7175083
Description
Flashcards by Liam Musselbrook, updated more than 1 year ago
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Created by Liam Musselbrook
over 7 years ago
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| Question | Answer |
| What is the most common cell pathology of head and neck cancer? | Squamous cell carcinomas |
| Tumours of oropharynx: age, sex and aetiological factors | A: Mainly 50-70 but increasingly 30-40 S: M:F = 5-8:1 AF: Smoking, alcohol, betel-nut chewing, radiation, iron deficiency anaemia |
| Presenting symptoms/signs of tumours of the oropharynx | Sore throat Odynophagia, dysphagia Otalgia Bleeding Voice change Trismus Weight loss Mass in neck |
| Hypopharyngeal tumours: age, sex and aetiological factors | A: Increasing incidence with age S: Postcricoid is the only H&N cancer more common in women AF: Smoking, alcohol, betel-nut chewing, radiation, ID anaemia, HPV infection |
| Presenting symptoms of hypopharyngeal tumours | Sore throat, odynophagia, dysphagia Otalgia Haemoptysis Hoarseness, stridor Occasionally weight loss (advanced) Neck mass |
| Laryngeal cancer: age, sex and aetiological factors | A: Increasing incidence w age (rare <45yrs) S: M:F = 4:1 AF: Smoking, alcohol, neck radiation |
| Presenting symptoms of laryngeal cancer | Change of voice/hoarseness Dyspnoea/stridor Pain/odynophagia Dysphagia Neck mass |
| Minor salivary glands | 600-1000 Beneath mucosa Named according to anatomical position e.g. buccal, lingual, tongue etc |
| Major salivary glands | 3 paired structures Parotid, Submandibular, Sublingual Each situated outside oral cavity but connected to it by a duct/system of ducts |
| Non-salivary swellings | Hypertrophy of masseter Ageing Neuromas, aneurysms and cysts within parotid Lymphadenopathy Dental infections Mastoiditis |
| Causes of bilateral parotid swelling | Viruses: mumps Sarcoidosis Sjogren's syndrome Lymphoma Alcoholic liver disease |
| Causes of unilateral parotid swelling | Tumour: pleomorphic adenomas Stones Infection |
| Parotitis | Viral: mumps, echo and coxsackie. HIV Bacterial: often staphylococcal, tuberculosis Fungal (rare): candidiasis, immunosuppressed Other: sarcoid, drugs |
| Sialectasis | Dilatation, stenosis and necrosis of acini Forms cysts Initial event in calculus formation, majority affect submandibular gland duct |
| Sjögren's syndrome | Autoimmune disorder Parotid enlargement Xerostomia Keratoconjunctivitis sicca Bilateral, non tender enlargement of the gland 90% female Treatment is supportive Increased risk of subsequent lymphoma |
| Sjögren's syndrome: investigations | HLA AI, B8, DR3 Specifica antigens: SSA and SSB Schirmer's test Carisson-Crittendon (salivary flow) Lateral biopsy (diagnostic) 1 in 6 risk of N-H B-Cell lymphoma |
| Sarcoidosis: parotid involvement | Parotid involvement occurs in 6% of patients with sarcoid Bilateral in most cases Gland is not tender Xerostomia may occur Management of isolated parotid disease is usually conservative |
| Benign salivary tumours: % of them which are benign | 80% tumours occur in parotid 80% of these are benign 60% of submandibular are benign 30% minor salivary gland tumours are benign |
| Types of benign salivary tumour | - Benign pleomorphic adenoma or benign mixed tumour - Warthin tumor - Monomorphic adenoma - Haemangioma |
| Pleomorphic adenomas | Most common parotid neoplasm (80%) Slow growing, lobular, and not well encapsulated Treatment: Parotid - superficial parotidectomy or tumour excision with complete cuff of normal tissue Prognosis: recurrence rate of 1-5% with excision, 2-10% malignant degeneration |
| Warthin's Tumour (adenolymphoma) | Soft, cystic masses in tail of parotid 5% of parotid neoplasms Most common bilateral benign neoplasm of the parotid Often in males >40yrs Lymphocytic infiltrate and cystic epithelial proliferation Incidence of bilaterality and multicentricity of 10% Malignant transformation v. rare |
| Hemangioma | Should be considered in the differential of a parotid mass in a child Accounts for 90% of parotid tumours in children less than 1 year of age Hypervascular on imaging Spontaneous regression may occur and malignant transformation is almost unheard of |
| Commonest types of malignant salivary tumours | Mucoepidermoid carcinoma Adenoid cystic carcinoma Acinic cell carcinoma Adenocarcinoma Lymphoma |
| Mucoepidermoid carcinoma | Usually low potential for local invasiveness and metastasis (depends mainly on grade) 90% found in parotid, prevelence highest in 5th decade, more common in females Commonest salivary carcinoma in children Up to 30% recurrence |
| Adenoid Cystic Carcinoma | Unpredictable growth pattern Tendency for perineural spread - presents with palsies and pain Nerve growth may display skip lesions resulting in incomplete excision Distant metastasis more common (visceral rather than nodal spread) 5 year survival 35% |
| Acinic Cell tumours | Intermediate grade malignancy May show perineural invasion Low potential for distant metastasis 5 year survival 80% 99% parotid gland, middle-aged and elderly, more common in females |
| Adenocarcinoma | Develops from secretory portion of gland Risk of regional nodal and distant metastasis 5 year survival depends upon stage at presentation, may be up to 75% with small lesions with no nodal involvement |
| Adenocarcinoma | Highly malignant Several histological types 5 year survival = 10% |
| Lymphoma | Commonest - Non-Hodgkin's Usually 5th-7th decade Rubbery, painless lymphadenopathy Present as firm rapidly enlarging masses May be associated night sweats and splenomegaly Diagnosis - open biopsy |
| What are the 'B symptoms' of lymphoma? | Fever Drenching night sweats Weight loss: > 10% of body mass in previous 6 months |
| Complications of Partial Superficial Parotidectomy | Facial nerve palsy or paresis Frey's syndrome Fistula Numbness of ear lobe |
| Complications of Submandibular Gland Excision | Haemorrhage (reactionary) Marginal mandibular nerve damage (asymmetrical smile) |
| Epidermoid cysts | Firm Round nodules of various sizes Central punctum may be present Proliferation of epidermal cells within a circumscribed space of the dermis |
| Cystic hygromas | Soft Painless Transilluminate brightly Congenital lymphatic lesions Typically found in the neck and axilla region Predilection for the left side Majority present by 2 years of age |
| Branchial cleft cysts | Smooth Painless Do not transilluminate Typically present by early adulthood Develop due to failure of obliteration of the second branchial cleft in embryonic development |
| Deep cervical abscesses | Painful and tender swelling May be hot to touch. May also have other signs of infection such as fever, chills, aches, and pains Typically occur following a source of infection e.g. dental work |
| Thyroid swelling: what is a characteristic presentation? | May be hypo-, eu- or hyperthyroid symptomatically Moves upwards on swallowing |
| Thyroglossal cyst | More common in patients < 20 years old Usually midline, between the isthmus of the thyroid and the hyoid bone Moves upwards with protrusion of the tongue May be painful if infected |
| Pharyngeal pouch: what is it? | More common in older men Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles |
| Presentation of pharyngeal pouch | Usually not seen but if large then a midline lump in the neck that gurgles on palpation Dysphagia Regurgitation Aspiration Chronic cough |
| What is significant about 'mirror image nuclei'? | Indicates Reed-Sternberg cells RS cells are diagnostic of Hodgkin's lymphoma |
| Thyroid malignancy: papillary carcinoma | Commonest sub-type Accurately diagnosed on fine needle aspiration cytology - psammoma bodies and 'orphan Annie' nuclei Typically metastasise via the lymphatics and thus laterally located apparently ectopic thyroid tissue is usually a metastasis from a well differentiated papillary carcinoma |
| Thyroid malignancy: follicular carcinoma | May present as a discrete nodule Lymph node metastases uncommon Tend to spread haematogenously Cannot be accurately diagnosed on fine needle aspiration cytology - needs at least a hemi thyroidectomy |
| Thyroid malignancy: anaplastic carcinoma | Rend to occur in elderly females Disease is usually advanced at presentation and often only palliative decompression and radiotherapy can be offered |
| Thyroid maligancy: medullary carcinoma | Tumours of the parafollicular cells (C Cells) Serum calcitonin may be elevated May be familial Occur as part of the MEN-2A disease spectrum Spread may be either lymphatic or haematogenous Not responsive to radioiodine |
| Investigations for suspected salivary gland neoplasm | FNAC is used in most cases Plain x-rays - exclude calculi Sialography - delineate ductal anatomy Where malignancy is suspected the primary approach should be definitive resection rather than excisional biopsy |
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