11.1.1 The Thyroid and Head & Neck Cancers Flashcards
(38 cards)
What is the course of the recurrent laryngeal nerve?
- Vagus starts at medulla
- Enters jugular foramen
- Continues within carotid sheath down entire length, two branches given off
- Recurrent laryngeal branches off, Left loops around the arch of the aorta Right loops around subclavian
- Tracks back up in the tracheooesophageal groove
What is the relationship between the superior laryngeal nerve and the thyroid?
External branch pierces the thyroid, internal provides sensory innervation
What is the predominant type of cancer that occurs in the head and neck?
Squamous cell carcinoma (not in thyroid cancers)
Common in oral cavity, larynx and oropharynx
Less common in nasopharynx and laryngopharynx (hypopharynx)
Rare- salivary glands, nasal cavity and sinuses
What are the risk factors for head and neck cancers?
- Male, older age (60-70), smoking, alcohol, betal nut chewing
- Occupation e.g exposure to hardwood
- Pre-malignant changes e.g. white patches (leucoplakia) or red patches (erythroplakia) seen on tongue
- HPV virus in oropharyngeal cancers
- EBV in nasopharyngeal
- Exposure to sunlight in lip cancers
- Thyroid cancer are previous radiation exposure/ family history
What is happening to the incidence of head and neck cancers and why?
Rising, particulary in 30-40 year olds due to HPV, even though smoking has decreased
What is the most common presentation of a head and neck cancer and some other symptoms a patient might present with?
Asymptomatic neck lump (cervical lymphadenopathy)
Also:
- Hoarseness of voice
- Dysphagia
- Odynophagia
- Otalgia with normal ear (pharynx and larynx)
- Mucosal ulceration e.g erythroplakia
How are head and neck cancers diagnosed?
- Clinical examination and biopsy with ultrasound
- CT/MRI
- Endoscopy for larynx biopsy
How do we stage head and neck cancers?
TNM Stage 1-4 then treat
T: size of tumour and location
N: degree of lymph node involvement
M: presence of distant metastases
Distant metastases (particularly in lung) have poor prognosis and often incurable. Need to stage to choose appropriate treatment
How are head and neck cancers often treated that are caught early?
Early stage by surgery or radiotherapy. Lasers or radical neck dissection
How do we treat H&N cancers that have advanced?
- Late stage surgery and adjuvant chemotherapy
- Incurable late stage then palliative
- Need MDT approach as lots of functions, e.g swallowing and talking, lost when surgery
What is a radical neck dissection?
Can use lasers
Remove:
Tumour
All ipsilateral lymph nodes
Spinal accessory nerve
IJV
SCM
What specialities may be needed in MDT for a radical neck dissection?
- Radiologist
- Pathologist
- Oncologist
- Dietician
- Plastic surgeon
- S and L therapist
- Head and neck surgeon
What palliatve care can be given for incurable laryngeal cancer?
Support with:
- Feeding
- Swallowing
- Pain
- Phonation
How does an oral cavity (lips and tongue) cancer often present?
- Usually SCC
- Unexplained lump or non-healing lesion e.g leukoplakia
- Side of tongue and lip
- Pain or problems swallowing
- Risk factors: alcohol, HPV, long term sunlight (lip)
How do we investigate oral cancer?
- Biopsy
- CT +/- MRI-if bone involvement is suspected (include chest)
- PET
How does a pharyngeal cancer often present?
- Lump in neck
- Hearing loss or otalgia
- Change in voice
- Weight loss
- Halitosis
- Dysphagia
How do we investigate pharyngeal cancer?
- Image with CT +/- MRI (INCLUDE CHEST 10% chance of picking up another cancer)
- PET
- Biopsy
How can we treat cancer of the pharynx?
Small tumour- removal
Medium tumour- radiotherapy
Large- if no response to radiotherapy may need extensive surgery e.g. pharyngectomy, mandibular split or robotic procedure
How do patients with pharyngeal cancer feed?
Gastrostomy tubes bypass the need for swallowing completely, tend to be in for ~6 months
How does a laryngeal cancer often present?
- Dysphonia
- Dysphagia (as the larynx has been damaged)
- Otalgia
- Neck lump
- Cough
How do we investigate laryngeal cancer?
- CT (include chest)
- May need PET
- Biopsy
What may be necessary to help patients with laryngeal cancer to breathe?
Laryngectomy to breathe out of neck
What is a laryngectomy?
Larynx completely removed, trachea stitched to anterior neck and opens directly in neck
Patient breathes through holy in neck and swallows through mouth (may be able to eat and breathe at same time?)
What is a tracheotomy?
Small hole made in trachea, tube is inserted to help breathing, larynx is not damaged
More common than laryngectomy, done secondary to cricothyrotomy to secure a more permanent temporary airway, e.g. if patient is in ICU and needs help breathing
