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
Why does radiotherapy for lip/oral cancers have bad morbidity?
- Causes lots of scarring and fibrosis
- Causes patients to struggle with chewing and swallowing
How does pharyngeal cancer present?
- Lump (nodal metastases or unknown primary)
- Pain (includes referred otalgia)
- Dysphagia
- Odynophagia
- Weight loss
- Often late presentation
How is pharyngeal cancer investigated?
- Imaging with CT +/- MRI (include chest)
- May need PET
- Biopsy
- Often need feeding assistance with gastronomy tubes
How is pharyngeal cancer treated?
- 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
How does laryngeal cancer present?
- Dysphonia (voice change) - main feature
- Dysphagia
- Referred otalgia
- Neck lump
- Weight loss
- Cachexia
How is laryngeal cancer investigated?
- Image with CT (include chest)
- May need PET
- Biopsy
- Often have long term voice issues and/or swallowing problems
How is laryngeal cancer treated?
- 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)
What is a tracheostomy?
- 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
How does thyroid cancer present?
- Lump in thyroid or neck nodal metastasis
- Compressive symptoms - dysphagia, feeling like they’re being strangled
- Potential voice change
How is thyroid cancer investigated?
- Full history and examination
- Imaging (ultrasound)
- Needle testing of any suspicious lumps via cytology (FNAC)
What are the cellular types of thyroid cancer?
- Papillary adenocarcinoma (80%)
- Follicular adenocarcinoma (10%)
- Medullary carcinoma (5%)
- Anaplastic carcinoma (5%)
How is thyroid cancer treated?
- Thyroidectomy (hemi- or total)
- Radioactive iodine
- Radiotherapy/chemotherapy
What are the different types of thyroid surgery?
- Hemi-thyroidectomy
- Sub-total thyroidectomy
- Total thyroidectomy
- Potential for iatrogenic injury to superior laryngeal and recurrent laryngeal nerves
What can cause recurrent laryngeal nerve palsy?
- Idiopathic
- Laryngeal cancer
- Thyroid disease (benign or malignant)
- Trauma (including iatrogenic)
- Cervical lymphadenopathy
- Oesophageal cancer
- Apical lung cancer
- Aortic aneurysm
- Neuropathic
