Session 11 Flashcards
What can thyroid/head and neck cancers give rise to?
- Asymptomatic neck lump
- Secondary to enlarged thyroid gland
- Cervical lymph node metastasis
- Sometimes first presenting sign
What are head and neck cancers?
- Broad category of different tumour types
- Affect upper aerodigestive structures
- Oral cavity, nose, nasal cavity and sinuses, pharynx, larynx
- Relatively uncommon
Which cell type is commonly affected by HNC?
- Squamous mucosal surfaces
- Most types are squamous cell carcinomas
What affects the outcome for HNC?
- Early diagnosis and treatment
- Recognise risk factors
- Urgently refer patients
What are the risk factors for HNC?
- Heavy alcohol use
- Heavy tobacco use
- 60-70 years old
- Male
- EBV infection previously
- HPV infection
Outline the anatomical location of the thyroid gland
- Anterior to larynx and trachea
- Inferior to thyroid cartilage
- Spans C5-T1 vertebrae
- Shaped like a bow tie
- Lobes wrap around cricoid cartilage and superior rings of trachea
What are the anatomical relations of the thyroid gland?
- Anteriorly - infrahyoid muscles
- Laterally - carotid sheath
- Medially - larynx, pharynx, trachea, oesophagus, external laryngeal and recurrent laryngeal nerves
Outline the arterial supply to the thyroid gland
- Superior thyroid artery - 1st branch of ECA, lies close to external branch of superior laryngeal nerve
- Inferior thyroid artery - arises from thyrocervical trunk (subclavian artery), lies close to recurrent laryngeal nerve
What is the thyroid ima artery?
- Found in ~10% of people
- Arises from brachiocephalic trunk
- Supplies anterior surface and isthmus of thyroid gland
Outline the venous drainage of the thyroid gland
- Carried by superior, middle and inferior thyroid veins
- Form a venous plexus around the thyroid gland
- Superior and middle veins drain into IJV
- Inferior vein drains into brachiocephalic vein
Which parts of the pharynx can be sites for tumours to grow?
- Oropharynx including tonsil
- Nasopharynx
- Hypopharynx
Which parts of the larynx can be sites for tumours to grow?
- Supraglottis
- Glottis
- Subglottis
What are the premalignant signs of HNC?
- Leucoplakia
- Erythroplakia
What are the thyroid-specific risk factors for cancer?
- Irradiation exposure
- Family history and certain inherited conditions
Which lumps of the thyroid are more likely to be malignant?
- Young lumps in <20 year olds
- Old lumps in >70 year olds
How are HNC staged?
- TNM staging
What steps are taken when a patient is diagnosed with cancer?
- Assessment - patient fitness for intervention, clinical staging, radiological staging
- Biopsy (tissue diagnosis)
- Discuss with MDT - curative or palliative treatment
- Definitive management with patient involvement
What medical treatments can be given for HNC?
- Radiotherapy
- Chemotherapy
What is the surgical management for HNC?
- Assessment of tumour
- Sample (biopsy)
- Remove tumour if possible
- Reconstruct
What is the supportive treatment of HNC?
- Swallowing
- Feeding
- Voice rehab
- Pain treatment
- Supportive care
Who would be on the MDT for a patient with HNC cancer?
- Oncologist
- Surgeons
- Radiologists
- Pathologists
- Cancer support nurse
- SALT
- Dieticians
How does lip/oral cancer present?
- Lump
- Pain (can be referred to ear)
- Fixation of tongue
- Dysphagia
- Odynophagia (pain on swallowing)
How is lip/oral cancer investigated?
- Biopsy
- May need imaging with CT +/- MRI (not needed for superficial lip lesions)
- May need PET
How are lip/oral cancers treated?
- Small tumours are excised and defect is repaired
- Radiotherapy (bad morbidity)
- Large tumours that do not respond to RT may need extensive surgery