H&N intro

Question 1

anterior triangle borders

Answer 1

• Inferior border of mandible
• Sternal notch
• Anterior border of SCM

Question 2

structureswithin ant triangle

Answer 2

• Submandibular gland
• Submental nodes
• Carotoid artery
• Internal jugular vien
• Cranial nerves

Question 3

posterior triangle borders

Answer 3

• Inf: clavicle
• Ant: post border of SCM
• Post: ant border of trapezius muscle

Question 4

structures within post triangle

Answer 4

• part of subclavian artery
• external jugular vein
• cervical and supraclavicular LN
• brachial plexus

Question 5

post triangle is divided into 2 triangles by what structure and what are the triangles called

Answer 5

omohyoid muscle

occipital and subclavian triangle

Question 6

what are the 2 nodes commonly in H&N Tx fields

Answer 6

jugular/subdigastric and node of rouviere

Question 7

location of node of rouviere

Answer 7

most sup/lat retropharyngeal LN that runs from base of skull to hyoid

Question 8

which node takes in nearly all drainage from HN area

Answer 8

jugular/subdigastric

Question 9

define brachial plexus

Answer 9

network of nerves formed by ant rami of the lower four cervical nerves and first thoracic nerve (C5, C6, C7, C8, and T1)

Question 10

location of brachial plexus

Answer 10

o Extends from spinal cord, through the cervicoaxillary canal in the neck, over the first rib and into the armpit

Question 11

structures with bilateral drainage

Answer 11

base of tongue
soft palate
tonsils
post pharyngeal wall
nasopharynx

Question 12

Level 1 LN group

Answer 12

submental and submadibular

Question 13

level 2 LN group

Answer 13

upper jugular group

Question 14

Level 3 LN group

Answer 14

middle jugular group

Question 15

level 4 LN group

Answer 15

lower jugular group

Question 16

Level 5 LN group

Answer 16

post triangle group

Question 17

Level 6 LN group

Answer 17

anterior compartment group

Question 18

which LNG is at highest risk of mets from oral cavity, nasal cavity, nasopharynx, oropharynx, hypo-pharynx, and parotid gland

Answer 18

level 2

Question 19

which LNG gets mets from larynx esp with glottis extension and hypopharyngeal cancers with esophageal extensions

Answer 19

level 6

Question 20

when is there risk for retrostyloid/ junctional node involvment

Answer 20

ipsilateral nodal disease

Question 21

when is there risk for nodes or rouviere/retropharyngeal node involvment

Answer 21

nasophaynx, post pharyngeal wall and pyriform sinus involvment

cuz it extends superiorly to the base of the skull and inferiorly to the hyoid bone

Question 22

name some etiological factors

Answer 22

tobacco - smoking and smokeless
weed
occupational exposures
UV light
Rad exposure
poor oral health hygiene
hereditary factors
viruses
p16 status

Question 23

what is the significance of p16 status

Answer 23

linked to HPV-16 common in 90% of oropharyngeal cancers; as well as many other tumours
helps determine prog, Tx strat, overall survival

Question 24

how is p16 testing done

Answer 24

staining

Question 25

prog factors

Answer 25

``` morbidity of treatment increases and prognosis decreases as the affected area progresses backwards from lip to hypo-pharynx (excludes pharynx) stage grade nutritional status tumours that cross midline SCC- non worse differentiation extend of LNI, fixed, vascular ```

Question 26

pathologies

Answer 26

90% SCC arise from epithelial linings of upper digestive tract adenocarcinoma - salivary glands melanoma sarcoma

Question 27

what are some variants of SCC

Answer 27

lymphoepithelioma spindle cell verrucous carcinoma undifferentiatied carcinoma

Question 28

diff between endophytic and exophytic

Answer 28

tumours more aggressive /hard to control and can spread and grow inward noninvasive with raised/elevated borders

Question 29

what are other causes of LN swelling other than cancer | when should it be concerning

Answer 29

infection or injury LN that continues to enlarge or persist for 2-4 weeks

Question 30

what is the epstein-barr virus

Answer 30

herpes virus - children + adults affects b cells ad therefore immunity perssists for life

Question 31

T stages

Answer 31

``` o T1 – 2cm or less o T2 - >2 or =4cm o T3 - > 4 cm o T4 -with invasion of adjacent structures  T4a – resectable  T4b – unresectable ```

Question 32

N stages

Answer 32

o N0 o N1 – single ipsilateral ln >3cm o N2 a - Single Ipsilateral node, > 3cm < 6cm b – Multiple Ipsilateral nodes, none > 6cm c – Bilateral/Contralateral , none > 6cm o N3 – Metastasis in a lymph node > 6cm

Question 33

what is en bloc resection

Answer 33

tumour, draining nodes, and everything between is taken out

Question 34

what are some types of resection

Answer 34

``` cryotherapy electro-cautery laser partial resection resection of primary tumour ```

Question 35

what is involved in a radical neck disection

Answer 35

remove LNG 1-5, SCM, internal jugular vein,spinal accessory/11th cranial nerve

Question 36

what is involved in a modified neck disection

Answer 36

spares SCM, internal jug vein, 11th cranial nerve still excises LVG 1-5 excises submandibular gland

Question 37

why are there standard fx schedules of 5x per week

Answer 37

there is accelerated repop in this area esp with SCC | even allows BID

Question 38

what is the typical dose/fx | typical doeses?

Answer 38

200cGy/fx | 7000/35 + 6000/30

Question 39

RT side effects?

Answer 39

``` mucositis xerostomia erythema dry eye trismus larngitis taste changes brachial plexus - muscle soreness/stiffness periodontal disease + cavities ```