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Flashcards in ENT neoplasms Deck (50):
1

Epidemiology of ENT neoplasms?

- male to female ratio: 2:1 to 4:1
- US: 3% of malignancies
- 12,000 Americans die and 60,000 develop these neoplasms annually

2

RFs of ENT neoplasms?

smoking
- 5-25 fold increase compared to non-smokers
- 2ndhand smoke exposure
-marijuana use maybe

alcohol: may have assoc with smoking

viral infection:
EBV - most common in S. China
HPV: HPV type 16, usually seen in younger men who are nonusers of tobacco or alcohol
HIV: 2-3x increase risk for SCC

occupational exposure: dry cleaning agents, pesticides, plastic and rubber products

radiation: assoc with thyroid cancer, salivary gland tumors, SCC, sarcomas

poor oral hygiene and periodontal disease

3

Mucosal oral tumors?

- leukoplakia
- erythroplakia
- oral lichen planus
- oral carcinoma

4

Salivary gland tumors?

- parotid
- warthin's tumor
- pleomorphic adenoma

5

What is leukoplakia?

- precancerous lesion that presents as white patches or plaques on oral mucosa that can't be removed by rubbing
- b/t 1-20% of lesions progress to carcinoma within 10 years
- common in smokeless tobacco users
- bx to rule out SCC
- distinguished by thrush - white patches can't rub off

6

What is erythroplakia?

- similar to leukoplakia except it has red erythematous component
- 90% cases are dysplasia or carcinoma
- ETOH/tobacco risk factors
- need bx to confirm

7

What is oral lichen planus?

- chronic inflammatory autoimmine disease
- presentation: lace like white patches on buccal mucosa, erosions on gingival margin
- exfoliative cytology or bx
- therapy aimed at managing pain and discomfort: corticosteroids
- good dental hygiene, going to dentist regularly

8

Oral cancer - Mostly what?
most common locations?

- 90% of all oral cancers are SCC
- most common locations:
tongue
tonsils
gums
floor of mouth
- 8th most common cancer in men

9

Signs and sxs of oral cancer?

- most common is sore in mouth that doesn't heal
- red or white patch in mouth
- persistent sore throat or something caught in throat
- hoarseness or change in voice
- chronic halatosis

10

Dx oral cancer?

- good hx for RFs
- exam: close inspection of oral cavity
- endoscopy
- bx: FNA, open bx, oral brush
- CT/MRI/US

11

Tx of oral cancer?

- surgery
- radiation: sometimes in combo or primary tx, used for pts who can't undergo surgery or surgery causes severe impairment

12

Most common sites for salivary gland tumors?

- parotids: 80-85%
- submandibular: 40-45%
- sublingual: 70-90%
- 50-70% minor salivary glands

- most common type of benign salivary gland tumor is pleomorphic adenoma (parotid)
- MC type of malignant tumors include mucoepidermoid carcinoma and adenoid cystic carcinoma

- rare tumor, 6-8% of head and neck tumors
- 2000-2500 cases/yr in US

13

RFs of salivary gland tumors?

- radiation exposure
- smoking: warthin's tumor only salivary tumor assoc with smoking
- virus infection: HIV, EBV
- industrial exposure: rubber manufacture, hair dressers, nickle compounds

14

Presentation of salivary gland tumors?

- painless mass or swelling of salivary glands
- minor salivary glands arising within oral cavity present:
sub-mucosal mass, mucosal ulceration of palate, lips or buccal mucosa
depending on location:
nasal obstruction
congestion
vision changes
trismus
(have face paralysis and other involvement - think malignant)

15

Work up: PE of salivary gland tumor, studies done?

- workup:
good hx about mass - how long has it been there? Getting bigger? any hx of skin cancer (SCC/melanoma)
PE:
impt close inspection of oral cavity, palpation of neck, facial nerve paralysis - have pt make faces at you!
imaging:
CT/MRI/US: with warthin tumor need to image both parotid glands, tendency to be bilateral (look for mass on otherside if found on one side)
- bx: FNA cytology, US guided core bx

16

Tx of salivary gland tumors? parotid gland tumor tx?

- usually surgery, radiation or combo

parotid gland: depends on size, involvement, benign, malignant, or facial involvement
- conservative: partial parotidectomy w/o 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 facial nerve (high grade tumor)
- benign:
superficial resection - pleomorphic adenomas
conservative - warthin's tumors

17

Tx of submandibular gland tumor?

- submandibular sialoadenectomy and resection of submandibular gland
- benign: simple excision of gland

18

Sublingual gland tumor tx?

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

19

Minor salivary gland tumor tx?

- surgical resection with radiation preferred

20

How common are pleomorphic adenomas?
Dx tests, tx?

- 3-6% of all head and neck tumors
- most common benign tumor of parotid (53-71%)
- slowly growing, painless, solitary, firm, smooth, moveable mass without nerve involvement
- CT/MRI/FNA
- superficial parotidectomy

21

Describe warthin's tumor?

- 2nd most common benign tumor
- tendency to be bilateral, parotid gland only
- older age group
- superficial location
- smoking is a RF: only salivary gland tumor with this risk factor (foot stomp)
- conservative resection

22

How common are nasal and sinus tumors?

- cancerous nasal cavity or sinus tumors are rare
- about 2000 cases diagnosed in US each year
- most of these tumors occur in maxillary sinus (60-70%)
- 20-30% are in nasal cavity
- 10-15% are in ethmoid sinuses
- cancer in sphenoid or frontal sinuses is extremely rare (5% of cancers)

23

Causes and RFs of nasal and sinus tumors?

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

24

Signs and sxs of nasal and sinus tumors?

- persistent nasal congestion, especially on one side
- pain in forehead, cheek, nose or around eyes or ear (double or blurred vision)
- post-nasal drip at back of throat
- frequent and persistent nosebleeds

25

Dx of nasal and sinus tumors?

- medical hx and PE of head and neck
- small fiberoptic scope may be used to look in the nasal cavity and sinuses
- bx:
FNA, open bx
- CT/MRI/PET

26

Tx of nasal and sinus tumors?

- surgery:
+/- radiation or chemo
- radiation
- chemo

27

Malignant nasal and sinus tumors?

- SCC: most common
- adenocarcinoma: occurs in sinus lining
- lymphomas
- esthesioneuroblastomas: develop from nerves at base of skull where they enter the nasal cavity and provide sense of smell

28

Benign nasal and sinus tumors?

- osteomas: usually don't cause sxs, but can impede the frontal, ethmoid or maxillary sinuses, if it does cause obstruction it will need to be removed surgically
- viral infections:
HPV - can cuase papillomas - wart like growths in the nose or sinus, 10% are cancerous, most are benign

29

How is nasopharyngeal cancer different than other pharyngeal cancers?

- much more common with Asians and SE Asian populations
- strongly correlated wth EBV
- some types are highly radiosensitive and radiotherapy is the preferred tx
- most nasopharyngeal cancers are SCC

30

Keratinizing form of nasopharyngeal cancer?

- well-differentiated cells that produce keratin:
more common in US, less in Asia
- less assoc with EBV
- may be assoc with tobacco use
- less radiosensitive and more radio resistant
- doesn't tend to met

31

Non-keratinizing nasopharyngeal cancer?

- tends to met to regional lymph nodes
- variable radiosensitivity
- often linked to EBV infection

32

Undiff subtype nasopharyngeal cancer?

- often occurs in conjunction with high numbers of lymphocytes
- more common in Asia
- most often assoc with EBV
- tend to met to regional lymph nodes
- very radiosensitive

33

Signs and sxs of pharnygeal tumors?

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

(triad: lump in nose or neck, nasal obstruction with nose bleeds, and serious otitis media)

34

Oropharyngeal cancer - most common type?
Areas for cancer?

- most are SCC
areas:
-base of tongue
-tonsillar region: most common site for primary cancers of oropharynx
- soft palate/uvula
- pharyngeal wall

35

RFs of oropharyngeal tumors?

- tobacco (both chewed and smoked)
- poor nutrition
- heavy ETOH consumption
- Eastern Asian descent

36

Signs and sxs of oropharyngeal tumors?

- sore throat that doesn't go away
- lump in back of mouth, neck, or throat
- dull pain behind breastbone
- cough
- trouble swallowing

37

Hypopharyngeal tumor - most common type?
RFs?

- least common type of pharyngeal cancer
- SCC MC type

- RFs:
excessive drinking
smoking
male gender
poor nutrition
HPV

38

Signs and sxs of hypopharyngeal cancer?

- sore throat that doesn't go away
- ear pain
-lump in neck
- painful or difficulty swallowing
- change in voice

39

Dx pharyngeal tumors?

- Hx and PE
- head, neck and CXRs
- CT/MRI/PET
- endoscopy
- bx: FNA, open bx
- HPV testing

40

Dx specific for nasopharyngeal cancer?

- nasoscopy
- EBV test

41

Dx specific for hypopharyngeal cancer?

- barium esophagogram
- esophagoscopy
- bronchoscopy

42

Tx of pharyngeal tumors?

- surgery mainstay for most
exceptions:
nasopharyngeal cancer - primarily tx with radiation, keratinizing form is much less responsive to radiation than non-keratinizing forms, so these benefit from surgery
- radiation: alone or with chemo
- chemo

43

MC type of laryngeal tumors?

- 95% are SCC
- most commonly arise from glottic region (vocal cords)
- majority of pts have hx of smoking and ETOH use

44

4 subtypes of laryngeal tumors?

- glottic carcinoma: involves true vocal cords (50-60%)
- supraglottic carcinoma: confined to supraglottic area (30-40%)
- subglottic carcinoma: arise more than 10 mm below free margin of vocal cords (5%)
- transglottic carcinoma: cross ventricle from supraglottic area to involve true and false vocal cords

45

Other laryngeal cancers?

- carcinoma in situ
- verrucous (spindle cell and basaloid SCC)
- undifferentiated carcinoma
- adenocarcinoma
- sarcomas

46

RFs of laryngeal tumors?

- tobacco/ETOH
- poor diet and oral hygiene
- HPV
- GERD (changes in cells from acid reflux)

- asbestos
- formaldehyde

47

How common are laryngeal tumors? What pt population are they most common in?

- comprises of 2-5% of all malignant disease
- highest in med aged 55-65
- male to female ratio:
5-20:1

48

Presentation of laryngeal tumors?

- progressive continuous hoarseness is cardinal sx
- dyspnea
- stridor
- dysphagia
- bad breath
- hemoptysis
- (also worry about lung cancer)

49

Workup of laryngeal tumors?

- CT/MRI/PET
- CXR
- direct laryngoscopy: can obtain bx
- FNA cytology

50

Tx of laryngeal tumors?

- early stages are tx with either radiation or surgical techniques to preserve laryngeal fxn
- advanced stages are tx with total laryngectomy, reconstruction, and postop chemorad therapy