Neck Lumps + H&N cancer Flashcards
(49 cards)
1
Q
What causes a branchial cyst
A
Remnant of fusion failure of branchial arches or lymph node cyst degeneration - 3,4,5
BENIGN
2
Q
How does it become infected
A
May form fistula
Typically following resp infection
Becomes infected and enlarges
3
Q
How do you deal with infection
A
Excise to prevent further infection
4
Q
How does branchial cyst present and where
A
Late childhood - early adulthood - 3rd decade Asymptomatic neck lump Lateral and anterior to SCM at junction between upper and middle third Unilateral Slowly enlarging Smooth, soft, fluctuant Non-tender No movement on swallow No transillumination
5
Q
How do you Dx / any neck lump
What does FNA show for brachial
A
Need to exclude malignancy - Esp if >40 - All cystic lumps = malignancy till proven otherwise USS - doesn't show Refer to ENT FNA - shows acellular fluid + crystals
6
Q
How do you Rx
A
Excision
Ax if acute infection
7
Q
What are Ddx of neck lump
A
Congenital Branchial cyst Thyroglossal cyst Dermoid cyst - midline and <20 Cystic hygroma - infancy and lymph aspirated due to malformation in lymphatic system (posterior, soft, non-tender and transilluminates) - risk of haemorrhage / infection and can interfere with feeding and breathing Rx = aspiration or surgery Vascular malformation
Infection
Reactive LN = most common (consider TB, HIV, EBV, chronic infections(
Neck abscess = emergency
Salivary gland infection
Other / malignancy Pharyngeal pouch TB Lymphoma - HSM Thyroid tumour Salivary gland tumour Cervical rib - thoracic outlet Carotid aneurysm - pulsatile and doesn't move on protrusion
8
Q
What is an emergency
A
Neck abscess
9
Q
What does a lymphoma tend to be
A
Rubbery
Painless
Associated splenomegaly
Weight loss
10
Q
How does carotid aneurysm present
A
Pulsatile lateral neck mass
Doesn’t move on swallowing
11
Q
Levels of LN in neck
A
1 = submental and mandibular 2,3,4 = down sternocleidmastoid
5 = posterior triangle
6 - around hyoid
12
Q
What does painful LN suggest
A
Infective
Reactive
13
Q
What does painless LN suggest
A
Malignancy
14
Q
How do malignant LN present
A
Round Firm / hard Irregular Craggy Fixed Non-tender Rapidly enlarged Lymphoedema
15
Q
What is important in Hx of neck lumps
A
How long - <3 weeks = likely reactive Where in neck - Intradermal suggest lipoma or sebaceous cyst Fluctuation - Has it changed in size - Does it come and go H+N symtpoms - Is it painful - Any sore throat / cough / cold - Hoarse voice - Difficulties or painful swallow - Any breathing issue - Any weight change - Any ear pain - Any blood B symptoms - Fever / night sweat / weight loss
PMH - Investigation or Rx of lump - Hx head or neck RT DH and allergies SH - Smokin - Alcohol - Foreign travel
16
Q
What do you look on examination
A
Site Size Shape - irregular or regular Sore Attached to skin / fixed Soft or hard
Does it move on swallow
17
Q
What are common symptoms in head and neck
A
Sore throat Dysphonia / hoarse - worry if persistant Dysphagia Odynophagia Mouth or throat ulcer Neck lump Otalgia Airway issue / stridor Blood Snoring
18
Q
What produces a bruit on auscultation
A
Grave’s
Carotid bruit
19
Q
What cells do head and neck cancers tend to affect and where
A
SCC = majority Mouth / nose / throat Oral cavity Pharyn / larynx Salivary glands - rare
20
Q
What are the symptoms
A
Neck lump Hoarse voice Persistent sore throat Persistent mouth ulcer - often painless Mouth numbness Mouth bleeding Sore tongue Patches in the mouth Earache / effusion Dysphagia
21
Q
What are RF
A
>40 Smoking Alcohol HPV 16+18 in oropharynx EBV in nasopharynx GORD Salted food Poor oral health Occupation Radiation / sun exposure FH Immunosuppression
22
Q
What are symptoms of oral cavity cancer (lip, gums, tongue)
A
White or red patch Painless ulcer or lump - non healing Non-healing ulcer Unusual bleeding Red / erythematous mucous membrane = strong association with malignancy Pain = late Sx Swollen jaw / neck lump if mets
23
Q
What are symptoms of pharynx cancer (oropharynx + hypopharnx)
A
Trouble breathing Trouble speaking Dysphagia Pain in neck or throat Painless tonsillar swelling Referred otalgia Trismus = red flag for infiltration Headache Ringing in ears
24
Q
What are sinus Sx of head and neck cancer
A
Blocked sinus Chronic infection Nose bleed Swollen eyes Pain in teeth
25
What are symptoms of salivary gland cancer
```
80% = in parotid
80% = pleomorphic adenoma (benign)
```
```
Sx
Swelling under chin
Hard fixed mass - painful
Numbness
Paralysis of muscles in the face - facial nerve = suggests malignancy
Pain in face or neck
LN involvement
```
Red flag
- Hard
- Rapid
- Tender
- Infiltrating surrounding structure / skin
- Facial weakness
26
When would you refer under the suspected cancer pathway
45+ with persistent unexplained hoarseness or lump in neck
Unexplained ulceration in oral cavity 3+ weeks
Lump on lip in oral cavity
Red or white patch in oral cavity consistent with erythroplakia
Unexplained thyroid lump
Dysphagia
27
How do you Dx
```
Refer ENT
Biopsy / FNA
Endoscopy
Physical exam
Imaging
- MRI for tumour margins
- CT for spread
```
28
How do you Rx
Surgery
Radiation
Chemotherapy
Targeted therapy
29
What is associated with nasopharyngeal cancer (SCC)
EBV
| Asian smoked fish
30
How does it present
```
Cervical LN
Otalgia
Unilateral serous otitis media - refer if not related to URTI
Obstruction
Discharge
Headache
Epistaxis
Tinnitus
Conductive hearing loss from otitis media
Blood in sputum
Ear fullness
CN palsy
```
31
How do you Dx
```
Detailed head and neck exam
Nasa-Endoscopy + biopsy
FNA of neck nodes
CT - better for bony
MRI - better for soft tissue
```
32
How do you Rx
RT = 1st line
| Combined chemo + RT
33
What are differential for swollen salivary glands
- Parotid
- Submandibular
- Sublinqual
```
Tumour
Infection - Parotiditis / HIV
Autoimmune - Sjogren / Sarcoid
Acute viral- Mumps
Ductus calculus - stone
```
34
How does ductus calculus (stone in duct) present
Recurrent unilateral pain and swelling on eating
Stone may be palpable
Can become infected leading to chronic
35
Where is most common and how do you Dx and Rx
80% = submandibular
X-ray
Surgical removal
36
How do benign salivary gland tumours (Adenoma) present
80% = parotid
| DO NOT invade strutures e.g. facial nerve
37
How do you Dx tumour
```
X-ray to exclude calculi
FNAC in most
If malignancy = parotidectomy = diagnostic and therapeutic
CT / MRI to stage
Lymphoma needs biopsy
```
38
What do you include
Facial nerve if involved
39
What does HIV cause in parotid gland
Bilateral multi cystic symmetrical swelling
40
What does Sjogren cause
Bilateral non-tender enlarement
41
What does sarcoid cause
Non-tender bilateral
| Facial nerve palsy
42
What should patient get if urgent referral for H+N cancer
CXR to exclude apical lung lesion
43
When is infection common
Elderly
Dehydration
Poor oral hygiene
44
What are the symptoms
Painful diffuse swelling of gland
Fever
Pus leaking from duct
45
How do you Rx
Antibiotics
Oral hygiene
Surgical drainage may be required
46
If lump in anterior triangle
Branchial cyst
Parotid tumour
Carotid artery aneurysm
47
If posterior triangle
```
Cervical rib C&
Pharyngeal pouch
Cystic hygroma- usually infant and transilluminate bright
Pancoast tumour
Subclavian artery aneurysm
```
48
What are red flags in head and neck that get urgent referral
```
Unexplained lump change over 3-6 months
Hoarse voice >3 weeks
New onset dysphagai
Unexplained persistent swelling salivary gland
Otalgia >4 weeks + normal otoscopy
Unexplained persistent or sore throat
Non-healing ulcer
White or red lesion in mouth or oropharynx
Any B Sx
Unexplained tooth loosening
```
49
Pathology of neck lumps in order of LN regions
1
- Submandibular gland pathology
- Tooth abscess
2
- Parotid pathology
- Brachial cyst
- LN (benign or malignant)
3
- Brachial cyst
- Paraganglioma
- LN
4
- LN
5
- Cystic hygroma
- LN
6
- Thyroid goitre
- Thyroglossal cyst
- Dermoid and epidermal cyst
