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Flashcards in ENT Neoplasms Deck (26)
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1

ENT neoplasms
-risk factors

-smoking

-alcohol

-viral (EBV, HPV, HIV)

-occupational exposure (dry cleaning agents, pesticides, plastic and rubber products, hair dressers)

-radiation

-poor oral hygiene and periodontal disease

2

What are the types of oral tumors?
-mucosal
-salivary gland

mucosal
-leukoplakia
-erythroplakia
-oral lichen planus
-oral carcinoma

salivary gland
-parotid
-warthlin's tumor
-pleomorphic adenoma

3

Mucosal: Leukoplakia
-what
-what % progress to carcinoma within 10 years?
-common in people who use what?
-dx

what
-precancerous lesion that presents as white patches or plaques on oral mucosa that cannot be removed by rubbing/scraping

-between 1 and 20% of lesions progress to carcinoma within 10 years

common in
-smokeless tobacco users

dx
-biopsy to rule out SCC

4

Mucosal: Erythroplakia
-what
-what % of cases are dysplasia or carcinoma
-specific risk factors
-dx

what
-similar to leukoplakia except it has a red erythematous component

-90% of cases are dysplasia or carcinoma

risk factors
-alocohol/tobacco

dx
-bx to confirm

5

Mucosal: Oral Lichen Planus
-what
-presentation
-dx
-tx

What
-chronic inflammatory autoimmune disease

Presentation
-lace-like white patches on buccal mucosa
-erosions on gingival margin

Dx
-bx or exfoliative cytology

tx
-aimed at managing pain and discomfort
-corticosteroids

6

Mucosal: Oral Cancer
-MC type
-MC locations
-sx

MC type
-90% of all oral cancers of squamous cell carcinoma

MC location
-tongue, tonsils, gums, floor of mouth

Sx
-MC is sore in mouth that does no heal
-red or white patch in mouth
-persistent sore throat or something caught in throat
-hoarseness or change in voice
-may have chronic bad breath, difficulty moving tongue and jaw

7

Mucosal: Oral Cancer
-Dx
-Tx

Dx
-Good history for risk factors
-close insepction of the oral cavity
-endoscopy
-bx (fine needle aspiration, open biopsy, oral brush)
-CT/MRI/US

Tx
-Surgery
-radiation
--combo or primary tx, used for pts that cant undergo surgery

8

Salivary Gland Tumors
-MC site
-other sites
-MC type of benign salivary gland tumor?
-MC type of malignant salivary gland tumor?

MC site
-parotid (80-85%)

other sites
-submandibular gland, sublingual, minor salivary glands

MC type of benign salivary gland tumor?
-Pleomorphic adenoma (parotid)

MC type of malignant salivary gland tumor?
-mucoepidermoid carcinoma and adenoid cystic carcinoma

9

What is the only salivary gland tumor associated with smoking?

Warthin's tumor

10

Salivary Gland Tumors
-Presentation
-workup

Presentation
-painless mass or swelling of the salivary glands
-depending on location: nasal obstruction, congestion, vision changes, trismus

*minor salivary glands arising within oral cavity present: sub-mucosal mass, mucosal ulceration of the palate, lips, or buccal mucosa

Workup
-Good hx, PE
-CT/MRI/US (with Warthin need to image both parotid glands, tendency to be bilateral)
-bx (fine needle aspiration cytology, ultrasound guided core bx)

11

Salivary Gland Tumors
-Tx
*Parotid
-pleomorphic adenoma
-warthin's tumor
*Submandibular glands
*Sublingual glands
*Minor salivary glands

Tx
-Usually surgery, radiation, or combo

*Parotid Gland:
--depends on size, involvement, benign, malignant, or facial involvement
--Conservative: partial parotidectomy without fully dissecting facial nerve
--Superficial: parotidectomy of entire superficial lobe and dissection along facial nerve
--Total: removal of entire lobe and surrounding tissue with preservation of the facial nerve
-Pleomorphic adenoma=superficial resection
-Warthin's tumor=conservative

*Submandibular glands
--submandibular sialoadenectomy and resection of submandibular gland
--Benign=simple excision of gland

*Sublingual glands
--resection of floor of mouth and involved sublingual gland, as well as ipsilateral submandibular gland

*Minor Salivary gland
--Surgical resection with radiation preferred

12

Salivary: Pleomorphic Adenoma
-Tumor of what gland
-progression
-dx
-tx

-Most common benign tumor of PAROTID

Progression
-slowly growing, painless, solitary, firm, smooth, moveable mass without nerve involvement

Dx
-CT/MRI/FNA (fine needle aspiration)

Tx
-Superficial parotidectomy

13

Salivary: Warthin's Tumor
-Tumor of what gland
-bilateral or unilateral
-risk factor
-common in what age group
-Tx

Tumor of what gland
-PAROTID

bilateral or unilateral
-tends to be bilateral

risk factor
-SMOKING (only salivary gland tumor with this risk factor)

common in what age group
-older people...

Tx
-conservative resection

14

Nasal and Sinus Tumors
-MC site?
-other sites
-causes and risk factors

MC site
-maxillary sinus

Other sites
-nasal cavity
-ethmoid sinuses
-sphenoid or frontal sinus (rare)

Causes/Risk factors
-smoking and tobacco smoke
-exposure to dust from wood
-leather or textiles
-inhaling vapors from glue
-formaldehyde
-solvents
-nickel
-HPV particles

15

Nasal and Sinus Tumors
-signs and sx
-dx
-tx

Signs and sx
-persistent nasal congestion, especially on one side
-pain in the forehead, cheek, nose, or around the eyes or ear
-post nasal drip
-frequent/persistent nose bleeds
-present late stage

Dx
-hx and PE
-small fiberoptic scope may be used to look in the nasal cavity and sinuses
-bx (FNA, open bx)
-CT/MRI/PET

Tx
-Surgery +/- radiation or chemo
-radiation
-chemo

16

Nasal and Sinus Tumors
-types of malignant
-types of benign

Malignant
-Squamous Cell Carcinoma (SCC) is MC
-Adenocarcinoma (occurs in sinus lining)
-Lymphomas
-Esthesioneuroblastoma (develop from nerves at base of skull where they enter the nasal cavity and provide sense of smell)

Benign
-Osteomas (usually do not cause sx, can impede frontal, ethmoid, or maxillary sinuses)
-viral infections (HPV) can cause papillomas (wart-like growths in the nose or sinus)

17

Pharyngeal Tumors: Nasopharyngeal cancer
-Common in what populations
-strongly correlated with what virus
-most common type of nasopharyngeal cancer
-preferred tx

Common in what populations
-asians and southeastern asian

strongly correlated with what virus
-EBV

most common type of nasopharyngeal cancer
-SCC

preferred tx
-radiotherapy

18

Pharyngeal Tumors: Nasopharyngeal cancer
Describe:
-Keratinizing
-non-keratinizing
-undifferentiated subtype

Keratinizing
-well differentiated cells that produce keratin
-common in the US

non-keratinizing
-tends to metastasize to regional lymph nodes

undifferentiated subtype
-often occurs in conjunction with high numbers of lymphocytes
-more common in Asia
-tends to metastasize to regional lymph nodes

19

Pharyngeal Tumors: Nasopharengeal Cancer
-Signs and sx

-lump in nose or neck
-sore throat
-trouble breathing or speaking
-nosebleeds
-trouble hearing
-pain or ringing in ears
-headaches

20

Pharyngeal Tumors: Oropharyngeal cancer
-Most common type
-sites
-risk factors

Most common type
-SCC

Sites
-Base of tongue
-tonsillar region *most common site for primary cancers of the oropharynx
-soft palate/uvula
-pharyngeal wall

Risk Factors
-Tobacco
-poor nutrition
-heavy alcohol consumption
-Eastern Asian descent
-HPV

21

Pharyngeal Tumors: Oropharyngeal cancer
signs and sx

-sore throat that does not go away
-lump in back of mouth, throat, or neck
-dull pain behind the breastbone
-cough
-trouble swallowing

22

Pharyngeal Tumors: Hypopharyngeal cancer
-Most common type
-risk factors
-signs and sx

Most common type
-SCC
(although hypopharyngeal cancer is the least common type of pharyngeal cancer)

Risk Factors
-Excessive drinking
-smoking
-poor nutrition
-male gender
-HPV

Signs and sx
-sore throat that does not go away
-ear pain
-lump in neck
-painful or difficulty swallowing
-change in voice

23

Pharyngeal Tumors
-Dx
-Nasopharengeal cancer dx
-hypopharengeal cancer dx
-Tx

Dx
-Hx and PE
-Head, neck, and chest Xrays
-CT/MRI/PET
-Endoscopy
-Bx (FNA, open bx)
-HPV testing

Nasopharengeal cancer dx
-nasoscopy
-EBV test

Hypopharengeal cancer dx
-Barium esophagogram
-esophagoscopy
-brochoscopy

Tx
-Surgery is mainstay*
--exception: nasopharyngeal cancer is primarily treated with radiation
--The keratinizing form is much less responsive to radiotherapy than non-keratinizing forms that benefit from surgery
-radiation (alone or with chemo)
-chemo

24

Laryngeal Tumors
-most common type
-commonly arise from what region
-most pts have a hx of what?

Most common type
-SCC

Commonly arise from what region
-Glottic (vocal cords)

Most pts have a hx of what?
-smoking and alcohol use

25

Laryngeal Tumors
Describe the following subtypes
-Glottic Carcinoma
-Supraglottic carcinoma
-Subglottic carcinoma
-Transglottic carcinoma

-Glottic Carcinoma: involves true vocal cords (most common)

-Supraglottic carcinoma: confined to supraglottic area

-Subglottic carcinoma: arise more than 10mm below free margin of vocal cords

-Transglottic carcinoma: cross ventricle from supraglottic area to involve true and false vocal cords

26

Laryngeal Tumors
-risk factors
-presentation
-workup
-tx

risk factors
-tobacco/alcohol
-poor diet and oral hygiene
-HPV
-GERD

presentation
-progressive continuous hoarseness is cardinal system
-dyspnea
-stridor
-dysphagia
*have to keep lung cancer in mind

workup
-CT/MRI/PET
-Chest xray
-Direct laryngoscopy (can obtain bx)
-FNA cytology

tx
-early stages: radiation or surgical techniques to preserve laryngeal fuction
-advanced stages: total laryngectomy, reconstruction, and post op chemo/radiation