimoto’s thyroiditis

Question 13

Ix for thyroid cancer

Answer 13

Any evidence of a toxic nodule (low TSH or raised T3 or T4, or radio-nucleotide imaging showing a “hot” nodule), then no further investigation for malignancy will be required as overactive nodules are very rarely malignant
US- solid, hypoechoic nodule(s) with irregular margins, microcalcifications, and evidence of local infiltration is suggestive

Question 14

papillary and follicular thyroid cancer management

Answer 14

1. Total thyroidectomy
2. Followed by radioiodine (I-131) to kill residual cells and TSH suppression therapy
3. Yearly thyroglobulin levels to detect early recurrent disease

Question 14

Risk Factors for Nasopharyngeal Carcinoma

Answer 14

Chinese ethnicity
Male
Diets with high salt intake
Cured meats
Fish (common in parts of Asia)
EBV infection
Family history
Tobacco smoking
Alcohol

Question 15

Clinical Features of Nasopharyngeal Carcinoma

Answer 15

Symptoms of eustachian tube obstruction (hearing loss, tinnitus, otalgia and/or sensation of aural fullness)
Nasal obstruction (blocked nose, facial pain)
Blood-stained nasal discharge
Persistent epistaxis
glue ear
unilateral symptoms