Session 11 Flashcards
Risk factors for thyroid cancer specifically
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)
Surgical features of H and N cancer treatment
Assessment of tumour
Sample (biopsy)
Remove (if possible)
Reconstruct
Lip/oral cavity cancer presentation
Lump
Pain (could be referred to ear)
Fixation of tongue
Dysphagia
Odynophagia
What is Odynophagia
Pain on swallowing
Surgery for lip or oral cavity cancers
Hemiglossectomy
Total glossectomy
Pharyngeal cancer presentation
Lump- mainly nodal mets or unknown primary
Pain (referred Otalgia)
Dysphagia
Odynophagia
Weight loss
Important feature of pharyngeal cancer presentation
Often present late - 25% untreatable at presentation
Pharyngeal cancer victims often need
Feeding assistance with gastrostomy tubes
Laryngeal cancer presentation
Dysphonia (voice change)
Dysphagia
Referred Otalgia
Glogus
neck lump
Weight loss
Cacexia
Issue with radiotherapy for HN cancers
Radiotherapy causes lots of scarring and fibrosis so in mouth can cause many problems
What are often the first presenting sign of underlying HNC
Neck lumps
Thyroid cancers and many HNC can give rise to a neck lump due to
Enlarged thyroid gland
Cervical lymph node metastasis
HNC affect the
Upper aero digestive structures
Oral cavity (beginning at vermillion border of lips), nose, nasal cavity, sinuses, pharynx, Larynx
Commonality of HNC
Uncommon compared to other types
most begin in mucosal surfaces lining structures- predominantly squamous cell carcinomas (>90%)
The largest proportion of head and neck cancers occur in the
Oral cavity, larynx, and oropharynx
Main risk factors for HNCs
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
HPV and HNC
Link between Oropharyngeal cancers
Rising in younger patients (30-40) due to increase in HPV related HNC
Common initial manifestations of HNC
Unexplained painful and/or mucosal ulceration or lesion (e.g. leukoplakia, erythroplakia, lump)
unexplained hoarseness of voice, dysphagia, Odynophagia, Otalgia
Cancers involving the head and neck area can readily spread to
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
Clinical diagnosis and staging of HNC will involve
Clinical examination, biopsy, imaging (CT/MRI), endoscopic investigation
Imaging evaluates the
Extent of primary cancer, involvement of other structures and Lymph nodes
Endoscopy will allow
Direct visualisation of the cancer and enable biopsy
Method of biopsy of neck lump
Fine needle aspiration for cytology or a core biopsy
Under ultrasound guidance
Staging for HNC
TMN
Surgical approaches range from
Microsurgical techniques using lasers to radical neck dissection
What is removed in radical neck dissection
All ipsilateral lymph nodes, spinal accessory nerve, internal jugular vein and SCM muscle
Patients with HNC may require expert support as
Treatments will often have permanent or significant implications for anatomical structures for eating/drinking/speaking/breathing
Specialist MDT includes
Radiologist, pathologist, head and neck cancer surgeons, oncologist, dieticians, speech and language therapists, plastic surgeons
HNC clinical features and other notes
What are these
What is laryngectomy
Removal of larynx and separation of airway from mouth
What is tracheostomy
Opening created in trachea at front of neck so a tube can be inserted into trachea for breathing
Arteries to be aware of around thyroid
Superior thyroid artery
Inferior thyroid artery
Position of thyroid
Below thyroid cartilage- NOT ON
Between 2nd and 3rd tracheal rings
Types of thyroid cancer
Papillary adenoCa (80%)
Follicular AdenoCa (10%)
Medullary Ca (5%)
Anaplastic Ca (5%)
Superior thyroid artery comes from
External carotid
What gives off inferior thyroid artery
Subclavian artery- thyrocervical trunk
Treatment of thyroid cancer
Thyroidectomy (hemi or total, most are total)
Radioactive iodine
Radiotherapy/chemotherapy
Causes of recurrent laryngeal nerve palsy
Idiopathic
Laryngeal cancer
Thyroid disease
Trauma
Cervical lymphadenopathy
Oesophageal cancer
Apical lung cancer
Aortic aneurysm
Neuropathic
Features of thyroid blood supply
Total thyroidectomy complications
Bleeding
Neck scar
Laryngeal nerve damage
Hypoparathyroidism
Recurrence
Thyroid storm
Diagram of thyroid blood supply
Pathway of recurrent laryngeal nerve
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.
