The Thyroid And H&N Cancers

Question 1

What are the risk factors for H&N cancer?

Answer 1

• Smoking
• Alcohol
• Beta nut chewing
• Dental hygiene
• Viruses - HPV for oropharynx
• Premalignant

Question 2

What are the risks for thyroid cancers?

Answer 2

• Irradiation exposure - including radioactive iodine and radiation leaks
• Family history and certain inherited conditions e.g. FAP
• Young lumps or old lumps (Under 20 or over 70) in thyroid gland are more likely to be malignant

Question 3

Describe blood supply to the thyroid

Answer 3

Arteries:

• Superior thyroid artery
• Inferior thyroid artery

Veins:

• Braches of internal jugular:
  
  • Superior thyroid vein
  • Middle thyroid vein
• Branches of brachiocephalic vein:
  
  • Inferior thyroid vein

Question 4

Describe anatomy of the thyroid

Answer 4

.

Question 5

How do you manage new cancers?

Answer 5

• Assessment
  
  • Patients fitness for inervention
  • Clinicl staging
  • Radiological staging
• Biopsy
  
  • To have a tissue diagnosis
• Discuss @ MDT
  
  • Curative or palliative..
• Definitive management with patient involvment

Question 6

How do you manage H&N cancers?

Answer 6

• Medical
  
  • Radiotherapy (RT)
  • Chemotherapy (<70)
• Surgical
  
  • Assessment of the tumour
  • Sample (biopsy)
  • Removal (if possible)
  • Reconstruct
• Supportive
  
  • Swallowing
  • Feeding
  • Voice rehab
  • Pain
  • Care

Have an MDT approach with multile different specialities.

Question 7

How do lip / oral cavity cancers present?

Answer 7

• Lump
• Pain (including referred pain to ear)
• Fixation of tongue
• Problem swallowing (dysphagia)
• Pain on swallwoing (odynophagia)

Question 8

How do cancer of the pharynx present?

Answer 8

• Lump (mainly nodal mets or unknown primary)
• Pain (including referred pain - otalgia)
• Problems swallowing (dysphagia)
• Pain on swallowing (odynophagia)
• Weight loss

Often present late - 25% are intreatable at presentation

Question 9

How do cancers of the larynx present?

Answer 9

• Dyphonia (voice change)
• Dyphagia
• Referred otalgia
• Glogus
• Neck lump
• Weight loss
• Cacexia

Question 10

How does a thyroid cancer present?

Answer 10

• Lump on the neck
  
  • Thyroid
  • Nodal metastasis
• Compressive symptoms
  
  • Problems swallowing,
  • feeling like being strangled,
  • maybe voice change

Question 11

What are the most common type of malignancy seen in head and necks?

Answer 11

Squamous cell carcinomas.