Thyroid, Head + Neck Cancers

Question 1

Head and neck Cancers are mostly Squamous cell carcinomas.

What are 3 places most of them occur?

Answer 1

• Oral cavity
• Larynx
• Oropharynx

Question 2

Head neck cancers are more commonly seen in Older Patients (60-70) and Men

List 5 risk factors

Answer 2

• Smoking
• Alcohol
• Betel nut chewing (Paan)
• Previous Epstein-Barr virus
• HPV (Oropharyngeal cancers)

(Also certain inhalants and long term exposure to sunlight)

Question 3

What are 5 common initial HNC manifestations

Answer 3

• Unexplained painful and/ or mucosal ulceration or lesion in oral cavity (Leukoplakia, Erythroplakia)
• Unexplained voice hoarseness
• Dysphagia or Odynophagia (Pain on swallowing)
• Otalgia
• Metastases to cervical lymph nodes

Question 4

Most HNC treatments will have a permanent effect on structures needed for feeding, speaking and breathing.

What are 2 ends of the spectrum with reference to surgical treatment?

Answer 4

Can range from microsurgery with lasers to Radical Neck Dissection

(Removal of Ipsilateral nodes, Spinal accessory nerve, IJV, SCM)

Question 5

List 7 types of doctors who may be part of a MDT involved in treating a HNC

Answer 5

• Radiologists
• Pathologists
• Specialist HNC surgeons
• Oncologists
• Dieticians
• Speech and language therapists
• Plastic surgeons (reconstruction of anatomical defects)

Question 6

How can HNCs affecting the Lip/ Oral Cavity present?

Answer 6

• Lump
• Pain (Possibly referred Otalgia)
• Dysphagia
• Odynophagia
• Fixation of Tongue

Question 7

How can HNCs affecting the;

• Lip/ Oral Cavity
• Pharynx
• Larynx be treated?

(Investigated with biopsy, imaging- CT, PET, MRI)

Answer 7

• Radiotherapy
• Small tumours: Excision and defect repair
• Large tumours: Extensive surgery

(Same treatments for all, but for larynx small tumours excised with lasers)

Question 8

How can HNCs affecting the Pharynx present?

Often present late, 25% untreatable at presentation

Answer 8

• Lump
• Pain (Possibly referred Otalgia)
• Dyspnea
• Odynophagia
• Weight loss

Question 9

How can HNCs affecting the Larynx present?

Often have long term voice issues and/ or swallowing problems

Answer 9

• Dyphonia (Voice change, main feature)
• Lump
• Dysphagia
• Otalgia (referred)
• Globus (Sensation of neck lump)
• Weight loss
• Cachexia

Question 10

How can Thyroid cancer present?

Answer 10

• Lump (In thyroid or neck)
• Usually normal TFTs
• Compressive symptoms (Oesophagus, Trachea)
• Voice change

Question 11

Thyroid cancers are investigated via Triple Assessment.

What does this mean?

Answer 11

1. Full history and examination
2. Imaging (USS)
3. Biopsy

Question 12

How can Thyroid cancer be treated?

Answer 12

• Radioactive iodine
• Thyroidectomy (Hemi or whole, dependant on type)
• Radiotherapy/ Chemotherapy

Question 13

What are 4 types of Thyroid cancer?

Which 2 are most common?

Answer 13

• Papillary adenocarcinoma (80%)
• Follicular adenocarcinoma (10%)
• Medullary cancer (5%)
• Anaplastic cancer (5%)

Question 14

When are Laryngectomy and Tracheostomy used typically?

Answer 14

Laryngectomy- Permanent (Opening of trachea fused with skin, so visible hole in neck)

Tracheostomy- Temporary