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ENT > MALIGNANT TUMOR H & N > Flashcards

MALIGNANT TUMOR H & N Flashcards

1
Q

Most malignant tumors that develop above the clavicles are

A

Squamous Cell Carcinomas

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2
Q

Differences in the natural history of tumors arising from different sites:

A
  • Blood supply
  • Lymphatic drainage
  • Histologic variation specific to the area
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3
Q
  • Associated with Nasopharyngeal carcinoma
  • Infection is prevalent in nasopharyngeal carcinoma
    > Elevated serum levels of EBV titers = increased risk
A

Epstein Barr virus

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4
Q
  • Signs and Symptoms:
    > Formication
    + Prograde neural symptom
    + Feeling of ants crawling along the lips or cheek
    + Represent mental or infraorbital nerve invasion
  • Changes in speech
    > Tethering of the tongue
  • 64% present with cervical or disseminated metastasis
  • otalgia
A

Carcinomas

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5
Q

Reffered psin in otalgia
- lingual
- glossopharyngeal
- vagus

A

lingual - auriculotemporal
glossopharyngeal - tympanic nerve
vagus - auricular nerve

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6
Q

Palpation of lymph node stations in carcinomas:

A
  • Submental (Level IA)
  • Submandibular (Level IB)
  • Jugulo-digastric (Level II)
  • Mid-jugular (Level III)
  • Jugulo-omohyoid (Level IV)
  • Posterior triangle (Level V)
  • Supraclavicular or Central lymph node
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7
Q

-Sympathetic nerve fiber injury
-Anhidrosis
-Miosis
-Ptosis
-Loss of ciliospinal reflex
-Enophthalmos

A

Horner’s Syndrome

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8
Q

Triple Endoscopy consist of :

A
  • Bronchoscopy
  • Esophagoscopy
  • Direct laryngoscopy
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9
Q

Definitive/curative treatment:
○ Consist of:
Early Stage (I and II)

A
  • Surgery alone
  • Radiotherapy alone
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10
Q

Definitive/curative treatment consist of:
- Advance Stage (III, IVA and IVB)

A
  • Surgery + radiotherapy ( pre-op or post-op adjuvant therapy)
  • Surgery + chemotherapy ( systemically by intravenous infusion or locally by intra-arterial infusion)
  • Surgery + Radiotherapy + Chemotherapy
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11
Q

Lymph Node Drainage
○ Radical Neck Dissection:

A

removal of Level I-V nodes with SCM, Internal Jugular Vein and Spinal Accessory nerve

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12
Q

Lymph Node Drainage

  • Site of potential lymph node metastasis can be accurately
    predicted by determining the site of the primary tumor
    > Oral Cavity → Level I-III
    > Nose, Pharynx → Level II-V
    > Thyroid and Larynx → Level III, IV, and VI
A

Selective Neck Dissection

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13
Q

Lymph Node Drainage

  • Spinal accessory nerve, Jugular vein and the
    Sternocleidomastoid muscles are preserved
  • Long term function is improved
A

Modified Neck Dissection

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14
Q
  • Common site of metastasis
  • Solitary lesions may also be a primary lesion
  • Resection is not recommended most of the time
A

Lung

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15
Q
  • Male predominance ( 20:1 )
  • Lower lip is the most common site ( 95% )
    > Higher exposure to sunlight
  • Squamous cell carcinoma = most common histology
A

Lip

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16
Q

Basal cell carcinoma predominates

A

Upper lip

17
Q

Bounderies:
- soft palate
- teeth

A
  • Posterior = soft palate
  • Anterior and lateral = teeth
18
Q
  • Most common salivary gland CA
  • Classified into Low-grade, Moderate and High grade MEC
    > According to mucous and squamoid appearance
  • More Squamoid=higher grade
  • Diagnostic: FNAB
    > CT Scan of the Neck with contrast
    > Metastatic work-up
  • Tx: Total Parotidectomy + Neck Dissection
A

Mucoepidermoid CA

19
Q
  • 10% of all salivary gland CA
  • May occur in all age group
  • Considered as low grade salivary gland CA but high-grade transformation exists
  • Diagnostic: FNAB + CT Scan of the neck with contrast
  • Metastatic work-up
  • Tx: Parotidectomy + Neck Dissection
A

Acinic Cell CA

20
Q
  • High-grade salivary gland malignancy
  • M=F; 50-60 years old
  • Known for “Perineural invasion”
  • Classic histologic findings “Cribriform or Swiss cheese appearance”
  • Same diagnostic work-up and treatment
A

Adenoid Cystic CA

21
Q
  • Most common well-differentiated thyroid carcinoma
  • 60-70% of thyroid CA
  • F>M; 30-40 years old
  • “Orphan Annie eye” appearance
  • Psammoma bodies – 40%
  • Known for lymphatic spread; usually at level VI or central neck nodes
  • Tx: Total Thyroidectomy + Neck dissection + RAI
    RAI for tumor > 4 cm
A

Papillary Thyroid CA

22
Q
  • 10% of thyroid CA; still considered as welldifferentiated
    thyroid CA
  • F>M; 50 years old
  • Known for distant metastasis- Hematogenous spread
  • Liver, Lung, Brain
  • Tx: Total Thyroidectomy + Neck dissection + RAI
A

Follicular Thyroid CA

23
Q
  • 5% of all thyroid CA; intermediate
  • Arises from Parafollicular C Cells secreting calcitonin, carcinoembryonic antigen CEA, histaminidase, prostaglandin, and serotonin
    > During work-up: Calcitonin, Calcium and CEA levels should be determined pre-op and 2-3 months post-operatively
  • Only type of thyroid CA that does not develop in a Thyroglossal duct cyst or Lingual thyroid that with CA formation
  • Tx: Total Thyroidectomy + Neck Dissection
A

Medullary Thyroid CA

24
Q
  • 5% of thyroid CA; poorly-differentiated thyroid CA
  • 60-70 years old; F>M
  • May develop from a pre-existing papillary thyroid CA
  • Worst type of thyroid CA (very poor prognosis)
  • Treatment is controversial, only palliative procedures such as tracheostomy, gastrostomy and chemo-radiation therapy
A

Anaplastic Thyroid CA

25
Q

SITE
- Squamous Cell Carcinoma
> 85-95%
- M>F
- Clinical features:
> Supraglottic- dysphagia
> Glottic- hoarseness
> Subglottic- dyspnea
- Stridor- high-pitch sounds secondary to airway obstruction
> Inspiratory, expiratory and biphasic

A

Larynx

26
Q

Risk factors OF MALIGNANCY IN THE LARYNX

A
  • Smoking
  • Alcohol intake
  • Vitamin deficiency
  • Radiation exposure
  • HPV 16 and 18
  • Laryngopharyngeal reflux
  • Occupational chemicals
    > Asbestos, cement, Isopropyl alcohol, Leather, Mustard gas, Sulfuric acid, Wood dust, Coal and Tar products
27
Q

Nodal spread of CA in the larynx

A
  • Supraglottic- Level II, III, IV
  • Glottic- rare
  • Subglottic- Level VI or also to level II, III, IV for large tumors

ENT (9 decks)

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