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HNN > Session 11 > Flashcards

Session 11 Flashcards

1
Q

Risk factors for thyroid cancer specifically

A

Irradiation exposure (incl. radioactive iodine and radiation leaks)

FH and certain inherited conditions e.g. FAP

Young or old = more likely to be malignant (less than 20 or more than 70)

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2
Q

Surgical features of H and N cancer treatment

A

Assessment of tumour

Sample (biopsy)

Remove (if possible)

Reconstruct

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3
Q

Lip/oral cavity cancer presentation

A

Lump
Pain (could be referred to ear)
Fixation of tongue
Dysphagia
Odynophagia

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4
Q

What is Odynophagia

A

Pain on swallowing

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5
Q

Surgery for lip or oral cavity cancers

A

Hemiglossectomy
Total glossectomy

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6
Q

Pharyngeal cancer presentation

A

Lump- mainly nodal mets or unknown primary

Pain (referred Otalgia)

Dysphagia

Odynophagia

Weight loss

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7
Q

Important feature of pharyngeal cancer presentation

A

Often present late - 25% untreatable at presentation

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8
Q

Pharyngeal cancer victims often need

A

Feeding assistance with gastrostomy tubes

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9
Q

Laryngeal cancer presentation

A

Dysphonia (voice change)
Dysphagia
Referred Otalgia
Glogus
neck lump
Weight loss
Cacexia

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10
Q

Issue with radiotherapy for HN cancers

A

Radiotherapy causes lots of scarring and fibrosis so in mouth can cause many problems

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11
Q

What are often the first presenting sign of underlying HNC

A

Neck lumps

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12
Q

Thyroid cancers and many HNC can give rise to a neck lump due to

A

Enlarged thyroid gland

Cervical lymph node metastasis

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13
Q

HNC affect the

A

Upper aero digestive structures

Oral cavity (beginning at vermillion border of lips), nose, nasal cavity, sinuses, pharynx, Larynx

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14
Q

Commonality of HNC

A

Uncommon compared to other types

most begin in mucosal surfaces lining structures- predominantly squamous cell carcinomas (>90%)

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15
Q

The largest proportion of head and neck cancers occur in the

A

Oral cavity, larynx, and oropharynx

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16
Q

Main risk factors for HNCs

A

Heavy alcohol and tobacco use (incl chewing), greater in people who use both

Common in older patients (60-70 years), men more than women

Previous Epstein-Barr virus infection (esp nasopharyngeal cancers), chewing of betal quid/Paan

Inhalants e.g. hardwood, sunlight or sun beds, HPV

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17
Q

HPV and HNC

A

Link between Oropharyngeal cancers

Rising in younger patients (30-40) due to increase in HPV related HNC

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18
Q

Common initial manifestations of HNC

A

Unexplained painful and/or mucosal ulceration or lesion (e.g. leukoplakia, erythroplakia, lump)

unexplained hoarseness of voice, dysphagia, Odynophagia, Otalgia

19
Q

Cancers involving the head and neck area can readily spread to

A

Lymph nodes - due to rich vascular supply and lymphatic drainage

Cervical lymphadenopathy due to cervical lymph node metastasis (i.e. neck lump) is a common initial presenting sign

20
Q

Clinical diagnosis and staging of HNC will involve

A

Clinical examination, biopsy, imaging (CT/MRI), endoscopic investigation

21
Q

Imaging evaluates the

A

Extent of primary cancer, involvement of other structures and Lymph nodes

22
Q

Endoscopy will allow

A

Direct visualisation of the cancer and enable biopsy

23
Q

Method of biopsy of neck lump

A

Fine needle aspiration for cytology or a core biopsy

Under ultrasound guidance

24
Q

Staging for HNC

A

TMN

25
Q

Surgical approaches range from

A

Microsurgical techniques using lasers to radical neck dissection

26
Q

What is removed in radical neck dissection

A

All ipsilateral lymph nodes, spinal accessory nerve, internal jugular vein and SCM muscle

27
Q

Patients with HNC may require expert support as

A

Treatments will often have permanent or significant implications for anatomical structures for eating/drinking/speaking/breathing

28
Q

Specialist MDT includes

A

Radiologist, pathologist, head and neck cancer surgeons, oncologist, dieticians, speech and language therapists, plastic surgeons

29
Q

HNC clinical features and other notes

A
30
Q

What are these

A
31
Q

What is laryngectomy

A

Removal of larynx and separation of airway from mouth

32
Q

What is tracheostomy

A

Opening created in trachea at front of neck so a tube can be inserted into trachea for breathing

33
Q

Arteries to be aware of around thyroid

A

Superior thyroid artery

Inferior thyroid artery

34
Q

Position of thyroid

A

Below thyroid cartilage- NOT ON

Between 2nd and 3rd tracheal rings

35
Q

Types of thyroid cancer

A

Papillary adenoCa (80%)
Follicular AdenoCa (10%)
Medullary Ca (5%)
Anaplastic Ca (5%)

36
Q

Superior thyroid artery comes from

A

External carotid

37
Q

What gives off inferior thyroid artery

A

Subclavian artery- thyrocervical trunk

38
Q

Treatment of thyroid cancer

A

Thyroidectomy (hemi or total, most are total)

Radioactive iodine

Radiotherapy/chemotherapy

39
Q

Causes of recurrent laryngeal nerve palsy

A

Idiopathic
Laryngeal cancer
Thyroid disease
Trauma
Cervical lymphadenopathy
Oesophageal cancer
Apical lung cancer
Aortic aneurysm
Neuropathic

40
Q

Features of thyroid blood supply

A
41
Q

Total thyroidectomy complications

A

Bleeding
Neck scar
Laryngeal nerve damage
Hypoparathyroidism
Recurrence
Thyroid storm

42
Q

Diagram of thyroid blood supply

A
43
Q

Pathway of recurrent laryngeal nerve

A

The recurrent laryngeal nerves branch off the vagus, the left at the aortic arch, and the right at the right subclavian artery. The left RLN passes in front of the arch, and then wraps underneath and behind it. After branching, the nerves typically ascend in a groove at the junction of the trachea and esophagus.

HNN (19 decks)

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