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35 Cards in this Set
- Front
- Back
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What is the term "field cancerization" mean?
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As a result of its structure, the entire upper aerodigestive tract is exposed to carcinogens and the entire area must be evaluated when malignancy is found
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What are the top two risk factors for head and neck cancer?
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Tobacco and alcohol
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Epstein-Barr virus is implicated in _____________ carcinoma and HPV is linked to ____________ carcinoma.
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Nasopharyngeal
Oropharyngeal |
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GERD is linked to ____________ carcinoma.
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Laryngeal
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What types of occupational exposures increase risk for head and neck cancer?
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Textile workers
Leather manufacturing Nickel refining Radiation Wood dust |
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Where do head and neck cancers typically originate and what are the two patterns of spread?
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Originates on mucosa of upper aerodigestive tract
Direct spread - invasion into submucosa and muscle Indirect spread - through invasion into tissue planes, along nerves, by entry into lymphatics |
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T or F: Most lesions are asymptomatic at onset.
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True
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Any patient presenting with _________ persisting beyond 6 weeks or __________ beyond 4 weeks needs pharyngeal evaluation.
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Hoarseness
Sore throat |
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What is trismus?
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Inability to open the jaw from compression of trigeminal n
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What is the most common type of cancer of the oral cavity and oropharynx?
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90% squamous cell
5-7% from salivary glands - adenocarcinoma |
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What is adenoid cystic carcinoma known for?
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Known for its spread through perineural metastasis and slow growth rate
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What is the most common type of cancer of the paranasal sinuses?
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80% squamous cell
15% adenocarcinoma 5% rare tumors - lymphoma, melanoma, olfactory neuroepithelial tumor |
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What is unique about cancers of the nasopharynx?
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Most are squamous cell arising in Rosenmuller's fossa (very rich lymphatic region)
Tend not to be associated with smoking More common in Asians, rare in whites |
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What is the most common cancer of the salivary glands?
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Majority of adenocarcinomas, but squamous cell may arise in the ducts
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What is the most common cancer of the larynx and hypopharynx?
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95% squamous cell
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What is verrucous cancer?
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Well differentiated subtype that "never metastasizes"
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How do you approach the patient that may have head/neck cancer?
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Thorough H&P
Detailed head and neck exam with laryngoscopy CT/MRI/CXR Baseline hematologic and biochemical tests *CEA elevated in about 45% of patients Nutritional status |
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Why is it important to assess nutritional status in patients with head/neck cancers?
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Treatment is usually multimodal and has a significant impact on nutrition (difficult to eat when you have throat/mouth cancer) and it may place a burden on patient/family
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What is the difference between radical neck dissection and a modified radical neck dissection?
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Radical - removal of all lymph nodes, strap muscles, spinal accessory nerve, superficial veins
Modified radical - leaves spinal accessory nerve |
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When is radiation therapy used for head/neck cancer, in general?
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Poorly differentiated tumors
Tumor at or near histologically defined surgical margins Extensive lymphatic involvement Multiple positive cervical lymph nodes Tumor extends thru node capsule to surrounding tissue |
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T or F: Radiation therapy may be given as external beam or via implants (brachytherapy).
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True
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How is chemotherapy used and in what types of tumors is it most effective?
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Combinations of agents or in combination with radiation
Most effective in laryngeal and nasopharyngeal tumors |
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How do you treat early stage lesions of the oral cavity/oropharynx? Advanced lesions?
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Early - Radiation and surgery equally effective
Advanced - Multimodal therapy (radiation and surgery) |
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What is the outcome of treatment of oral cavity/oropharynx lesions?
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Early - 80-90% 5 year survival rate
Advanced - 25-35% 5 year survival rate |
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What is the most frequent site for head/neck cancers?
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Larynx
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How do you treat early and advanced lesions of the larynx?
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Early - surgery and radiation equally effective
Advanced - Typically require laryngectomy (and neck dissection if lymph nodes positive) and post-op radiation |
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What is the outcome of treatment of larynx lesions?
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Early glottic - 80-95% cure rate
Advanced glottic - 20% 5 year survival rate Supraglottic fare 10-25% worse than glottic lesions Subglottic - fare poorly uniformly <25% 5 year survival |
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How do you treat early and advanced lesions of the hypopharynx and cervical esophagus ?
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Early - very rare, most are asymptomatic until lesions are advanced. Treat with radiation, occasionally used
Advanced - aggressive surgical and radiotherapeutic treatment |
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What is the outcome of treatment of hypopharynx lesions?
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Early - 60-70% curability
Advanced - <30% long term survival |
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What is the treatment for nasopharyngeal lesions?
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Often asymptomatic until advanced - ear pain and nasal stuffiness
Primary treatment is radiation regardless of size but seems to be sensitive to chemo *Must treat bilaterally!!!! |
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What is the outcome of treatment of nasopharyngeal lesions?
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Virulent tumor - <15% long term survival
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What are the treatment options for nasal cavity and paranasal sinus lesions?
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Surgery combined with radiation offers better response rates
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What is the outcome of treatment of nasal cavity/paranasal sinus lesions?
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Poor. Recurrence common with <15% 5 year survival
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How are lesions of salivary glands treated?
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Surgical removal of affected gland (parotid most common)
Ipsilateral radical neck dissection |
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What is the outcome of treatment of salivary gland lesions?
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40% 5 year survival
Adenoid cystic carcinoma - 70-80% at 5 years, 40% at 10, 20% at 20 |
