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ENT Tumours Flashcards

1
Q

what are the causes of HNSCC?

A
  • Cigarette smoking
  • Alcohol consumption
  • Vitamin A & C Deficiency
  • Nitrosamines in salted fish
  • HPV
  • GORD
  • Deprivation
  • Hot drinks
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2
Q

what is HSNCC?

A

Squamous cell carcinomas of the head and neck

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3
Q

where do HSNCC arise from?

A

• Develop form lining of aerodigestive tract oral cavity, orophargynx, hypopharynx, larynx and trachea

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4
Q

how does HPV cause HSNCC?

A

produces proteins E6 and E7 which disrupt p53 and Rb pathways, leading to cellular immortality

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5
Q

what are the throat clinical features of HSNCC?

A 
Neck pain/lump
Hoarse voice >6wks
Sore throat >6wks
Speech change 
Dysphagia
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6
Q

what are the mouth clinical features of HSNCC?

A
  • Mouth bleeding
  • Mouth numbness
  • Sore tongue
  • Painless ulcers
  • Patches in mouth
  • Lumps (lip, mouth, gum)
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7
Q

what are the ear clinical features of HSNCC?

A

Earache/effusion

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8
Q

what are the referral guidelines for HSNCC?

A

o A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:
o persistent unexplained hoarseness or
o An unexplained lump in the neck.

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9
Q

what are the clinical features of HSNCC of the oral cavity and tongue?

A

persistent painful ulcers, white or red patches on tongue, gums or mucosa, otalgia, odynophagia, lymphadenopathy

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10
Q

what is the management of HSNCC of the oral cavity and tongue?

A

surgery/radiotherapy

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11
Q

what is the epidemiology factors of oropharyngeal carcinomas?

A

Male: female, 5:1

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12
Q

what are the risk factors of oropharyngeal cancer?

A

pipe smoking, or chewing tobacco, HPV

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13
Q

what type of cancer is oropharyngeal cancer?

A

squamous cell

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14
Q

what are the clinical features of oropharyngeal cancer?

A

older patient, smoker with sore throat, sensation of lump, referred, otalgia

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15
Q

how is oropharyngeal carcinomas diagnosed?

A

MRI

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16
Q

how are oropharyngeal carcinomas managed?

A

surgery, radiotherapy

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17
Q

what are the clinical features of hypopharyngeal carcinoma?

A

lump in throat, dysphagia, odynophagia, pain referred to ear, hoarse voice

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18
Q

what are the premalignant conditions to hypopharyngeal tumour?

A

leucoplakia, Patterson-kelly-brown syndrome

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19
Q

what is the management of hypopharyngeal carcinoma?

A

radiotherapy, surgery

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20
Q

what type of tumour is hypopharyngeal tumours?

A

squamous cell

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21
Q

what are the clinical features of laryngeal carciomas?

A

Typical Patient: older, progressive hoarseness, then stridor, difficulty or pain on swallowing +/- haemoptysis +/- ear pain (if pharynx involved)
Younger Patient: HPV +ve

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22
Q

where do laryngeal cancers occur?

A

supraglottic, glottic or subglottic

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23
Q

how are laryngeal cancers diagnosed?

A

laryngoscopy + biopsy, HPV status, MRI Staging

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24
Q

how are laryngeal cancers managed?

A

o Radical radiotherapy for small tumours

o Larger tumours – partial/total laryngectomy +/- block dissection of neck glands

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25
Q

what is stertor?

A

caused by obstruction of airway above the level of the larynx, low pitched snoring or snuffle sound

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26
Q

what is stridor?

A

due to airflow changes, narrowed or obstructed airway path, high pitched sound, inspiratory (higher in airway), expiratory, biphasic

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27
Q

what is wheeze?

A

continuous, coarse, whistling sound, polyphonic sound

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28
Q

what is hoarseness?

A

A voice change really = dysphonia” i.e. abnormal voice

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29
Q

what is aphonia?

A

A complete loss of voice

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30
Q

what is nasopharyngeal carcinoma?

A

squamous cell carcinoma

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31
Q

what are the causes of nasopharyngeal carcinoma?

A
  • Combination of viral, environmental, genetics
  • Epstein Barr virus
  • Also volatile nitrosamines in food
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32
Q

what are the clinical features of nasopharyngeal carcinoma?

A
  • Blocked or stuffy nose
  • Nosebleeds
  • Neck lump (cervical lymphadenopathy)
  • Hearing loss (in one ear) – otalgia, unilateral serous otitis media
  • Cranial nerve palsy
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33
Q

what is the histology of nasopharyngeal carcinoma?

A

solid lesions (look like eyeballs)

34
Q

how does EBV cause nasopharyngeal tumours?

A

Infects epithelial cells of oropharynx and B cells

hi-jacks and mimics helper T cells responses leading to proliferation and survival of B cells

35
Q

how are nasopharyngeal carcinomas mediated cellularly?

A
  • Mediated largely by latent membrane protein 1 (LMP-1)

* Encodes EBNA-2 activating cyclin D and promoting transition from G0 to G1

36
Q

how are nasopharyngeal carcinomas diagnosed?

A

endoscopic biopsy, combined CT and MRI

37
Q

how are nasopharyngeal carcinomas managed?

A

radiotherapy, chemotherapy, surgery

38
Q

what are examples of benign nasal tumours?

A

squamous papillomas, Schneiderian papilloma, angiofibromas

39
Q

what are examples of malignant nasal tumours?

A

most commonly squamous cell carcinoma

primary adenocarcinoma, nasopharyngeal carcinoma, neuroblastoma, lymphoma

40
Q

what is an important part of nasal tumour history?

A

occupation – carpenter

41
Q

what are the causes of squamous papilloma’s in the head and neck?

A
  • HPV exposure – types 6 and 11

* Risk Factors – female, smoking, alcohol

42
Q

what is the pathophysiology of squamous papilloma’s in the head and neck?

A
  • Generally benign papilloma
  • Nipple like (grows exophytical projecting outward)
  • Red or pink in colour – too much production of keratin
43
Q

where do squamous papillomas occur?

A

Arises from squamous epithelium of skin, lip, oral cavity, tongue, pharynx, larynx, esophagus

44
Q

what are the clinical features of squamous papillomas?

A
  • Hoarseness
  • Cough
  • Palpable lymphnodes
  • Referred pain to ear
  • Stridor
45
Q

what is the management of squamous papillomas?

A
  • Radiotherapy
  • Laser resection
  • Endoscopic resection
  • Laryngectomy and neck dissection
46
Q

what is a pharyngeal pouch?

A

Acquired diverticulum of mucosa through the muscles layers of the wall of the pharynx

47
Q

where do pharyngeal pouches occur?

A

between thyropharynheus and the cricopharyngeus

48
Q

what are the clinical features of pharyngeal pouches?

A

dysphagia, cough, regurgitation, weight loss, hoarse voice, aspiration pneumonia, halitosis, lung abscess
Boyces sign
patients > 50

49
Q

how are pharyngeal pouches classification?

A

Lakey classification

50
Q

what are paragangliomas?

A

• Tumours arising from clusters of neuroendocrine cells

51
Q

what are the causes of paragangliomas?

A
  • MEN2 (autosomal dominant)

* NF 1

52
Q

what are the types of head and neck paragangliomas?

A

Chromaffin +ve

Non-Chromaffin

53
Q

what are examples of chromaffin +ve paragangliomas?

A

Usually adrenal or paravertebral

54
Q

what are examples of non-chromaffin paragangliomas?

A

carotid bodies, aortic bodies, jugulotympanic ganglion, ganglia nodosum of vagus and clusters and oral cavity nose, nasopharynx, larynx + orbit

55
Q

what is the pathophysiology of chromaffin +ve paragangliomas?

A

sympathetic nervous system and secrete adrenaline and noradrenaline

56
Q

what is the histology of paragangliomas?

A

nested cell appearance, oval cells

57
Q

what are the clinical features of paraganglioms?

A
  • Most asymptomatic
  • Painless mass
  • Occur 1-3% procedure excess catechol to be symptomatic
  • Occur after hard physical activity, stress, injury, childbirth, going under anaesthesia, eating foods high in tyramine
58
Q

how are paragangliomas diagnosed?

A
  • 24 hr urine test
  • Blood catecholamine
  • CT and MRI san
  • Genetic tests
59
Q

how are paragangliomas managed?

A

surgery, embolization, radiotherapy

60
Q

what is a pleomorphic adenoma?

A

most common salivary gland tumours

61
Q

what are the causes of pleomorphic adenomas?

A
  • Genetic – rearrangement of chromosome band 8q12, 12q13-15
  • Sporadic
  • PLAG 1 and HMGA2 gene translocation
  • Simian virus
  • MUC1 gene
62
Q

what is the structure of pleomorphic adenomas?

A

epithelial, myoepithelial, stromal (mesenchymal)

63
Q

what type of cancer are pleomorphic adenomas?

A

Benign neoplastic proliferation of parenchymal glandular cells

64
Q

what are the clinical features of pleomorphic adenomas?

A
  • Slow growing
  • Painless
  • If parotid + large – facial nerve weakness
  • Dysphagia, dyspnoea, hoarseness, difficulty in chewing, epitasis
65
Q

how are pleomorphic adenomas diagnosed?

A

Excision biopsy, FNA, CT or MRI

66
Q

how are pleomorphic adenomas managed?

A

surgical resection, difficult to excise (recurrence)

67
Q

what are the complications of pleomorphic adenomas?

A

malignant transformation

68
Q

what are warthins tumours?

A

second most common salivary gland tumour

69
Q

what are the causes of warthins tumours?

A

unknown, strong association with smoking, radiation exposure? Autoimmune disorder?

70
Q

what type of tumour is Warthins tumour?

A

Benign cystic tumour

71
Q

where do Warthins tumours occur?

A

tail of parotid gland

72
Q

what is the histology of Warthins Tumour?

A

Contains abundant lymphocytes and germinal centres

papillary folds composed of a double layer of ocnocystic cells

73
Q

what are the clinical features of Warthins tumours?

A
  • bilateral
  • firm, painless lump
  • swelling
  • facial nerve palsy
74
Q

how are Warthins tumours diagnosed?

A
  • xray
  • CT, MRI, US
  • Gland biopsy
75
Q

how ware Warthin tumours managed?

A

surgical removal, non recurrent

76
Q

what are the causes of adenoid cystic tumour?

A
  • Unknown
  • Genetic – chromosomal translocation t(6:9)q22-23
  • Environmental – too much protein
77
Q

what are adenoid tumours derived from?

A

reserve epithelial cells of the intercalated ducts

78
Q

where do adenoid cystic tumours occur?

A

Most commonly salivary gland – also breast, lacrimal, parotid, lung, brain, trachea, paranasal

79
Q

what are the histopathology’s of adenoid cystic tumours?

A

cribriform, tubular, solid

80
Q

what are the clinical features of adenoid cystic tumours?

A
  • Painless slow growing mass
  • Facial nerve paralysis
  • Proptosis (lacrimal glands)
  • Difficulty breathing, hoarseness (larynx)
81
Q

what is the management of adenoid cystic tumours?

A
  • Surgical removal with clear margin
  • Radiotherapy
  • Chemo – if metastatic
82
Q

what is the complications of adenoid cystic tumours?

A

distant mets

ent (13 decks)

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