Head & Neck Lumps & Bumps. R S Allison Department of Otolaryngology, Head & Neck Surgery Christchurch Hospital
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1 Head & Neck Lumps & Bumps R S Allison Department of Otolaryngology, Head & Neck Surgery Christchurch Hospital August 2010
2 OVERVIEW Neck Lumps: Children Head & Neck Tumours Neck Lumps: Adults Salivary Glands
3 Neck Lumps: Children
4 Neck Lumps - Children Majority Minority - Lymphadenopathy - Resolve +/- antibiotic - Persist / enlarge Neck lumps Lateral Midline
5 Lateral neck masses in children Duration? Change in size? Solid / cystic? Skin changes? Lymph nodes Bacterial / viral Non tuberculous mycobacterial Other Branchial cleft cyst Lymphangioma Malignancy
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12 Lateral neck masses - management Solid - antibiotics 2 weeks - review 3 weeks - refer? FNA? Cystic - refer? FNA?
13 Midline neck masses - children (usually developmental) Duration? Position? Solid/cystic? Moves on swallowing? - Thyroglossal duct cyst - Submental node - Dermoid cyst - Plunging ranula
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19 Midline neck masses - management Solid - antibiotics 2 weeks - review 3 weeks - refer? FNA? Cystic - ultrasound - refer? FNA?
20 Neck Lumps: Adults
21 Neck Masses - Adult Midline Thyroid Thyroglossal cyst Lateral Node Inflammatory NEOPLASTIC Branchial cyst Other eg. neural / vascular tumour Normal variant
22 Midline Neck Masses - Adult Thyroid nodule Duration? Obstructive symptoms? dysphagia airway obstruction hoarseness Hyper / Hypothyroidism?
23 Thyroid Nodule Ultrasound 30-50% all adults Palpation 4-8% women 1-2% men 5-10% malignant Increased risk if <30 years >60 years male
24 Thyroid Nodule Multinodular goitre Solitary cystic solid - benign - follicular adenoma - Hurtle cell adenoma - malignant - papillary carcinoma - follicular carcinoma - medullary carcinoma - anaplastic carcinoma
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29 Thyroid Nodule - Investigation TSH normal / FNA malignant refer indeterminate repeat, refer? benign cosmetic/obstructive refer review 3/12 TSH Radionuclide scan cold nodule FNA hot nodule thyroid clinic
30 Lateral Neck Mass - Adult Node - inflammatory - bacterial / viral Branchial cyst - MALIGNANCY - metastatic - primary Other eg neural / vascular tumours Normal variant eg hyoid bone carotid bulb
31 Head & Neck Malignant Neck Node Rich lymphatic system numerous lymphatic channels high density of cervical nodes Cancer metastasises early Neck node? Sole presenting symptom of malignancy
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37 Enlarged Neck Node Probably malignant Probably metastatic SCC Probably primary in head & neck
38 Lateral Neck Mass - Management History - Associated symptoms eg. - mouth ulcer - dysphagia - hoarseness - otalgia Examination Investigations - Assess lump - Upper aerodigestive tract - Routine bloods - FNA - CXR - Refer
39 Salivary Gland Disorders
40 Salivary Glands Major Glands Parotid Submandibular Sublingual Minor Glands Mucosa mouth/pharynx esp. palate
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42 mls/day Salivary Gland Function Parotid - serous saliva - short duct - stones uncommon - radiolucent Submandibular - mucinous saliva - long duct - uphill flow - stones common - radio-opaque
43 Parotid Swelling Generalised Localised (usually tumour) local systemic benign malignant disorder disease
44 Parotid Swelling Generalised Local Disorder sialoadenitis +/- stones acute chronic recurrent Systemic Disease Sjogren s sarcoidosis diabetes alcoholism
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46 Parotid Gland Tumours Localised swelling Benign 60% pleomorphic adenoma Warthin s tumour etc Malignant 40% metastatic SCC adenocarcinoma mucoepidermoid ca etc
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54 Sialadenitis Management of Salivary Gland Disease Acute - massage, hydration,? sialagogues -? bacterial - usually staph -? stone -? surgical drainage Chronic / Recurrent - surgical removal gland?
55 Management of Salivary Gland Disease Salivary Gland Tumours FNA CT? / MRI? Submandibular - whole gland removed Parotid - partial parotidectomy - facial n. preserved - if malignant -? facial n. resected
56 Fine Needle Aspiration Parotid / Thyroid / Neck masses Easy Cheap Low morbidity No risk of tumour seeding BUT? Accuracy
57 FNA Parotid Masses Christchurch Hospital: 100 Parotid tumours Benign Malignant pleomorphic adenoma Warthins metastatic SCC mucoepidermoid ca Pathologist in ENT Department accuracy 86% BUT General Practice accuracy LESS
58 If FNA not consistent with clinical? D/W Pathologist? Repeat FNA? U/S guided FNA If considering FNA Consider specialist opinion
59 Head & Neck Cancer
60 Head & Neck Cancer Head and Neck oral cavity pharynx larynx nose & sinuses salivary glands - parotid - submandibular - minor skin - invasive - metastatic thyroid
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62 Head & Neck Cancers 5-8% of all cancers new cases/year in Christchurch
63 Head & Neck Cancer Histology - squamous cell cancer - others - adenocarcoma - adenoid cystic carcinoma - mucoepidermoid cancer - melanoma - sarcoma etc
64 Risk factors: smoking alcohol hardwoods Head & Neck Cancer - tobacco - roll your own - filterless - filtered - marijuana - spirits - beer (wine) nitrosamines - salted fish
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80 Head & Neck SCC Neck - very rich lymphatic supply lymph nodes H&N SCC - metastasises early to neck nodes Enlarged neck node - may be only symptom - need to search for primary tumour
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84 Head & Neck SCC Assessment History and examination Examination - biopsy under anaesthesia FNA neck nodes CT scan primary site neck chest/abdomen MRI PET OPG TNM stage
85 Head & Neck SCC Treatment Options Management - Multidisciplinary - Radiotherapist - Surgeon - Support Personnel - dentist / oral surgeon - speech therapist - dietician - social worker etc
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87 Head & Neck SCC Treatment Options Small tumours eg. oral cavity larynx - single modality - surgery - radiotherapy/co2 laser Large tumours eg. - combined modality - surgery + post-op radiotherapy - chemoradiation
88 Head & Neck Cancer Conclusion Relatively common but variety of sites Range of symptoms similar to benign disease Usually diagnosed on thorough clinical examination Treatment - multidisciplinary - usually curative
89 Head & Neck Tumours- Summary Thyroid / parotid / neck mass: FNA useful -? Interpretation Hoarseness Dysphagia Oral ulcer Local pain More than 3 weeks - Consider referral NECK LUMP
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1.6 Spider naevi These are skin blood vessels which have become enlarged to form spidery red blobs in the skin. They can be cauterised away.
MINOR SURGERY 1 MINOR SKIN CONDITIONS...1 1.1 Skin tags...1 1.2 Moles...2 1.3 Warts...2 1.4 Sebaceous cysts...3 1.5 Lipomas...4 1.6 Spider naevi...4 1.7 Basal Cell Carcinomas (rodent ulcers or BCCs)...4
Mesothelioma: Questions and Answers
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Mesothelioma: Questions