Patient Y is a 58year old male that was referred to our department with a large (3x3cm) node of the R neck, level II, which he had had for 3 years. His fine needle aspiration (FNA) results showed potential small cell neuro-endocrine tumour, but had insufficient tissue for a confirmed diagnosis.
His oncologist sent him for further staging tests, which included a MRI which only confirmed the nodal involvement and advised a core needle biopsy of the mass. This revealed a squamous cell carcinoma with basaloid features. Patient Y had poorly controlled diabetes, and could not receive a PET-CT to identify the primary.
A radical neck dissection was done. Three metastatic carcinomas were removed at level II and III, with clear margins. Histological …show more content…
From superior to inferior it comprises of 3 parts, namely the nasopharynx, oropharynx and laryngopharynx.
The oropharynx extends from the soft palate to the hyoid bone and opens anteriorly into the mouth. It contains the posterior third of the tongue, the lingual tonsils, palatine tonsils and the superior constrictor muscle. It is lined by non-keratinized squamous stratified epithelium (Teach me Anatomy, 2017).
The oropharynx functions as an airway and as part of the alimentary canal.
It works with both the respiratory and digestive systems, and is involved in the voluntary and involuntary phases of swallowing.
Because both food and air passes through the pharynx, the epiglottis prevents aspiration when food is swallowed (Teach me Anatomy, 2017).
90% of malignant tumours are squamous cell carcinomas (SCC). There is a convincing link between oral tumours and tobacco smoking and alcohol abuse. In some regions, particularly the Indian subcontinent, where tobacco is chewed, the incidence is also higher. HPV 16 and 18 genotypes are found in 50% of oropharyngeal SCC’s. Recent studies suggest HPV to be responsible for 40% of oropharyngeal tumours …show more content…
Treatment Plan
4.3.1. Immobilization
The patient lies supine with his arms at his sides, with the spine as straight as possible. Patients receiving radiation to the head and neck region require a thermoplastic mask for immobilization (Barret et al., 2009:138). Head and neck immobilization is achieved by using a specialized head-rest and wedged blocks, for optimal neck support. A knee-rest is used to facilitate comfort. The mask is made prior to the CT scan. It is essential that the shoulders are pulled down to elongate the neck as much as possible. The mask is molded to shape the patient's head and neck area (Equra Health protocol, 2017).
4.3.2. Localization
For the CT scan, the patient is immobilized in the treatment position, with his thermoplastic mask placed once a needle is sited for intravenous contrast. A contrast agent is given to all IMRT patients as this indicates nodal involvement which can be better visualized with the aid of the contrast medium. Midline and lateral radiopaque markers are placed on the patient’s cast and a spiral CT is performed at 3mm slices. CT acquisition is done from the skull base superiorly to the top of the aortic arch inferiorly (Equra Health protocol,
His oncologist sent him for further staging tests, which included a MRI which only confirmed the nodal involvement and advised a core needle biopsy of the mass. This revealed a squamous cell carcinoma with basaloid features. Patient Y had poorly controlled diabetes, and could not receive a PET-CT to identify the primary.
A radical neck dissection was done. Three metastatic carcinomas were removed at level II and III, with clear margins. Histological …show more content…
From superior to inferior it comprises of 3 parts, namely the nasopharynx, oropharynx and laryngopharynx.
The oropharynx extends from the soft palate to the hyoid bone and opens anteriorly into the mouth. It contains the posterior third of the tongue, the lingual tonsils, palatine tonsils and the superior constrictor muscle. It is lined by non-keratinized squamous stratified epithelium (Teach me Anatomy, 2017).
The oropharynx functions as an airway and as part of the alimentary canal.
It works with both the respiratory and digestive systems, and is involved in the voluntary and involuntary phases of swallowing.
Because both food and air passes through the pharynx, the epiglottis prevents aspiration when food is swallowed (Teach me Anatomy, 2017).
90% of malignant tumours are squamous cell carcinomas (SCC). There is a convincing link between oral tumours and tobacco smoking and alcohol abuse. In some regions, particularly the Indian subcontinent, where tobacco is chewed, the incidence is also higher. HPV 16 and 18 genotypes are found in 50% of oropharyngeal SCC’s. Recent studies suggest HPV to be responsible for 40% of oropharyngeal tumours …show more content…
Treatment Plan
4.3.1. Immobilization
The patient lies supine with his arms at his sides, with the spine as straight as possible. Patients receiving radiation to the head and neck region require a thermoplastic mask for immobilization (Barret et al., 2009:138). Head and neck immobilization is achieved by using a specialized head-rest and wedged blocks, for optimal neck support. A knee-rest is used to facilitate comfort. The mask is made prior to the CT scan. It is essential that the shoulders are pulled down to elongate the neck as much as possible. The mask is molded to shape the patient's head and neck area (Equra Health protocol, 2017).
4.3.2. Localization
For the CT scan, the patient is immobilized in the treatment position, with his thermoplastic mask placed once a needle is sited for intravenous contrast. A contrast agent is given to all IMRT patients as this indicates nodal involvement which can be better visualized with the aid of the contrast medium. Midline and lateral radiopaque markers are placed on the patient’s cast and a spiral CT is performed at 3mm slices. CT acquisition is done from the skull base superiorly to the top of the aortic arch inferiorly (Equra Health protocol,