Session 11 Flashcards by Ellie Matthews

Risk factors for thyroid cancer specifically

Irradiation exposure (incl. radioactive iodine and radiation leaks)

FH and certain inherited conditions e.g. FAP

Young or old = more likely to be malignant (less than 20 or more than 70)

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Surgical features of H and N cancer treatment

Assessment of tumour

Sample (biopsy)

Remove (if possible)

Reconstruct

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Lip/oral cavity cancer presentation

Lump
Pain (could be referred to ear)
Fixation of tongue
Dysphagia
Odynophagia

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What is Odynophagia

Pain on swallowing

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Surgery for lip or oral cavity cancers

Hemiglossectomy
Total glossectomy

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Pharyngeal cancer presentation

Lump- mainly nodal mets or unknown primary

Pain (referred Otalgia)

Dysphagia

Odynophagia

Weight loss

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Important feature of pharyngeal cancer presentation

Often present late - 25% untreatable at presentation

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Pharyngeal cancer victims often need

Feeding assistance with gastrostomy tubes

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Laryngeal cancer presentation

Dysphonia (voice change)
Dysphagia
Referred Otalgia
Glogus
neck lump
Weight loss
Cacexia

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Issue with radiotherapy for HN cancers

Radiotherapy causes lots of scarring and fibrosis so in mouth can cause many problems

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What are often the first presenting sign of underlying HNC

Neck lumps

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Thyroid cancers and many HNC can give rise to a neck lump due to

Enlarged thyroid gland

Cervical lymph node metastasis

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HNC affect the

Upper aero digestive structures

Oral cavity (beginning at vermillion border of lips), nose, nasal cavity, sinuses, pharynx, Larynx

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Commonality of HNC

Uncommon compared to other types

most begin in mucosal surfaces lining structures- predominantly squamous cell carcinomas (>90%)

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The largest proportion of head and neck cancers occur in the

Oral cavity, larynx, and oropharynx

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Main risk factors for HNCs

Heavy alcohol and tobacco use (incl chewing), greater in people who use both

Common in older patients (60-70 years), men more than women

Previous Epstein-Barr virus infection (esp nasopharyngeal cancers), chewing of betal quid/Paan

Inhalants e.g. hardwood, sunlight or sun beds, HPV

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HPV and HNC

Link between Oropharyngeal cancers

Rising in younger patients (30-40) due to increase in HPV related HNC

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Common initial manifestations of HNC

Unexplained painful and/or mucosal ulceration or lesion (e.g. leukoplakia, erythroplakia, lump)

unexplained hoarseness of voice, dysphagia, Odynophagia, Otalgia

Cancers involving the head and neck area can readily spread to

Lymph nodes - due to rich vascular supply and lymphatic drainage

Cervical lymphadenopathy due to cervical lymph node metastasis (i.e. neck lump) is a common initial presenting sign

Clinical diagnosis and staging of HNC will involve

Clinical examination, biopsy, imaging (CT/MRI), endoscopic investigation

Imaging evaluates the

Extent of primary cancer, involvement of other structures and Lymph nodes

Endoscopy will allow

Direct visualisation of the cancer and enable biopsy

Method of biopsy of neck lump

Fine needle aspiration for cytology or a core biopsy

Under ultrasound guidance

Staging for HNC

TMN

Surgical approaches range from

Microsurgical techniques using lasers to radical neck dissection

What is removed in radical neck dissection

All ipsilateral lymph nodes, spinal accessory nerve, internal jugular vein and SCM muscle

Patients with HNC may require expert support as

Treatments will often have permanent or significant implications for anatomical structures for eating/drinking/speaking/breathing

Specialist MDT includes

Radiologist, pathologist, head and neck cancer surgeons, oncologist, dieticians, speech and language therapists, plastic surgeons

HNC clinical features and other notes

What are these

What is laryngectomy

Removal of larynx and separation of airway from mouth

What is tracheostomy

Opening created in trachea at front of neck so a tube can be inserted into trachea for breathing

Arteries to be aware of around thyroid

Superior thyroid artery Inferior thyroid artery

Position of thyroid

Below thyroid cartilage- NOT ON Between 2nd and 3rd tracheal rings

Types of thyroid cancer

Papillary adenoCa (80%) Follicular AdenoCa (10%) Medullary Ca (5%) Anaplastic Ca (5%)

Superior thyroid artery comes from

External carotid

What gives off inferior thyroid artery

Subclavian artery- thyrocervical trunk

Treatment of thyroid cancer

Thyroidectomy (hemi or total, most are total) Radioactive iodine Radiotherapy/chemotherapy

Causes of recurrent laryngeal nerve palsy

Idiopathic Laryngeal cancer Thyroid disease Trauma Cervical lymphadenopathy Oesophageal cancer Apical lung cancer Aortic aneurysm Neuropathic

Features of thyroid blood supply

Total thyroidectomy complications

Bleeding Neck scar Laryngeal nerve damage Hypoparathyroidism Recurrence Thyroid storm

Diagram of thyroid blood supply

Pathway of recurrent laryngeal nerve

The recurrent laryngeal nerves branch off the vagus, the left at the aortic arch, and the right at the right subclavian artery. The left RLN passes in front of the arch, and then wraps underneath and behind it. After branching, the nerves typically ascend in a groove at the junction of the trachea and esophagus.