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ENT > Neck Lumps + H&N cancer > Flashcards

Neck Lumps + H&N cancer Flashcards

1
Q

What causes a branchial cyst

A

Remnant of fusion failure of branchial arches or lymph node cyst degeneration - 3,4,5
BENIGN

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2
Q

How does it become infected

A

May form fistula
Typically following resp infection
Becomes infected and enlarges

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3
Q

How do you deal with infection

A

Excise to prevent further infection

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4
Q

How does branchial cyst present and where

A 
Late childhood - early adulthood - 3rd decade 
Asymptomatic neck lump
Lateral and anterior to SCM at junction between upper and middle third 
Unilateral
Slowly enlarging 
Smooth, soft, fluctuant
Non-tender
No movement on swallow
No transillumination
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5
Q

How do you Dx / any neck lump

What does FNA show for brachial

A 
Need to exclude malignancy
- Esp if >40 
- All cystic lumps = malignancy till proven otherwise 
USS - doesn't show 
Refer to ENT
FNA - shows acellular fluid + crystals
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6
Q

How do you Rx

A

Excision

Ax if acute infection

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7
Q

What are Ddx of neck lump

A 
Congenital 
Branchial cyst
Thyroglossal cyst
Dermoid cyst - midline and <20 
Cystic hygroma - infancy and lymph aspirated due to malformation in lymphatic system (posterior, soft, non-tender and transilluminates)  - risk of haemorrhage / infection and can interfere with feeding and breathing 
Rx = aspiration or surgery 
Vascular malformation

Infection
Reactive LN = most common (consider TB, HIV, EBV, chronic infections(
Neck abscess = emergency
Salivary gland infection

Other / malignancy 
Pharyngeal pouch
TB 
Lymphoma - HSM 
Thyroid tumour
Salivary gland tumour
Cervical rib - thoracic outlet 
Carotid aneurysm - pulsatile and doesn't move on protrusion
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8
Q

What is an emergency

A

Neck abscess

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9
Q

What does a lymphoma tend to be

A

Rubbery
Painless
Associated splenomegaly
Weight loss

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10
Q

How does carotid aneurysm present

A

Pulsatile lateral neck mass

Doesn’t move on swallowing

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11
Q

Levels of LN in neck

A

1 = submental and mandibular 2,3,4 = down sternocleidmastoid
5 = posterior triangle
6 - around hyoid

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12
Q

What does painful LN suggest

A

Infective

Reactive

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13
Q

What does painless LN suggest

A

Malignancy

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14
Q

How do malignant LN present

A 
Round
Firm / hard
Irregular
Craggy 
Fixed
Non-tender
Rapidly enlarged
Lymphoedema
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15
Q

What is important in Hx of neck lumps

A 
How long
- <3 weeks = likely reactive 
Where in neck 
- Intradermal suggest lipoma or sebaceous cyst 
Fluctuation 
- Has it changed in size
- Does it come and go 
H+N symtpoms
- Is it painful
- Any sore throat / cough / cold 
- Hoarse voice 
- Difficulties or painful swallow
- Any breathing issue 
- Any weight change
- Any ear pain
- Any blood 
B symptoms - Fever / night sweat / weight loss
PMH 
- Investigation or Rx of lump
- Hx head or neck RT  
DH and allergies 
SH
- Smokin
- Alcohol
- Foreign travel
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16
Q

What do you look on examination

A 
Site
Size
Shape - irregular or regular 
Sore
Attached to skin / fixed 
Soft or hard

Does it move on swallow

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17
Q

What are common symptoms in head and neck

A 
Sore throat
Dysphonia / hoarse - worry if persistant
Dysphagia 
Odynophagia
Mouth or throat ulcer
Neck lump
Otalgia
Airway issue / stridor
Blood 
Snoring
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18
Q

What produces a bruit on auscultation

A

Grave’s

Carotid bruit

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19
Q

What cells do head and neck cancers tend to affect and where

A 
SCC = majority 
Mouth / nose / throat
Oral cavity
Pharyn / larynx 
Salivary glands - rare
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20
Q

What are the symptoms

A 
Neck lump
Hoarse voice 
Persistent sore throat
Persistent mouth ulcer - often painless 
Mouth numbness
Mouth bleeding
Sore tongue 
Patches in the mouth
Earache / effusion 
Dysphagia
21
Q

What are RF

A 
>40
Smoking
Alcohol
HPV 16+18 in oropharynx 
EBV in nasopharynx 
GORD 
Salted food 
Poor oral health
Occupation
Radiation / sun exposure 
FH
Immunosuppression
22
Q

What are symptoms of oral cavity cancer (lip, gums, tongue)

A 
White or red patch 
Painless ulcer or lump - non healing 
Non-healing ulcer 
Unusual bleeding
Red / erythematous mucous membrane = strong association with malignancy 
Pain = late Sx 
Swollen jaw / neck lump if mets
23
Q

What are symptoms of pharynx cancer (oropharynx + hypopharnx)

A 
Trouble breathing
Trouble speaking
Dysphagia
Pain in neck or throat
Painless tonsillar swelling 
Referred otalgia 
Trismus = red flag for infiltration 
Headache
Ringing in ears
24
Q

What are sinus Sx of head and neck cancer

A 
Blocked sinus
Chronic infection
Nose bleed
Swollen eyes
Pain in teeth
25
Q

What are symptoms of salivary gland cancer

A 
80% = in parotid 
80% = pleomorphic adenoma (benign)
Sx  
Swelling under chin
Hard fixed mass - painful 
Numbness
Paralysis of muscles in the face - facial nerve = suggests malignancy 
Pain in face or neck
LN involvement

Red flag

  • Hard
  • Rapid
  • Tender
  • Infiltrating surrounding structure / skin
  • Facial weakness
26
Q

When would you refer under the suspected cancer pathway

A

45+ with persistent unexplained hoarseness or lump in neck
Unexplained ulceration in oral cavity 3+ weeks
Lump on lip in oral cavity
Red or white patch in oral cavity consistent with erythroplakia
Unexplained thyroid lump
Dysphagia

27
Q

How do you Dx

A 
Refer ENT
Biopsy / FNA
Endoscopy 
Physical exam
Imaging
- MRI for tumour margins 
- CT for spread
28
Q

How do you Rx

A

Surgery
Radiation
Chemotherapy
Targeted therapy

29
Q

What is associated with nasopharyngeal cancer (SCC)

A

EBV

Asian smoked fish

30
Q

How does it present

A 
Cervical LN
Otalgia
Unilateral serous otitis media - refer if not related to URTI 
Obstruction
Discharge
Headache 
Epistaxis
Tinnitus
Conductive hearing loss from otitis media 
Blood in sputum
Ear fullness
CN palsy
31
Q

How do you Dx

A 
Detailed head and neck exam 
Nasa-Endoscopy + biopsy 
FNA of neck nodes 
CT - better for bony
MRI - better for soft tissue
32
Q

How do you Rx

A

RT = 1st line

Combined chemo + RT

33
Q

What are differential for swollen salivary glands

  • Parotid
  • Submandibular
  • Sublinqual
A 
Tumour 
Infection - Parotiditis / HIV 
Autoimmune - Sjogren / Sarcoid 
Acute viral- Mumps 
Ductus calculus - stone
34
Q

How does ductus calculus (stone in duct) present

A

Recurrent unilateral pain and swelling on eating
Stone may be palpable
Can become infected leading to chronic

35
Q

Where is most common and how do you Dx and Rx

A

80% = submandibular
X-ray
Surgical removal

36
Q

How do benign salivary gland tumours (Adenoma) present

A

80% = parotid

DO NOT invade strutures e.g. facial nerve

37
Q

How do you Dx tumour

A 
X-ray to exclude calculi
FNAC in most
If malignancy = parotidectomy = diagnostic and therapeutic
CT / MRI to stage 
Lymphoma needs biopsy
38
Q

What do you include

A

Facial nerve if involved

39
Q

What does HIV cause in parotid gland

A

Bilateral multi cystic symmetrical swelling

40
Q

What does Sjogren cause

A

Bilateral non-tender enlarement

41
Q

What does sarcoid cause

A

Non-tender bilateral

Facial nerve palsy

42
Q

What should patient get if urgent referral for H+N cancer

A

CXR to exclude apical lung lesion

43
Q

When is infection common

A

Elderly
Dehydration
Poor oral hygiene

44
Q

What are the symptoms

A

Painful diffuse swelling of gland
Fever
Pus leaking from duct

45
Q

How do you Rx

A

Antibiotics
Oral hygiene
Surgical drainage may be required

46
Q

If lump in anterior triangle

A

Branchial cyst
Parotid tumour
Carotid artery aneurysm

47
Q

If posterior triangle

A 
Cervical rib C&amp; 
Pharyngeal pouch 
Cystic hygroma- usually infant and transilluminate bright 
Pancoast tumour
Subclavian artery aneurysm
48
Q

What are red flags in head and neck that get urgent referral

A 
Unexplained lump change over 3-6 months
Hoarse voice >3 weeks
New onset dysphagai
Unexplained persistent swelling salivary gland
Otalgia >4 weeks + normal otoscopy
Unexplained persistent or sore throat
Non-healing ulcer
White or red lesion in mouth or oropharynx
Any B Sx 
Unexplained tooth loosening
49
Q

Pathology of neck lumps in order of LN regions

A

1

  • Submandibular gland pathology
  • Tooth abscess

2

  • Parotid pathology
  • Brachial cyst
  • LN (benign or malignant)

3

  • Brachial cyst
  • Paraganglioma
  • LN

4
- LN

5

  • Cystic hygroma
  • LN

6

  • Thyroid goitre
  • Thyroglossal cyst
  • Dermoid and epidermal cyst

ENT (14 decks)

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