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62 Cards in this Set

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  • Back
What is in the increase in risk for cancer for those who use tobacco and ethanol excessively?
15-fold
What are the subsites of the oral cavity?
1)lips
2)tongue (ant 2/3)
3)floor of mouth
4)buccal mucosa
5)alveolar ridge (sup & inf)
6)retromolar trigone
7)hard palate
What are the subsites of the oropharynx?
1)base of tongue
2)soft palate and uvula
3)tonsillar pillars
4)pharyngeal tonsils
5)glossotonsillar sulci
6)oropharyngeal walls, lateral and posterior
What are the subsites of the hypopharynx?
1)pyriform sinuses
2)hypopharyngeal walls, lateral and posterior
3)post cricoid region
what are the subsites of the nasopharynx?
1)lateral walls
2)vault
3)posterosuperior wall
Describe staging criteria for oral cavity, oropharyngeal, and hypopharngeal ca?
Stage0: TisN0M0
Stage1: T1N0M0
Stage2: T2N0M0
Stage3: T3N0M0, T1-3N1M0
Stage4: T4N0M0, T1-3N2M0,
T1-4N0-3M1
Describe T staging for nasopharyngeal ca?
Tis: carcinoma in situ
T1: confined to nasopharynx
T2: extends to soft tissues of oropharynx and/or nasal fossa
T2a: without parapharyngeal extension
T2b: with parapharyngeal extension
T3: invades bony structures and/or paranasal sinuses
T4: intracranial extension and/or involvement of CN, infratemporal fossa, hypopharynx, or orbit
Describe N staging for NP Ca.
Nx: cannot be assessed
N0: no regional LN mets
N1: unilateral LN <6cm above supraclavicular fossa
N2: bilateral LN <6cm above supraclavicular fossa
N3a: >6cm
N3b: extension to supraclavicular fossa
Describe staging criteria for nasopharyngeal cancer.
StageI: T1N0M0
StageIIa: T2aN0M0
StageIIb: T1-2N1M0, T2aN1M0, T2bN0-1M0
StageIII: T1-2bN2M0, T3N0-2M0
StageIVA: T4N0-2M0
StageIVB: T1-4N3M0
StageIVC: T1-4N0-3M1
What is the incident of occult mets that demands elective ND over RT?
25-30%
What is the incidence of second primary tumors?
5-10%
How frequently do distant mets develop in pts with H&N Ca?
15%
When do recurrences typically occur?
first 2 years after treatment
What are some pathologic findings that demand postop xrt?
1)perineural spread
2)extensive nodal dz
3)extracapsular extension
What is the overall 5 year survival for lip CA?
91%
What is the distribution of cancer on the lips (lower vs upper)?
95% lower lip, 5% upper lip
How frequently does regional metastasis occur with lip cancer?
10%
What is the lymphatic drainage of the lips?
submental and submandibular nodes
Discuss reconstruction of lip defects.
<1/4-1/3:primary closure
1/4-1/2:Abbe flap, when close to oral commissure; Estlander, when involving oral commissure
1/2-1/3:Karapandzic flap
2/3-total:local flap recon or free tissue transfer
In tongue cancer, what is the depth of invasion that correlates with higher rates of mets, recurrence, and mortality?
>2-4mm
What is occult regional metastasis in tongue ca?
25-33% occult mets
What are the 5-year survival rates for tongue CA?
60-75% for Stage I, II
25-40% for Stage III, IV
What is occult regional mets in FOM CA?
23-50% occult mets
Where is the most common site of recurrence for FOM CA?
41% primary site versus 20% failure in the neck
What are the 5-year survival rates for FOM CA?
StageI:64-80%
StageII:61-84%
StageIII:28-68%
StageIV:6-36%
For RMT Ca, what is the rate of regional mets at presentation?
10-20% regional mets at presentation
When should management of the neck be considered for RMT CA?
1)for clinically evident dz
2)advanced-stage primaries
What is the overall 5-year survival rate of RMT CA?
26-55% - not good because most present at later stages
For alveolar ridge CA, what percentage of pts present for bony invasion?
40% with bony invasion at time of dx
For alveolar ridge CA, what is the rate of regional mets at presentation? Occult mets?
25-30% regional mets
15% occult cervical mets
What is management of the neck for alveolar ridge CA?
1) treat clinical evident dz
2) electively treat advanced when
a)advanced T-stage
b)bony invasion
c)poor differentiation
What is the overall 5-year survival rate for alveolar ridge CA?
50-65% overall five-year survival rate
What are the three main tumors that arise on the palate?
1) SCC
2) minor salivary gland tumor
3) necrotizing sialometaplasia
What percentage of patients with ca of the palate present with clinically evident neck mets?
10-25%
What is the management of the neck for palate CA?
No elective treatment - occult met rate low
What is the overall 5-year survival for palate CA?
44-75% overall 5-year survival
What is the most common oral cavity cancer in India?
CA of buccal mucosa
What is the tumor thickness of buccal ca that corresponds with increased morbidity and mortality?
>6mm
What is the management of the neck for buccal CA?
Elective mgmt of the neck is recommended. (either xrt or ND)
In general, when is postop xrt recommended?
1)advanced stage
2)close or positive surgical margins
3)perineural or lymphovascular invasion
4)poor differentiation
5)bony invasion
What are the three types of cancers most often found in the oropharynx?
1)SCC - nonkeratinizing vs. keratinizing
2)Lymphoma
3)Salivary gland Ca
What is the rate of cervical mets for soft palate CA?
50%
For soft palate CA, what is the tumor thickness that correlates with worse regional mets and survival?
>3mm thickness
Cystic cervical mets likely have primary lesions where?
oropharynx
Tonsil CA is treated with radiation. When should the contralateral neck be addressed for tonsil CA?
1) spread to soft palate, especially midline
2) clinically apparent dz in contralateral neck
3) involvement of tongue
What are the surgical approaches to the oropharynx?
1)transoral excision
2)anterior mandibulotomy
3)lateral mandibular osteotomy
4)composite resection
5)midline transligual pharyngotomy
6)extended lateral pharyngotomy
7)transhyoid pharyngotomy
What is the five-year survival of oropharyngeal CA in general?
Stage I-II: 70-85%
Stage III-IV: 20-50%
Soft palate better than tonsil and BOT with 64% 5-year survival for Stage III
What are some risk factors for hypopharyngeal cancers?
1)tobacco
2)ethanol
3)possibly GERD
4)Plummer-Vinson Syndrome
In the US, which subsite of the hypopharynx is most commonly involved with cancer? How about in Europe?
pyriform sinuses in US
postcricoid in Europe
What percentage of hypopharyngeal CAs present as Stage III?
70%
What percentage of pts with hypopharyngeal carcinoma have cervical mets on presentation?
60-75%
What are the five-year survival rates for hypopharyngeal CA?
pyriform:20-50%
pharyngeal wall:21%
postcricoid:35%
Describe the WHO classifications for NP CA?
WHO type I:keratinizing SCC
WHO type II:non-keratinizing
WHO type III:undifferentiated
Which WHO type is most common in NP CA?
WHO type III: undifferentiated
Which WHO types are endemic and are associated with EBV?
WHO type II
WHO type III
What are common presenting symptoms of NP CA?
1)neck mass
2)aural fullness
3)hearing loss
4)epistaxis
5)nasal obstruction
What percentage of patients with NP CA have clinical cervical mets?
87%
What percentage of pts with NP CA have bilateral cervical mets?
20%
What percentage of patients with NP CA have or develop distant mets?
25-30%
What are surgical approaches to the NP?
1)infratemporal fossa approach
2)transpalatal, transmaxillary, transcervical approach
3)extended osteoplastic maxillotomy (maxillary swing)
What is the five-year survival of NP CA after chemo XRT?
70-80% with chemo XRT
36-58% with XRT alone
What is the ten-year survival of NP CA?
10-40%