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H&N Flashcards

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1
Q

Subsites of oral cavity

A

Hard palate, RMT, alveolar ridge, oral tongue, floor of mouth, buccal mucosa, mucosal lip

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2
Q

T staging oral cavity

A

T1: <2 cm with < 5mm Doi, T2: <2 cm with >5 mm DOI or 2-4 cm with DOI <10 mm, T3: 2-4 cm with DOI>10 mm or Tumor>4 cm with DOI < 10 mm, T4a: >4 cm and DOI > 10mm OR tumor invades adjacent structures, T4b: invades deeper(skull base)

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3
Q

N stage oral cavity

A

N1: single ipsi LN 3cm or smaller without ENE, N2a: single ipsi 3-6 cm, N2b: multiple ipsi < 6cm, N2c: bilateral or contralateral < 6cm, N3a: >6 cm, N3b: ENE

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4
Q

Management of Oral cavity cancer

A

Surgery with LND

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5
Q

When to use adj RT after oral cavity resection

A

T#-4, N2+, PNI/LVSI, Close margin < 5mm, LEVEL IV/Vb LN+

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6
Q

When to use adj CCRT after oral cavity SCC resection

A

Positive margin, ENE

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7
Q

Subsites of oropharynx

A

palatine tonsil, BOT, soft palate, pharyngeal wall

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8
Q

T staging P16+ HN SCC

A

T1:<2cm, T2:2-4 cm, T3: >4cm, T4: Invasion of larynx, tongue, medial pterygoid, hard palate, mandible, or beyond

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9
Q

N staging p16+ SCC

A

cN1: ipsi LN < 6 cm, cN2: contralateral or bilateral LN < 6 cm, cN3: LN>6 cm, pN1: 1-4 LN, pN2: 5+ LN

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10
Q

Management of oropharynx T1-2N0

A

TORS or RT alone (66/60/54)

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11
Q

Management of T3 or N+ SCC of oropharynx

A

CCRT 70 Gy/2Gy+HDC 100 mg/m2 q 3w

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12
Q

Subsites of hypopharynx

A

pyriform sinus, posterior pharyngeal wall, post-cricoid space

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13
Q

Glottis T staging

A

T1a: limited to one vocal cord, T!b: involving bot vocal cords ,T2: extension to supra or sub glottis or impaired vocal cord mobility, T3: invasion of inner cortex of thyroid cartilage or VC fixation, T4a: invasion through outer cortex of Thyroid cartilage, T4b: very advanced

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14
Q

Management of T1-2N0 glottic

A

cord stripping or CO2 laser or RT (Tis 60.75, T1: 63 Gy, T2: 65.25 Gy)

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15
Q

Management of cT1-2N0 Supraglottic

A

Definitve RT 70Gy/2Gy

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16
Q

Management of cT3-4N+ larynx

A

Larynx preservation if less than T4a disease with some function, 70/2 with cisplatin OR total laryngectomy + LND with adj RT vs CCRT

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17
Q

Management of cT4b larynx

A

CCRT, laryngectomy is off the table

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18
Q

Management of hypopharynx cT1N0

A

Partial laryngopharyngectomy + LND or definitive RT 70/2 DAHANCA

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19
Q

Management of cT12-4a or N+ hypopharynx

A

Total laryngopharyngectomy + LND with adj RT vs CCRT OR Definitive CCRT

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20
Q

Management of cT4b Hypopharynx

A

Definitive CCRT

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21
Q

Borders for T1 larynx field

A

Superior: top of thyroid cartilage, Inf: bottom of cricoid cartilage, Post: anterior VB, Anter: flash skin

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22
Q

Borders for T2 larynx field

A

Sup: top of hyoid, Inf: first tracheal ring, Post; anterior VB, Ant: Flash skin

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23
Q

In larynx definitive CCRT what are your CTVs

A

CTV70 is GTV + 5mm, CTV 63 Is 5 mm more and also the whole larynx and LVL II-IV in N+ neck, CTV56 to uninvolved bilateral II-IV (cover VI if subglottic extension, cover RP if hypopharynx extension.

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24
Q

Which WHO GRADE Nasopharynx SCC is associated with EBV

A

G3

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25
Which WHO GRADE Nasopharynx SCC is associated with smoking
G1
26
T staging Nasopharynx
T1: confined to NPX with extension to OPHX or nasal cavity without parapharyngeal involvement, T@: extension to parapharyngeal space and/or adj soft tissue involvement, T3: invasion of bone and/or paranasal sinuses, T4: intracranial extension.
27
N staging nasopharynx
N1: unilateral, N2: bilateral, N3: any >6 cm or below the caudal border of cricoid cartilage
28
Management of cT1N0 nasopharynx
RT alone (70/63/56
29
Management of cT2N0 nasopharynx
CCRT
30
Management of cT3-4 or N+ nasopharynx
Induction CHT + CCRT
31
What induction chemo is used for nasopharynx
cis 80 + gem 1000
32
What is covered in CTV for nasopharynx
GTV+1 cm, Vomer and surrounding ethmoid sinus, Sphenoid sinus, cavernous sinus (T3-4), Clivus, Bilateral foramen ovale, rotunda, and lacera, posteirior 5mm nasal caviy and maxillary sinus, Parapharyngeal space.
33
Mandible constraint
max 70 Gy
34
Parotid constraint
Mean < 26 Gy
35
What nodes should be treated in nasopharynx
bilateral II-V and RP and retrostyloid LN (level IV can go to lowest level)
36
What are the paranasal sinuses
ethmoid, sphenoid, maxillary, frontal
37
Management of maxillary sinus SCC
same as oral cavity, craniofacial resection then adj RT vs CCRT if needed
38
Olfactory neuroblastoma staging system
Kadish staging
39
Kadish staging A-D
Stage A: confined to nasal cavity, Stage B: extends to paransal sinuses, Stage C: Beyond nasal cavity or paranasal sinuses, Stage D: LN or DM
40
Management for Stage A Olf Neuroblast
craniofacial resection +/- RT 60/2Gy
41
Management for Stage B-D Olf Neuroblast
If Resectable resect then PORT, if borderline, preop chemo then resect then PORT, if unresectable, definitive CCRT
42
Management of SNUC
Induction CHT, PR/CR: CCRT 70/2Gy, if SD/PD: craniofacial resection --> PORT 60/2 (debulk as much as possible if not complete resectable then CCRT 70/2
43
What is the first CN affected in NPX carcinoma, through what route?
CN VI, through lacerum to cavernous sinus
44
Next most common CN involvement in NPX?
CN V1 and V2, V1: Superior orbital fissure, V2: rotundum, V3: ovale
45
What is ccrt chemo and what is adj chemo for NPX?
cis 100, then cis/5FU
46
What is FU NPX?
PET CT at 12 weeks, if node positive, FNA then dissection if positive. Also consider EBV viral load, it's prognostic
47
What is T4a stage for OPX?
HTML (hard palate, tongue, medial pterygoid, larynx)
48
What is the contralateral parotid constraint if treating unilateral neck?
Max < 10 Gy
49
What is the management for T1-2N0-1 OPX?
Resection or RT alone
50
What is the management of T3-4 or N2+ OPX?
CCRT
51
What if creatinine is high in CCRT?
cetuximab instead of cis
52
What is the oral cavity constraint?
Mean < 40 Gy
53
What is the larynx constraint?
Mean < 40 Gy
54
What is the mandible max constraint?
70 Gy
55
What is the SMG constraint?
Mean < 39 Gy
56
What is needed for H&N follow up?
H&P, imaging once, TSH, regular dental, swallowing, hearing
57
What is the management of T1-T2N0 supraglottic?
RT alone T1: 66, T2: 70
58
What is the management of T3+ or N+ supraglottic?
chemo-RT (70Gy)
59
What are considered adequate margins in oral cavity?
1.5 cm tongue, 1 cm everywhere else
60
Who gets postop RT for salivary gland cancer?
Everyone except T1-2 Low grade
61
What are the low grade SGC histologies?
low grade mucoep, acinic cell, epithelial-myoepithelial.
62
What is the management of Occult primary T0N1?
ipsi modified radical neck dissection, observe if no ECE or RT guided by HPV and EBV
63
What is the management of Occult primary T0N2-3?
Neck dissection-->RT vs CRT for ENE OR CCRT
64
What is the T staging for melanoma?
T1a: <0.8mm without ulceration, T1b: <0.8 mm with ulceration, T2a/b: 1-2mm without/with ulceration, T3a/b: 2-4 mm, T4a/b: >4mm
65
What are the Clark levels for melanoma?
I: confined to epidermis, II: invasion into papillary dermis, III: tumor filling papillary dermis and compressing the reticular dermis, IV: invasion of reticular dermis, V: invasion of subcutaneous tissue

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