Thyroid And Head & Neck Cancers

Question 1

Risk factors for developing head and neck cancers

Answer 1

Smoking 
Alcohol 
Beta nut chewing (oral)
Dental hygiene (oral cancer) 
Viruses (HPV for oropharynx)
Premalignant (leucoplakia - white thick patches mouth, 
erythroplakia - fiery red patch)

Question 2

Thyroid cancer risk factors

Answer 2

Irradiation exposure (radioactive iodine/ radiation leaks)

FH and certain inherited conditions e.g. FAP

Young ppl lumps or old lumps TG (<20/ >70yrs) more likely to be malignant

Question 3

Types of thyroid cancer

Answer 3

• papillary adenocarcinoma 80%

Follicular adenocarcinoma 10%

Medullary cancer 5%

Anaplastic cancer 5%

Question 4

What’s the most common type of malignancy seen in head and neck cancers?

Answer 4

Squamous cell carcinomas

Question 5

Lip/ oral cavity cancer presentation

Answer 5

Lump
Pain (May referred ear) 
Fixation of tongue
Dysphagia 
Odynophagia (pain swallowing)

Question 6

Pharynx cancer presentation

Answer 6

Lump (mainly nodal metastasis Or unknown primary)

Pain (may referred otalgia)

Dysphagia

Odynophagia

Weight loss

Question 7

Larynx cancer presentation

Answer 7

Dyphonia (voice change)

Dysphagia

Referred otalgia

Globus (lump in throat)

Neck lump

Weight loss

Cachexia (weakness/ wasting body)

Question 8

Thyroid cancer presentation

Answer 8

Lump in thyroid/ neck nodal metastasis

Compressive symptoms - dysphagia, feeling strangled, dyphonia

Question 9

Lip/ oral cavity, pharynx and larynx cancers investigations and treatment

Answer 9

Biopsy

May need imaging CT/ MRI (not needed for superficial lip lesions or MRI for larynx) - include chest for pharynx and larynx

May need PET

✅small tumours excised and repair defect

Radiotherapy

Larger tumours which don’t respond RT extensive surgery (hemiglossectomy/ total glossectomy for lip/ oral and mandibular split/ other pharyngectomy/ robotic procedure for pharynx)

Treatment for larynx cancers:

• Small tumours resection or RT
• medium tumours RT +/- chemo
• larger don’t respond RT may extensive surgery (laryngectomy)

Question 10

Thyroid cancer investigations

Answer 10

Triple assessment (similar to breast lumps)

• full history and examination
• ultrasound
• needle testing of nay suspicious lumps via cytology (fine needle aspiration cytology)
• May need advanced investigations

Question 11

Thyroid cancer treatment

Answer 11

Thyroidectomy (hemi Or total dependent on type of Cancer - most are total)

Radioactive iodine

Radiotherapy- chemotherapy

Question 12

What forms the cervical plexus? Where are these structures found? Where do the sensory and motor branches emerge and what do they supply?

Answer 12

cervical plexus formed from Anterior primary rami of first 4 cervical nerves (C1-4)

Primary rami lie in surface of scalenus medius and levator scapulae muscles, deep to sternocleidomastoid

Sensory branches emerge from around posterior border of SCM -> skin neck/ scalp/ ear/ superior thorax (dermatomes C2-C4)

Cervical plexus several motor branches (including phrenic Nerve carries roots from C3-C4 and from ventral Ramus C5) , many form a loop (ansa cervicalis) -> further branches -> most of 4 paired infrahyoid muscles