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49 Cards in this Set
- Front
- Back
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What are the six major head and neck sites for cancer?
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1 Oral cavity
2 Pharynx - Nasopharynx - Oropharynx - Hypopharynx 3 Larynx 4 Paranasal sinuses 5 Salivary glands 6 Thyroid gland |
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List the seven levels of lymph nodes in H&N cancer.
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I: Submental, submandibular
II: Upper jugular III: Mid jugular IV: Lower jugular V: Posterior triangle VI: Prelaryngeal, pretracheal, paratracheal VII: Upper mediastinal |
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List other groups of lymph nodes in H&N cancer.
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1 Sub-occipital
2 Retropharyngeal 3 Parapharyngeal 4 Buccinator (facial) 5 Preauricular 6 Periparotid and intraparotid |
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What are the boundaries of Level I?
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Contains the submental and submandibular triangles
Bounded -Anterior and posterior bellies of the digastric muscle -Inferiorly hyoid bone -Superiorly body of the mandible |
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What are the boundaries of Level II?
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Contains the upper jugular nodes
-Superiorly level of the skull base -Inferiorly hyoid bone |
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What are the boundaries of Level III?
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Contains the middle jugular lymph nodes
-Superiorly hyoid bone -Inferiorly lower border of the cricoid cartilage |
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What are the boundaries of Level IV?
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Contains the lower jugular lymph nodes
-Superiorly cricoid cartilage -Inferiorly clavicle |
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What are the boundaries of Level V?
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Contains the lymph nodes in the posterior triangle
- Posteriorly - anterior border of the trapezius - Anteriorly - posterior border of SCM - Inferiorly - clavicle |
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What are the boundaries of Level VI?
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Contains lymph nodes of the anterior central compartment
-Superiorly hyoid bone -Inferiorly suprasternal notch - Laterally medial border of carotid sheath |
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What are the boundaries of Level VII?
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Contains lymph nodes inferior to the suprasternal notch in the superior mediastinum
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What is the definition of N1?
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N1 - A single ≤ 3 cm ipsilateral lymph node
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What is the definition of N2a?
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N2a - A single 3 < X ≤ 6 cm ipsilateral lymph node
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What is the definition of N2b?
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N2b - Mets in multiple ipsilateral lymph nodes ≤ 6 cm
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What is the definition of N2c?
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Bilateral or contralateral lymph nodes ≤ 6 cm
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What is the definition of N3?
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Metastasis in a lymph node > 6 cm in greatest dimension
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What is the definition of M1?
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Distant metastasis
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Nasopharynx staging: T stage
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Nasopharynx staging: T stage
T1: Confined to nasopharynx T2: Extends to soft tissues T2a: Oropharynx +/- NC without parapharyngeal extension T2b: Parapharyngeal extension T3: Bony structures +/- paranasal sinuses T4: Intracranial extension, CN involvement, infratemporal fossa, orbit, hypopharynx, or masticator space |
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Nasopharynx staging: N stage
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Nasopharynx staging: N stage
N1: Unilateral met(s) ≤ 6 cm above supraclavicular fossa N2: Bilat mets ≤ 6 cm above supraclavicular fossa N3a: Mets > 6 cm N3b: Extension to supraclavicular fossa |
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Nasopharynx staging: M stage
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Nasopharynx staging: M stage
M1: No distant mets M2: Distant mets |
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Oropharynx subsites
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Oropharynx subsites
- Extends from superior soft palate to superior hyoid 1 Base of tongue 2 Soft palate and uvula 3 Tonsillar pillars 4 Glossotonsillar sulci 5 Pharyngeal tonsils 6 Lat and post pharyngeal walls |
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Hypopharynx subsites
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Hypopharynx subsites
- Extends from superior border of hyoid to lower cricoid 1 Piriform sinuses 2 Lateral and posterior hypophyarngeal walls 3 Postcricoid region |
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Larynx sites
1 2 3 |
Larynx sites
1 Supraglottis 2 Glottis 3 Subglottis |
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Supraglottis subsites
1 2 3 4 5 |
Supraglottis subsites
1 Supraglottic epiglottis 2 Infrahyoid epiglottis 3 AE folds (laryngeal aspect) 4 Arytenoids 5 FVCs |
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Glottis subsites
1 2 3 |
Glottis subsites
1 TVCs 2 AC 3 PC |
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Subglottis subsites
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Subglottis subsites: Subglottis
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Esthesioneuroblastoma staging
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Esthesioneuroblastoma staging
Kadish system A: Confined to nasal cavity B: Extends more than one paranasal sinus C: Extends beyond nasal cavity or paranasal sinuses D: Regional mets (cervical nodes) Distant metastases |
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Esthesioneuroblastoma treatment
Small, low-grade tumors confined to the ethmoids Otherwise |
Esthesioneuroblastoma treatment
Small, low-grade tumors confined to the ethmoids: Surgery +/- RT or RT (65-70 Gy if def) --> Local control stage A: 70% Otherwise: CMT - Surgery then -- PORT 50-60 Gy -- Adj CCRT 50-60 Gy -- PORT 45 Gy --> LC stage B: 50-65% LC stage C: 30-50% |
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Esthesioneuroblastoma pearls
Age on presentation Symptoms at presentation Lymph node spread |
Esthesioneuroblastoma pearls
Age on presentation: 11-20 & 40-60 Symptoms at presentation - Unilateral nasal blockage - Epistaxis Lymph node spread - Early stage: <10% - Stage C: up to 50% |
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Esthesioneuroblastoma Histology
1 2 3 4 |
Esthesioneuroblastoma Histology
1 Epithelial components provide supporting stroma 2 Nerve component corresponding to olfactory cells 3 Rosettes - Rows of columnar cells with radially oriented nuclei arranged around a central area 4 Pseudorosettes - Ring of blue cells around a tangle of neurofibrils |
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Esthesioneuroblastoma Imaging
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Esthesioneuroblastoma Imaging
- MR for soft tissue and brain involvement - CT for bone involvement - Octreotide scan -- Uses tagged somatostatin analog -- Produces scintigraphic image of neuroendocrine tumors |
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Esthesioneuroblastoma prognosis
Local recurrence rate Cervical metastatic rate |
Esthesioneuroblastoma prognosis
Local recurrence rate: ~70% Cervical metastatic rate: ~25% |
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H&N: PORT indications
1 2 3 4 5 6 7 Ref |
H&N: PORT indications
1 Oral cavity site 2 PNI 3 Largest node > 3cm 4 Multiple positive nodes 5 Tx delay > 6 wks postop 6 Positive margins (= Adj CCRT) 7 ECE (= Adj CCRT) Ref: Ang IJROBP 2001 |
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H&N: Adj CCRT indications
1 2 Ref |
H&N: Adj CCRT indications
1 Positive margins ("microscopically involved") 2 ECE Ref 1 EORTC 22931 Bernier 2 RTOG 9511 Cooper 3 Comparison Bernier & Cooper |
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Oropharynx T staging
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T1 ≤ 2 cm
T2 2 < X ≤ 4 cm T3 > 4 cm T4a invades larynx, deep tongue muscles, medial pterygoid, hard palate, or mandible T4b invades lateral pterygoid, pterygoid plates, lateral nasopharynx, skull base, or encases cartoid |
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Hypopharynx T staging
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T1 - One subsite ≤ 2 cm
T2 - More than one subsite OR - 2 < X ≤ 4 cm T3 > 4 cm T4a Invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, esophagus, or central compartment soft tissues T4b invades prevertebral fascia, encases carotid, involves mediastinal structures |
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Oropharynx and Hypopharynx N staging
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N1 Single ipsi node ≤ 3 cm
N2a Single ipsi node 3 < X ≤ 6 cm N2b Multiple ipsi nodes ≤ 6 cm N3 > 6 cm |
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Nasopharynx Stage Grouping
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I: T1N0M0
IIA: T2aN0M0 IIB: T1-2bN1M0, T2bN0M0 III: T1-3N2M0, T3N0-1M0 IVA: T4N0-2M0 IVB: Any T N3M0 IVC: Any T Any N M1 |
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Oro- / Hypopharynx Stage Grouping
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I: T1N0M0
II: T2N0M0 III: T1-3N1M0, T3N0M0 IVA: T4aN0-1M0, T1-4aN2M0 IVB: T4b Any N M0, Any T N3M0 IVC: Any T Any N M1 |
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Lip/OC T Staging
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T1: ≤ 2 cm
T2: 2 < X ≤ 4 cm T3: > 4 cm Lip T4 invades through cortical bone, inferior alveolar nerve, floor of mouth, skin of face OC T4a invades through cortical bone, deep tongue mesucles, maxillary sinus, skin of face OC T4b invades masticator space, pterygoid plates, skull base, encases carotid |
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Lip/OC N Staging
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N1: Single ipsi node ≤ 3 cm
N2a - Single ipsi node 3 < X ≤ 6 cm N2b - Multiple ipsi nodes ≤ 6 cm N2c - Bilat or contralateral nodes ≤ 6 cm N3 > 6 cm - |
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Supraglottis T Staging
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T1: One subsite with normal cord mobility
T2: More than on subsite or region outside the glottis without fixation T3 - Limited to larynx with cord fixation - Invades postcricoid area, pre-epiglottic tissues, paraglottic space, minor thyroid cartilate erosion T4a invades through thyroid cartilage, tissues beyond larynx T4b invades prevertebral space or mediastinal structures, encases carotid |
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Glottis T Staging
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T1a: Limited to one cord with normal mobility
T1b: Involves both cord with normal mobility T2 - Extends to supraglottis +/- subglottis - Impaired cord mobility T3 - Limited to cord fixation - Invades paraglottic space - Minor cartilage erosion T4a - Invades through thyroid cartilage - Invades tissues beyond larynx T4b - Invades prevert space or med structures or encases carotid |
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Subglottis T Staging
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T1: Limited to subglottis
T2: Extends to cords with normal or impaired mobility T3: Limited to larynx with fixation T4a - Invades cricoid or thyroid cartilage or tissue beyond larynx T4b - Invades prevert space or med structures or encases cartoid |
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Larynx N Staging
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N1: Single ipsi node ≤ 3 cm
N2a: Single ipsi node 3 < X ≤ 6 cm N2b: Multiple ipsi nodes ≤ 6 cm N2c: Bilat or contralateral nodes ≤ 6 cm N3: > 6 cm |
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Larynx Stage Grouping
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I: T1N0M0
II: T2N0M0 III: T3N0M0, T1-3N1M0 IVA: T4aN0-1M0, T1-4aN2M0 IVB: T4b Any NM0, Any T N3M0 IVC: Any T Any N M1 |
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Major Salivary Gland T Staging
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T1: ≤ 2 cm without extraparenchymal extension
T2: 2 < X ≤ 4 cm without extraparenchymal extension T3: > 4 cm +/- extraparenchymal extension T4a: Skin, mandible, ear canal, facial nerve T4b: Skull base, pterygoid plates, encases carotid |
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Major Salivary Gland N Staging
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N1: Single ipsi node ≤ 3 cm
N2a: Single ipsi node 3 < X ≤ 6 cm N2b: Multiple ipsi nodes ≤ 6 cm N2c: Bilat or contralateral nodes ≤ 6 cm N3: > 6 cm |
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Thyroid T Staging
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T1: ≤ 2 cm limited to thyroid
T2: 2 < X ≤ 4 cm limited to thyroid T3: < 4 cm or minimal extrathyroi extension T4a: Beyond thyroid capsule into subcu soft tissues, larynx, trachea, eso, or RLN T4b: Invades prevert fascia or encases carotids or med vessels |
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Thyroid N Staging
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N1a: Mets to level VI
N2b: Met to uni-, bi-, or contralateral cervical or superior med nodes |
