Thyroid | Head + Neck Cancers Flashcards
Risk factors of head + neck cancers
- smoking
- alcohol
- beta nut chewing (oral cancer)
- dental hygiene (oral cancer)
- viruses (e.g. HPV 16 for oropharynx)
- erythroplakia
Risks of thyroid cancer
- radiation exposure
- family history
- female
- young + old people’s lumps are more likely to be malignant
Supportive Managment of H+N cancers
- swallowing
- feeding
- voice rehab
- pain
- supportive care
Presentation of lip/oral cavity cancer
- lump
- pain > can refer to ear
- fixation of tongue
- dysphagia
- odynophagia
What is odynophagia?
Pain on swallowing
Investigations of lip/oral cavity cancer
- biopsy
- CT +/- MRI (including chest)
- PET
Treatment of lip/oral cavity treatment
- small tumour excise + repair
- radiotherapy
- extensive surgery for larger tumours that don’t respond to radiotherapy (hemiglossectomy/total glossectomy)
Presentation of pharynx cancer
- often asymptotic > present with advanced disease
- lump
- pain
- referred otalgia
- dysphagia
- odynophagia
- weight loss
Investigation of pharynx cancer
- biopsy
- CT +/- MRI (including chest)
- PET
Treatment of pharynx cancer
- small tumour excise + repair
- radiotherapy
- extensive surgery for larger tumours that don’t respond to radiotherapy
Presentation of larynx cancer
- dyphnoia (main feature) - hoarse voice
- dysphagia
- referred otalgia
- globus
- neck lump
- weight loss
- cacexia
What is dyphonia?
Voice change
What is globus?
Persistent or intermittent non painful sensation of lump in throat
What is cacexia?
Weakening + wasting of body due to severe chronic illness
Investigations of larynx cancer
- CT (including chest)
- PET
- biopsy
Treatment of larynx cancer
- small tumours: laser resection or radiotherapy
- medium sized tumours: radiotherapy +/- chemotherapy
- large tumours: that do not respond to radiotherapy may need laryngectomy
Presentation of thyroid cancer
- lump in thyroid
- neck nodal metastasis
- dysphagia
- feeling like being strangled
- dysphonia - hoarseness of voice
Investigations of thyroid cancer
Triple assessment
- full history + exam
- ultrasound
- needle testing of suspicious lumps as fine needle aspiration cytology
Head and neck cancers red flags
- persistent hoarseness of voice
- unexplained neck lump
- mass on lip or oral cavity
- erythroplakia or erythroleukoplakia
What is erythroplakia?
Red patches on tongue + oral cavity
What is erythroleukoplakia
Combination of leukoplakia + erythroplakia
White + red patches on tongue + oral cavity
What is the most common type of thyroid cancer?
Papillary adenocarcinoma
Then follicular adenocarcinoma
Treatment of thyroid cancer
- surgery (thyroidectomy)
- radio-iodine therapy: after total thyroidectomy to kill residual malignant cells
- radiotherapy
Types of thyroid cancer
Papillary adenocarcinoma
Follicular adenocarcinoma
Medullary carcinoma
Anaplastic carcinoma
(Lymphoma)
What do patients who have a total thyroidectomy need post op?
Lifelong thyroxine replacement
What is the most common type of cancer of the head and neck?
Squamous cell carcinoma
What are thyroid nodules?
Localised lumpy bumps on the thyroid
Most often benign
Hot vs cold thyroid nodules
- hot: hyperfunctioning nodule that takes up more radioactive tracer than surrounding tissue - low malignancy risk
- cold: non functioning nodules that takes up little to no tracer - mostly benign but higher risk of malignancy than hot
Presentation for thyroid nodules
- Often asymptomatic + patient won’t know they have one until discovered by doctor
- large nodules can become visible or make it harder to swallow or breathe
- sometimes nodule can produce extra thyroxine > hyperthyroidism symptoms
First line imaging for thyroid nodules
USS
What scan can differentiate between hot and cold thyroid nodules?
Radioisotope scan
Hot - take up more then surrounding tissue
Cold - take up no/little tracer
Treatment of thyroid nodules
- if benign, often left untried
- if Tx is needed :percutaneous radio frequency ablation, ethanol ablation or surgery
- if malignant, surgery + thyroid replacement medicines
