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Head, neck and introduction to neuroanatomy > Session 11 > Flashcards

Session 11 Flashcards

1
Q

What can thyroid/head and neck cancers give rise to?

A
  • Asymptomatic neck lump
  • Secondary to enlarged thyroid gland
  • Cervical lymph node metastasis
  • Sometimes first presenting sign
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2
Q

What are head and neck cancers?

A
  • Broad category of different tumour types
  • Affect upper aerodigestive structures
  • Oral cavity, nose, nasal cavity and sinuses, pharynx, larynx
  • Relatively uncommon
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3
Q

Which cell type is commonly affected by HNC?

A
  • Squamous mucosal surfaces
  • Most types are squamous cell carcinomas
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4
Q

What affects the outcome for HNC?

A
  • Early diagnosis and treatment
  • Recognise risk factors
  • Urgently refer patients
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5
Q

What are the risk factors for HNC?

A
  • Heavy alcohol use
  • Heavy tobacco use
  • 60-70 years old
  • Male
  • EBV infection previously
  • HPV infection
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6
Q

Outline the anatomical location of the thyroid gland

A
  • 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
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7
Q

What are the anatomical relations of the thyroid gland?

A
  • Anteriorly - infrahyoid muscles
  • Laterally - carotid sheath
  • Medially - larynx, pharynx, trachea, oesophagus, external laryngeal and recurrent laryngeal nerves
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8
Q

Outline the arterial supply to the thyroid gland

A
  • 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
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9
Q

What is the thyroid ima artery?

A
  • Found in ~10% of people
  • Arises from brachiocephalic trunk
  • Supplies anterior surface and isthmus of thyroid gland
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10
Q

Outline the venous drainage of the thyroid gland

A
  • 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
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11
Q

Which parts of the pharynx can be sites for tumours to grow?

A
  • Oropharynx including tonsil
  • Nasopharynx
  • Hypopharynx
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12
Q

Which parts of the larynx can be sites for tumours to grow?

A
  • Supraglottis
  • Glottis
  • Subglottis
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13
Q

What are the premalignant signs of HNC?

A
  • Leucoplakia
  • Erythroplakia
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14
Q

What are the thyroid-specific risk factors for cancer?

A
  • Irradiation exposure
  • Family history and certain inherited conditions
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15
Q

Which lumps of the thyroid are more likely to be malignant?

A
  • Young lumps in <20 year olds
  • Old lumps in >70 year olds
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16
Q

How are HNC staged?

A
  • TNM staging
17
Q

What steps are taken when a patient is diagnosed with cancer?

A
  • Assessment - patient fitness for intervention, clinical staging, radiological staging
  • Biopsy (tissue diagnosis)
  • Discuss with MDT - curative or palliative treatment
  • Definitive management with patient involvement
18
Q

What medical treatments can be given for HNC?

A
  • Radiotherapy
  • Chemotherapy
19
Q

What is the surgical management for HNC?

A
  • Assessment of tumour
  • Sample (biopsy)
  • Remove tumour if possible
  • Reconstruct
20
Q

What is the supportive treatment of HNC?

A
  • Swallowing
  • Feeding
  • Voice rehab
  • Pain treatment
  • Supportive care
21
Q

Who would be on the MDT for a patient with HNC cancer?

A
  • Oncologist
  • Surgeons
  • Radiologists
  • Pathologists
  • Cancer support nurse
  • SALT
  • Dieticians
22
Q

How does lip/oral cancer present?

A
  • Lump
  • Pain (can be referred to ear)
  • Fixation of tongue
  • Dysphagia
  • Odynophagia (pain on swallowing)
23
Q

How is lip/oral cancer investigated?

A
  • Biopsy
  • May need imaging with CT +/- MRI (not needed for superficial lip lesions)
  • May need PET
24
Q

How are lip/oral cancers treated?

A
  • Small tumours are excised and defect is repaired
  • Radiotherapy (bad morbidity)
  • Large tumours that do not respond to RT may need extensive surgery
25
Q

Why does radiotherapy for lip/oral cancers have bad morbidity?

A
  • Causes lots of scarring and fibrosis
  • Causes patients to struggle with chewing and swallowing
26
Q

How does pharyngeal cancer present?

A
  • Lump (nodal metastases or unknown primary)
  • Pain (includes referred otalgia)
  • Dysphagia
  • Odynophagia
  • Weight loss
  • Often late presentation
27
Q

How is pharyngeal cancer investigated?

A
  • Imaging with CT +/- MRI (include chest)
  • May need PET
  • Biopsy
  • Often need feeding assistance with gastronomy tubes
28
Q

How is pharyngeal cancer treated?

A
  • Smaller tumours are excised and defect is repaired
  • Radiotherapy
  • Large tumours that do not respond to RT may need extensive surgery (mandibular split/pharyngectomy /robotic procedure
29
Q

How does laryngeal cancer present?

A
  • Dysphonia (voice change) - main feature
  • Dysphagia
  • Referred otalgia
  • Neck lump
  • Weight loss
  • Cachexia
30
Q

How is laryngeal cancer investigated?

A
  • Image with CT (include chest)
  • May need PET
  • Biopsy
  • Often have long term voice issues and/or swallowing problems
31
Q

How is laryngeal cancer treated?

A
  • Small tumours may have resection of radiotherapy
  • Medium sized tumours do well with RT +/- chemo
  • Larger tumours that do not respond RT may need extensive surgery (laryngectomy)
32
Q

What is a tracheostomy?

A
  • An opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help you breathe.
  • More common than laryngectomy
33
Q

How does thyroid cancer present?

A
  • Lump in thyroid or neck nodal metastasis
  • Compressive symptoms - dysphagia, feeling like they’re being strangled
  • Potential voice change
34
Q

How is thyroid cancer investigated?

A
  • Full history and examination
  • Imaging (ultrasound)
  • Needle testing of any suspicious lumps via cytology (FNAC)
35
Q

What are the cellular types of thyroid cancer?

A
  • Papillary adenocarcinoma (80%)
  • Follicular adenocarcinoma (10%)
  • Medullary carcinoma (5%)
  • Anaplastic carcinoma (5%)
36
Q

How is thyroid cancer treated?

A
  • Thyroidectomy (hemi- or total)
  • Radioactive iodine
  • Radiotherapy/chemotherapy
37
Q

What are the different types of thyroid surgery?

A
  • Hemi-thyroidectomy
  • Sub-total thyroidectomy
  • Total thyroidectomy
  • Potential for iatrogenic injury to superior laryngeal and recurrent laryngeal nerves
38
Q

What can cause recurrent laryngeal nerve palsy?

A
  • Idiopathic
  • Laryngeal cancer
  • Thyroid disease (benign or malignant)
  • Trauma (including iatrogenic)
  • Cervical lymphadenopathy
  • Oesophageal cancer
  • Apical lung cancer
  • Aortic aneurysm
  • Neuropathic

Head, neck and introduction to neuroanatomy (11 decks)

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