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24 Cards in this Set
- Front
- Back
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What are the two functions of the Pharynx?
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Respiratory and digestive, all others are for respiratory.
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Why do Pt's receive RT for oropharynx?
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- not because RT did the best job but because surgeons did not want to operate on that area where ppl can lose function.
- Although, now with more modern medicine ppl are having surgery and chemo. |
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Where is Throat Cancer also located?
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BOT (Base of Tongue)
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What is 1/3 of the tongue being the junction of?
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Soft Palate of Mouth
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What kind of tissue are Tonsils?
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Lymphfroid, they will be more sensitive to radiation (radioresistant)
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How do alcohol and tobacco have an a effect on oropharynx?
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The Effects are made worst
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What are some other illnesses associated with H&N Cancers?
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HVP is a virus of herpes, cold sores and shingles.
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What are the 3 Pharynx (open spaces)
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- Nasopharynx
- Oropharynx - Hypoparynx |
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How come ppl with a oropharyngeal lesion don't notice it till its in late stage?
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b/c there are no real symptoms and the tumor has a lot of space to grow
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Histopathology BOT
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Usually SCC 95%
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What is the pattern of spread?
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- Local invasion
- SCC at the BOT tends to develop early, silent(no symptoms), unfortunately there is deep infiltration before they are diagnosed |
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What type of Lymphatic Nodal spread is to be expected?
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- 1st is the subdigastic ("two stomach") nodes (level II)
- Jugular Chain to Midjugular (Level III) - Lower Jugular (Level IV) - Posterior Cervical (Level V) - Submandibular (Level I) become involved if the tumor extends anterior - Nodes can be Bilateral b/c it's midline structure, Bilateral nodes are common - Even if posterior cervical nodes for not clinically evident; they are included in the field b/c Natural history (statically) common |
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What of Lymphatic involvement?
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~75% of Pt w/ BOT have clinically positive neck nodes at diagnosis
- 30% of Pt's have bilateral nodes b/c of central presentation. If 25% do not appear to have nodes, it just means they haven't been found |
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Because of the incapability of knowing exactly what percentage of the nodes are involved what would be done as far as tx?
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Because the unsuraly of full nodal involvement, we will treat will larger than normal field size to ensure all nodes (positive or not) are getting treated.
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What are some symptoms of Oropharynx?
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1st symptom can be pain (diaphagis) , or neck mass
- Sensation of a lump pain on swallowing , and foul breath. |
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What type of treatment principles are available?
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Surgery and RT have similar results but Pt's tend to go with RT cause surgery is fairly destructive and Pt's would have to have a feeding tube (which is very uncomfortable)
- Some Pt's may have chemo to help shrink tumor |
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What are the techniques for treating BOT?
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+Lateral fields: submandibular and cervical nodes are big fields, even with IMRT cannot spare to much
+ Anterior Neck Field: always included b/c of IMRT (not a 3rd field) |
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With Oropharynx what is the dose consideration for T1?
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T1 lesion is a big dose and big field, dose is usually 60-66Gy over 6-6.5 wks
Higher Stage requires higher doses |
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With Oropharynx what is the dose consideration for T2-T4?
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Bigger lesion requires 1.2 Gy BID with a minimum of 6 hrs between fractions to a total dose of 74.4-79.2 Gy; BID is very popular for this type of Stage in H&N
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What other way can T1 cx be treated?
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With Hyperfractionation to 74.4 Gy
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With the Tx of H&N using IMRT what are some benefits?
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Helps to spare salivary later down the road (hope is to recover better) to reduce long-term xerostomia
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How has different field arrangements become beneficial?
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Because field within a field and nodes included in whole tx field
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What are some problems with conventional 3 field techniques?
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+Treatment lasts 7-8 weeks and the pt's have horrible reactions, skin sores, thin
+ Inaccurate Match Lines causing hot and cold spots + Increasing side effects with increasing dose. |
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How did Modern techniques help?
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1st conformal(static field) and now IMRT reduce or eliminate some of the earlier problems (inhomogenitis due to topography), allowing for dose escalation
+Helped out with Paranoids |
