Neck / throat Flashcards

Question

Symptoms of head and neck cancers?

Answer 1

``` Symptoms • Ulcers – non healing for 2-3 weeks • Hoarse voice > 6 weeks • Sore throat > 6 weeks • Mouth bleeding • Mouth numbness • Sore tongue • OTALGIA/otorrhoea • White, red or speckled patch in mouth • Lump/mass in lip, mouth or gum • Speech change • Dysphagia • Lymphadenopathy • Pathological fracture ```

Answer 2

Uncommon in the UK ``` Persistent painful ulcers White or red patches on tongue, gums or mucosa Otalgia Odonophagia Lymphadenopathy ``` Tx: Surgery/radiotherapy Prognosis: 80% 5 year survival in early disease

Answer 3

Often advanced at presentation 5 male: 1 female Typical presentation: older patient, smoker with sore throat, sensation of a lump, referred otalgia Risk factors: pipe smoking or chewing tobacco. 20% are node +ve at presentation Imaging: MRI Tx: Surgery and radiotherapy. Radiotherapy may be first line if tumour is T1 (<2cm) or T2 (>2cm but <4cm) Prognosis: 50% 5 year survival for stage 1.

Answer 4

Rare – can present as lump in throat, dysphagia, odonophagia, pain referred to the ear and a hoarse voice. Anatomical limits of the hypopharynx are the hyoid bone to the lower edge of the cricoid cartilage. Premalignant conditions: leukoplakia (hyperparakeratosis + underlying epithelial hyperplasia), Patterson-Kelly-Brown syndrome (pharyngeal web associated with iron defiency) Tx: Radiotherapy and surgery Prognosis: Poor – 60% mortality at 1 year

Answer 5

Incidence: 2300/year Typical presentation: older patient, male smoker with progressive hoarseness, then stridor, difficulty or pain on swallowing + haemoptysis + ear pain. Younger person may have HPV. Sites: Supraglottic, glottic or subglottic. Glottic tumours have best prognosis as they cause hoarseness earlier. Ix: laryngoscopy and biopsy, HPV status, MRI staging Tx: Radical radiotherapy for small tumours, large tumours treated with partial/total laryngectomy + block dissection of neck glands. 5 year survival rate is 66%.

Answer 6

* Squamous cell papilloma * Gingival hyperplasia (caused by nifedipine, phenytoin) * Cyst (e.g. mucocele) * Polyp (e.g. related to sharp tooth) * Lichen planus * Recurrent oral ulceration (e.g. due to stress) * Osteonecrosis of the jaw * Candida (can be wiped off) Making the diagnosis • History of hoarse voice, sore mouth or tongue, difficulty or pain on swallowing, neck mass • Examination of upper aerodigestive tract (including fibreoptic nasendoscopy) and neck o 1st line diagnostics of a neck lump: US-guided fine needle aspirate cytology and biopsy. Do NOT perform open biopsy on neck masses o Rigid endoscopy (panendoscopy) under GA and biopsy of primary site o CXR/USS/CT neck + chest/MRI/PET ``` Staging: clinical, radiological and pathological, TNM staging o Primary tumour T0-T4 o Neck nodes (N0-N3) o Distant spread (M0-M1) o Histopathology: biological aggression ```

Answer 7

Early tumours: surgery or radiotherapy. Good outcomes, low morbidity. Advanced tumours: surgery and radiotherapy, or chemoradiotherapy. Poor outcomes, high morbidity. Radiotherapy: given by fractionation, in small doses with enough time between for normal cells to repair, but not enough for the cancer cells - spinal cord and cornea are particularly sensitive to radiotherapy in the head and neck – dose must be carefully considered. good for small tumours, and well oxygenated tissues. Advantages: Normal anatomy preserved, performed as outpatient. Disadvantages: rarely reactions (e.g. soreness), late reactions (e.g. mouth dryness, fibrosis), normal tissue damage makes subsequent surgery more difficult, can’t irradiate the same tissues, possible long term carcinogenesis Chemotherapy: often effective at shrinking tumours, only rarely produce a cure on its own, many combinations and drugs tried – most used are cisplatinum and 5FU. Surgery - lots of options: minimally invasive endoscopic laser microsurgery, open organ preserving surgery, reconstructive surgery. More effective in large tumours Advantages: may be less morbidity than than radiotherapy in more small tumours, can be shorter treatment. Disadvantages: damages normal anatomy, only works if the anatomy and tumour biology allows a good margin of clearance. Neck dissection • Radical neck dissection: all lymph nodes removed (level 1-5) + spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle * Modified radical neck dissection: as radical but with preservation of one or more non-lymphatic structures * Selective neck dissection: one or more of the lymphatic groups is preserved, based on the patterns of metastases which are predictable for each site of disease * Extended neck dissection: additional lymph node groups or non-lymphatic structures are removed

Answer 8

Largest salivary gland. Located on the side of the face in front of the ear. Contains the great auricular nerve – if damaged, can cause facial palsy, numb earlobe, salivary leakage, Frey’s syndrome (flushed and sweating).

Answer 9

* Look for external swellings, palpate for stones, test facial nerve function * Note size, mobility, fixity and extent of any mass * Tenderness? * Assess surrounding skin for malignancies

Answer 10

Acute infection of the submandibular or parotid glands. Usually in elderly or debilitated patients who are dehydrated and have poor oral hygiene. Painful diffuse swelling of the gland + fever. Pressure applied to gland may lead to pus leaking out of the duct. Tx: Abx and good oral hygiene, oral drops to stimulate salivation (sialogogues), surgical drainage.

Answer 11

Salivary stones - usually affect the submandibular gland where secretions are richer in calcium and thicker Pain and tense swelling of the gland during/after meals. Stone may be palpable in floor of mouth Imaging: plain x-ray or sialogram Tx: small stones may pass spontaneously (sialogogues may help). Larger stones may need surgical removal

Answer 12

Sialadentis Sialoithiasis Sjögren’s syndrome may cause enlargement of the parotid Viral infections e.g. mumps and HIV may cause inflammation of the parotid or submandibular glands Granulomatous disease e.g. TB and sarcoidosis

Answer 13

80% of salivary gland tumours occur in the parotid gland, 80% of these are pleomorphic adenomas (benign) 50% of submandibular gland tumours are malignant Risk factors: radiation to the neck, smoking Symptoms: hard, fixed mass +/- pain. May be overlying skin ulceration and local lymph enlargement. Tumours do not vary in size e.g. when eating. Associated facial nerve palsy. Refer all patients with unexplained persistent salivary gland swelling or any unexplained neck lump Ix: US/MRI, FNAC/CT-guided bipsy Tx: surgery, radiotherapy

Answer 14

Pleomorphic adenoma: slow growing benign tumour occuring in middle age that may turn malignant after many years. Usually diagnosed by FNAC. Tx – Surgery Warthin’s tumour (adenolymphoma): usually occur in elderly men, most commonly in the parotid gland. Tx – partial parotidectomy. Mucoepidermoid carcinoma: aggressive high grade tumour require excision and radiotherapy. Low grade tumours usually only need surgery. Adenoidcystic tumours: Painful slow growing tumours that tend to spread along the nerves (perineural infiltration) + distant mets and late recurrence. Tx – surgical excision and postoperative radiotherapy.

Answer 15

Blockage of salivary gland resulting in mucous retention or extravasation cyst. Often in lower lip, uncommon in upper lip.

Answer 16

Frog's belly A mucocele of the sublingual gland. If fluid gets past myelohyoid muscle there can be swelling in the submental/submandibular area.

Answer 17

otitis media quinsy - peritonsillar abscess rheumatic fever and glomerulonephritis very rarely Indications for tonsillectomy are controversial. NICE recommend surgery considered only if the person meets all of the following: - sore throats are due to tonsillitis (i.e. not recurrent URTIs) - 5 or more episodes of sore throat per year - symptoms have been occurring for at least a year - the episodes of sore throat are disabling and prevent normal functioning Other established indications for a tonsillectomy include recurrent febrile convulsions secondary to episodes of tonsillitis obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils peritonsillar abscess (quinsy) if unresponsive to standard treatment primary (< 24 hours): haemorrhage in 2-3% (most commonly due to inadequate haemostasis), pain secondary (24 hours to 10 days): haemorrhage (most commonly due to infection), pain

Answer 18

Unexplained oral ulceration or mass persisting for greater than 3 weeks Unexplained red, or red and white patches that are painful, swollen or bleeding Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks Unexplained persistent sore or painful throat Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion The level of suspicion should be higher in patients who are over 40, smokers, heavy drinkers and those who chew tobacco or betel nut (areca nut).

Neck / throat Flashcards

(42 cards)