S11 L1 Head and Neck cancers

Question 1

GW:
- Gag reflex - which nerves?

• Epliglottis - Why in the sniffing position
• Two other concerning causes of voice hoarseness

Answer 1

• Gag reflex:
  Afferent - Glossopharygneal
  Efferent - Vagus
• Sniffing position - tends to allow the larynx to rise away from the posterior pharyngeal structures, opening the airway (effectively doing a hilt tilt and chin lift) Harsh noise - stridor, evidences airway obstruction
• Apical lung cancer, Aorta arch aneurysm (specific to the left side), Tumour of the thyroid gland, Laryngeal cancer

Question 2

Most common risk factors associated with HNC and thyroid cancers

Answer 2

Alcohol + Tobacco 🍾 🚭

Older patients 👴🏽

Female ♂️

past EBV infection 🦠

Chewing betel quid/paan 🍃

Exposure to inhalants, sunlight/sunbeds 🌞

Question 3

What are the 4 types of thyroid cancers?

Answer 3

Papillary adenocarcinoma

Follicular adenocarcinoma

Medullary carcinoma

Anaplastic carcinoma

Question 4

What is the most common type of malignancy seen in HNC (non-thyroid)?

Answer 4

Squamous cell carcinoma

Question 5

Anatomy of the thyroid gland

Answer 5

Question 6

Potential complication of thyroid surgery? (hint: nerves)

Answer 6

Thyroid surgery - close proximity to superior laryngeal and recurrent laryngeal nerves (branches of the vagus nerve) = iatrogenic recurrent laryngeal nerve palsy

Question 7

Anatomical relations of other structures around the thyroid

Answer 7

Question 8

Blood supply to the thyroid

• Arteries
• Veins

Answer 8

Arteries - pic attached

Veins -
Venous drainage is carried by the superior, middle, and inferior thyroid veins, which form a venous plexus around the thyroid gland.

The superior and middle veins drain into the internal jugular vein and the inferior empties into the brachiocephalic vein.

Question 9

General Signs and Symptoms of HNC (Head and Neck cancers)

Answer 9

Generally, referred pain to ear (otalgia), cancer red flags (weight loss), neck lump from tumour growth or cervical lymphadenopathy.

Question 10

• *Oral cancer:**
• What are the typical signs and sx of HNC: oral cavity cancer
• What investigations are carried out to determine the diagnosis and severity of this cancer?

Answer 10

Question 11

• *Phraynx cancer:**
• What are the typical signs and sx of HNC: phraynx cancer
• What investigations are carried out to determine the diagnosis and severity of this cancer?

Answer 11

Question 12

• *Larynx cancer:**
• What are the typical signs and sx of HNC: larynx cancer
• What investigations are carried out to determine the diagnosis and severity of this cancer?

Answer 12

Question 13

• *Thyroid cancer:**
• What are the typical signs and sx of HNC: Thyroid cancer
• What investigations are carried out to determine the diagnosis and severity of this cancer?

Answer 13