Thyroid And Head And Neck Cancers

Question 1

Describe teh blood supply to th ethruodu

Answer 1

Ss

Question 2

Why is the left RLN more prone to damage

Answer 2

More likely to hav epthology of arota thean subclavian

Question 3

What are the most common type of malignancy seen in hncs

Answer 3

Squamous cell carcinomas

Question 4

What are the risk factors for H&n cancers

Answer 4

H&N Cancers 
• Smoking 
• Alcohol 
• Betal nut chewing (oral ca) 
• Dental hygiene (oral ca) 
• Viruses- HPV for oropharynx 
• Premalignant condition
 - leukoplakia, erythroplakis

Question 5

What are risk factors forthyroid cancer

Answer 5

Thyroid specifically
• Irradiation exposure
(including radioactive
iodine & radiation leaks)
• Family history and certain inherited conditions (e.g. FAP)
• Young lumps or old lumps (<20 or >70yr olds) in thyroid glands are more
likely to be malignant

Question 6

What are the general principles of assessing cancer

Answer 6

• Assessment:
– Patients fitness for intervention 
– Clinical staging 
– Radiological staging
• Biopsy:
– To have a tissue diagnosis
• Discuss @ MDT (involve all who may help):
– Curative or palliative intention?
• Definitive management with patient involvement

Question 7

Descirb ethe general principles of H&N cancer management

Answer 7

Ss

Question 8

Descirb elip/oral cavity precancerous presentation

Answer 8

• Presentation
– Lump
– Pain (included
referred pain to the ear)
– Fixation of tongue
– Problems swallowing
(dysphagia) 
– Pain on swallowing
(odynophagia)

Question 9

Describe lip/oral cavity investigations

Answer 9

• Investigations
– Biopsy
– May need imaging
with a CT +/- MRI
(include chest)- not
needed for superficial
lip lesions – May need PET

Question 10

Describe lip/oral cavity treatment

Answer 10

• Treatment
– Small tumours excise
and repair the defect 
– Radiotherapy (bad morbidity)
– Larger tumours that do not respond to RT may need extensive
surgery (hemiglossectomy or
total glossectomy)

Question 11

Describe pharynx cancer presentation

Answer 11

• Presentation
– Lump (mainly nodal
mets or unknown 1o) 
– Pain (included referred pain otalgia) 
– Problems swallowing
(dysphagia) 
– Pain on swallowing
(odynophagia) 
– Weight loss
Often present late (25% are untreatable at presentation)

Question 12

Describe pharynx investigations

Answer 12

• Investigations
– imaging with a CT +/-
MRI (include chest) – May need PET 
– Biopsy
• Often need feeding assistance with
gastrostomy tubes

Question 13

Describe pharynx treatment

Answer 13

• Treatment
– Small tumours excise and repair the defect
– Radiotherapy
– Larger tumours that do not respond to RT may need extensive surgery (mandibular split or other type of
pharyngectomy or robotic procedure)

Question 14

Describe larynx cancer presentation

Answer 14

• Presentation
– Dyphonia (voice
change)- main feature 
– Dyphagia – Referred otalgia – Glogus – Neck lump – Weight loss – Cacexia
`

Question 15

Describe larynx investigations

Answer 15

• Investigations
– imaging with a CT
(include chest) – May need PET – Biopsy
• Often have long term voice issues and/or swallowing problems

Question 16

Describe larynx treatment

Answer 16

• Treatment
– Small tumours may
have resection or RT – Medium size tumours
do well with RT +/-
chemo
– Larger tumours that
do not respond to RT
may need extensive
surgery
(laryngectomy)

Question 17

What is laryngectomy

Answer 17

Ss

Question 18

What is a tracheostomy

Answer 18

Ss

Question 19

Describe thyroid cancer presentation

Answer 19

• They either tend to
present with a lump (in
the thyroid or neck
nodal metastasis)
• Rarely have problems with thyroid status
(not true for all thyroid lumps)
• Compressive symptoms- problems swallowing, feeling like they are being strangled 
• Can have voice change

Question 20

Describe thyroid investigations

Answer 20

Triple assessment
(similar to breast
lumps)
– Full Hx and Ex – Imaging (ultrasound) – Needle testing of any
suspicious lumps via
cytology in the form
of Fine Needle
Aspiration Cytology
(FNAC) – May need advanced Ix

Question 21

Describe thyroid treatment

Answer 21

Ss