Ent- Head And Neck Cancer

Front 1

What kind of cancer arises on Mucosal Surfaces?

Back 1

SCCA

Front 2

What kind of cancer arises on skin? (3)

Back 2

BCCA
SCCA
Melanoma

Front 3

Name three different kinds of thyroid cancer

Back 3

Papillary
Follicular
Medullary

Front 4

What kind of cancer arises on soft tissue?

Back 4

Sarcoma (by definition)

Front 5

1) 95% of Mucosal H&N Cancers are:

2) Other 5%?

Back 5

1) SCCA

2) salivary gland or lymphoma

Front 6

Two Major risk factors for mucosal cancer of H&N (and therefore for SCCA)?

Back 6

Alcohol
Tobacco

Front 7

EBV is predisposing factor for what kind of cancer?

Back 7

Nasopharynx SCCA

Front 8

In addition to Alcohol and Tobacco, HPV is a risk factor for SCCA at what specific site?

Back 8

Oropharynx

Front 9

Predominant pattern of spread of Mucoas H&N cancers

Back 9

Neck Lymph nodes prior to distant site.

Front 10

____% of Mucosal H&N cancer patients present with advanced stage disease.

Back 10

70%

Front 11

Name the Five general areas where Mucosal cancers can appear

Back 11

Oral
Pharynx
Larynx
Esophagus
Nasal Cavity/Sinuses

Front 12

1) Name the three divisions of the pharynx

2) Two of them can be affected by viruses predisposing them to SCCA. Match the virsues.

Back 12

Oropharynx - HPV
Nasopharynx - EBV
Hypopharynx

Front 13

Name seven distinct sites of cancer in the mouth.

Back 13

Lip
Anterio 2/3 of tongue
Floor of of mouth
Alveolar ridge
Retromolar trigone
Buccal mucosa
hard palate.

Front 14

What are the worst and second worst places to get cancer in the mouth?

Back 14

worst- Buccal Mucosa

second worst- Anterior 2/3 of tongue

Front 15

Nasopharynx subsites (2)

Back 15

1) fossa of Rosenmuller
(behind eust. tube ostium)
2) posterior pharyngeal wall

Front 16

where are the frontal, maxillary, ethmoid, and sphenoid sinueses

Back 16

Front 17

Mucosal tumor staging (TNM)

Back 17

Stage I: T1 N0 M0
Stage II: T2 N0 M0
Stage III: T3 N0 M0, T1-3 N1 M0
Stage IV: T4 Nx M0, Tx N2-3 M0, Tx Nx M1

Front 18

Any tumor which is M1:
1) stage?
2) treatment?

Back 18

1) 4
2) palliative rather than curative

Front 19

1) The most important prognostic indicator for mucosal cancers is:

2) How does this affect prognosis?

Back 19

1) cervical lymph node involvement
2) 50% decrease in survivial

Front 20

A tumor with ANY node metastasis is stage:

Back 20

3 or 4

Front 21

Any tumor with distant metastasis is stage:

Back 21

4

Front 22

General strategy for evaluation of a patient with mucosal H&N cancer.
(4 parts)

Back 22

History
physical
imaging
biopsy

Front 23

Who gets involved in a H&N tumor case?

Back 23

Multidisciplinary tumor board
H&N surgeon
rad-onc
med-onc
pathologist
radiologist
speech patholgist
prosthodontist
occasionally neurosurgeon or Thoracic Surgeon

Front 24

Rule of 80 for neck masses

Back 24

If over 40 and have a neck mass for more than 2 weeks. 80% are neoplastic, and 80% of those are malignant.

Front 25

Most important symptoms of H&N cancer

Back 25

Hoarseness
Unilateral Otalgia
Unilateral Middle ear fluid
Neck Mass
Chronic Sore throat

Front 26

Less emphasized symptoms of H&N Cancer

Back 26

Dysphagia
Odynophagia (painful swallowing)
weight loss
trimus (lockjaw)
nasal obstruction
epistaxis
cranial neuropathies
aspiration
airway obstruction
Hemoptysis (coughing blood)

Front 27

Pertinent elements of history

Back 27

Past cancer
meds
soc
fam

Front 28

Familal inheritance patterns aof H&N cancer are common/rare

Back 28

rare

Front 29

Physical exam IN ADDITION to a FULL PHYSICAL

Back 29

All mucosa
skin and scalp
cranial nerves
ears
neck/thyroid/salivary glands
Bimanual (2 fingers) palpation of oral cavity, oropharynx

Front 30

Evaluation of neck "nodes"

Back 30

size, location, numbers
fixation?
pulsatile?

Front 31

1) How do we biospy neck nodes?

2) when would we not do this?

Back 31

1) fine needle aspiration

2) pulsatile

Front 32

Describe the 5 neck "levels"

Back 32

Front 33

1) Do we do open biopsies of nodes?

2) why?

Back 33

1) NOT UNLESS UNAVOIDABLE

2) can spill cancerous cell out of node

Front 34

What two kinds of anatomical cross sectional imaging do we use?

Back 34

CT, MRI

Front 35

What form of functional imaging do we use?

Back 35

PET

Front 36

What kind of noninvasive imaging do we do?

Back 36

US

Front 37

What three characteristics make a cancer very high risk for metastasis?

Back 37

1) multiple nodes
2) LOWER neck nodes
3) extracapsular spread from nodes

Front 38

1) What is our main mode of evaluation for distant metastases

2) why?

Back 38

imaging

2) CXR, and Labs (alk phos, Ca++, LFTs) are insensitive

Front 39

1) Three major distant sites of mucosal H&N cancer spread
2) single most common one?

Back 39

1) lung
bone
liver

2) lung

Front 40

In what % of cases will panendoscopy show a second tumor?

Back 40

5-15%

Front 41

Why do we use panendoscopy?

Back 41

biopsy and mapping of primary tumor

(diagnosis, staging, treatment planning)

Front 42

When do we use a curative approach to treatment? (by stage)

Back 42

1-3 and some 4

Front 43

3 reasons we would pursue a palliative approach to mucosal H&N cancer?

Back 43

1) distant mets
2) far advanced local or regional disease
3) co-morbidities limit treatment options

Front 44

Treatment for:
Nasopharyngeal stage I and II

Back 44

Radiation alone

Front 45

Treatment for:
Nasopharyngeal Stage 3 and 4

Back 45

Chemo/radiation

Front 46

What role does surgery play in the treatment of nasopharyngeal cancers?

Back 46

Little role at primary site, may be used to excise residual nodes after primary has been cured by chemo/rads

Front 47

Treatment of:
Non-nasopharynx cancers stage 1 and 2

Back 47

Single modality treatment

Surgery OR Radiation

Front 48

Treatment of:
Non-nasopharynx cancers stage 3 and 4 that we are trying to CURE

Back 48

Multi-modality
a) surgery/postop rads +/- chemo
b) chemo/rads wth surgery for salvage or lymph node removal

Front 49

Treatment of:
Non-nasopharynx cancers stage 3 and 4 when we are doing palliative approach

Back 49

Chemotherapy alone

Front 50

Nasal and paranasal sinus cancer early signs

Back 50

non-specific

Front 51

MANY typse of cancer can arise in the nose/paranasal area

Back 51

SCCA, minor salivary gland cancers, lymphoma, melanoma, rhabdomyosarcoma, SNUC, olfactory neuroblastoma, Ewing’s sarcoma/PNET

Front 52

Therapy for nose/paranasal area?

Back 52

Multimodality and dependant upon the pathology

Front 53

Treatment consideration in nose/paranasal area cancer

Back 53

proximity to palate, orbit, skull base, dura, brain

Front 54

evaluation of nose/paranasal area cancer almost includes what imaging?

Back 54

CT AND MRI

Front 55

significant prognostic indicators for SCCA and its likelihood to metastasize

Back 55

N0 vs. N1
size of largest node
number of positive nodes
location of positive nodes
extracapsular spread
soft tissue deposits

Front 56

Incidence and pattern of mets of HNSCCA is predictable based upon (2 simple ones)

Back 56

disease site
T-stage

Front 57

Name three kinds of tissue transfers used to restore form and function?

Back 57

local flaps
regional flaps (pec. major, latissimus)
Distant (free) flaps- radial forearm, fibula

Front 58

Example given for facial reconstructions

Back 58

Andy Gump Deformity

Front 59

Post-treatment recommendations for H&N cancer.

Back 59

1) STOP tobacco and alcohol (associated with 30-50% recurrence)
2) optimize nutritional, medical psychosocial status

Front 60

8 post-treatment considerations

Back 60

Speech/swallowing therapy
Xerostomia
Taste Alterations
Physical therapy
Prosthodontics
Social support
Thyroid function
Tumor surveillance

Front 61

Tumor surveillance:
_______% of recurrences occur within ______ years.

Back 61

80% within 3 years

Front 62

1)Considerd cured if free of recurrence after _______
2) then the focus turns to

Back 62

1) 5 years
2) watching for secondary tumors

Front 63

Prognosis:
Survival for stage I and II is:

Back 63

75%

Front 64

Prognosis:
Survival for stage 3-4 is:

Back 64

40%

Front 65

Except for _____ cancer, we have not imporved survival in the past 50 years

Back 65

nasopharyngeal

Front 66

most nasopharyngeal cancer start in the____

Back 66

Fossa of Rosenmuller

Front 67

People wo have never smoked have a better prognosis in what specific cancer?

Back 67

stage 3 or 4 HPV+ oropharynx cancer