Lumps in the Neck and ENT Cancers Flashcards
How should a lump in the neck be investigated?
USS FNAC (fine needle aspiration cytology) note perform 2 if first negative CT Virology and Mantoux test FBC and TFTs
What are branchial cysts and fistulas?
Embryological cyst in the lateral part of the neck due to failure of fusion of the 2nd branchial cleft or less commonly the 1st, 3rd or 4th clefts. Commonly have openings to the outside forming fistulas and are frequently infected.
What are the signs and symptoms of branchial fistulas and cysts?
Slowly enlarging, smooth soft and fluctuant mass that sometimes increase in size after a URTI
Fistulas may become infected
Usually found down the front edge of the sternocleidomastoid muscle near angle of mandible and on the left side
No movement on swallowing and no transillumination
Anechogenic on USS – if echogenic suggest infection of cyst.
How should branchial cysts and fistulas be managed?
Conservative treatment i.e. none
Surgical excision
What is a thyroglossal duct cyst?
Fibrous cyst that forms from a persistent thyroglossal duct. Most common in people <20yrs old.
What are the signs and symptoms of a thyroglossal duct cyst?
Anterior triangle, irregular midline neck mass or lump
Inferior to the hyoid bone
Anywhere from the base of the tongue (foramen cecum) to the suprasternal notch
Mass moves on swallowing and upwards with protruding the tongue
Dysphagia and difficulty breathing
Oral secretions if fistula
Painless, smooth and cystic
Anechogenic on USS – if echogenic suggest infection of cyst.
How are thyroglossal duct cysts managed?
Treat thyroid dysfunction
Surgical removal if there are any symptoms
What are common causes of lumps in the anterior triangle?
Lymphadenopathy from Lymphoma
Parotid tumour (if superior-posterior portion)
Carotid artery aneurysm, or carotid body tumour
What are common causes of lump in the posterior triangle?
Cervical ribs
Pharyngeal pouches
Cystic hygromas
Lymphadenopathy
What is the most common histological type of ENT cancers?
90% of head and neck cancers are squamous cell carcinoma. These can include oral cavity, oropharynx, hypopharynx, larynx and trachea.
What are the common risk factors for ENT cancers?
Smoking Alcohol Vitamin A and C deficiency Nitrosamines in salted fish HPV GORD
How do ENT cancers usually present?
Neck pain/lump Hoarse voice >6weeks or sore throat >6 weeks Mouth bleeding due to painless ulcers Mouth numbness Sore tongue Patches in the mouth Earache/effusion – referred pain Lumps on the lip, mouth and gum Speech change Dysphagia
When should a 2ww referral be considered for potential laryngeal or oral cancers?
Laryngeal cancer – people who are 45 and over with persistent unexplained hoarseness or unexplained neck lump.
Oral cancers – unexplained ulceration lasting >3 weeks or a persistent unexplained neck lump.
Consider 2WW for those with a lump on the lip or oral cavity or with red or white patches in the oral cavity consistent with erythroplakia or erthroleukoplakia.
What do oral cavity and tongue cancers present with?
Uncommon, persistent painful ulcers, white or red patches on the tongue, gums or mucosa, otalgia, odynophagia, lymphadenopathy
What do oropharyngeal cancers present with?
Often advanced at presentation, typically smoker, sore throat, sensation of a lump and referred otalgia.
What do hypopharyngeal cancers present with?
Rare, lump in throat, dysphagia, odynophagia, referred otalgia and hoarseness. There are some pre malignant disorders such as leucoplakia, and Patterson Kelly brown syndrome.
How do laryngeal cancers present?
Typically, older patients, male, smokers with progressive hoarseness, stridor, difficulty or pain in swallowing, haemoptysis and ear pain. In younger patients typically HPV +ve. Can be supraglottic, glottic or subglottic.
What investigations should be done for ENT cancers?
Refer urgently for ENT review
Endoscopy
Fine needle aspiration biopsy
CT/MRI of the tumour site
When should someone be investigated for thyroid cancer and what investigations are ordered?
If someone has deranged thyroid function and a goitre/thyroid nodule then the following investigations should be done USS FNCA CXR Autoantibodies
What are the two types of thyroid cancers?
60% of thyroid cancers are papillary spreading to the lymph nodes and lungs, often in young females and has an excellent prognosis
25% of thyroid cancers are follicular occurring in middle age and spread via blood to bones and lungs. Usually well differentiated.
Medullary, lymphoma and anaplastic are the remaining 15%
How are thyroid cancers managed?
Total thyroidectomy
Radioiodine to kill residual cells
Yearly thyroglobulin levels to detect recurrence
What are dermoids?
Derived from pleuripotent stem cells and are located in the midline. Most commonly in a suprahyoid location. They have heterogeneous appearances on imaging and contain variable amounts of calcium and fat.
What is a cystic hygroma?
Cystic hygroma is a congenital lymphatic lesion typically seen on the left side that results from from occlusion of lymphatic channels. The painless, fluid filled, lesions usually present prior to the age of 2. They are often closely linked to surrounding structures and surgical removal is difficult. They are typically hypoechoic on USS.
