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