Hats and Scarves 1 Flashcards by Business @ KG!!! student 4ever

What are the Diagnosis investigation tools?

FNABX (Fine-needle aspiration biopsy)
Core biopsy
Incisional biopsy
Excisional Biopsy
Histology

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What are the types of treatment options for Head and neck cancer?

Surgery
Radiation therapy (preserve structure and function)
Surgery + post-op RT +/- chemotherapy
Chemo-radiation +/- surgery for residual disease

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What are the indications for post-op RT?

Locally advanced disease
Close/positive margins
≥ 3 nodes involved
Extra-capsular spread
Lymph-vascular or peri-neural spread

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What are the indications for post-op CT/RT?

Positive margins

Extracapsular spread

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What are the different RT doses for the different stages?

T1-2 disease: 60-66Gy/30-33#
T3/4 disease: 70Gy/35#
N0 neck 50Gy/30# 
N1 neck 60Gy/ 30#
Post-op neck 60Gy/30#
Post-op neck ECS (extracapsular spread), close/ +ve margins 66Gy/33#

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What things do we check during follow-up?

Detect recurrence (and allow salvage therapy)
Side-effects of therapy
Speech therapy
Rehabilitation

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What are the different histology types of head and neck cancer?

SCC
Adeno-carcinoma
Adenoid cystic
Muco-epidermoid
Other (plasmacytoma, lymphoma, melanoma)

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Acute side effects of Head & neck RT?

lethargy
nausea and vomiting
skin changes
mucousitis
alteration in taste
dysphagia
odynophagia 
Alteration in saliva consistency

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Late side effects of Head & Neck RT?

xerostomia
radiation caries (tooth decay that results from radiation-induced dry mouth (xerostomia)
second malignancy
mucosal fragility
alopecia
loss of sweating
trismus
atrophy of SC tissues
Endocrine abnormalities
osteoradionecrosis

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What is the monitoring of Head & neck cancer?

Daily review by RT’s, nurses
Weekly review by medical staff
Allied health review (dietician, speech pathology, social work, occupational therapy, physiotherapy)

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What are the main chemotherapy agents used for chemo radiation?

cisplatin

5 fluorouracil

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What are the aetiology factors of H&N cancer?

male >female
smoking
alcohol (synergistic)
marijuana

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What is the principle aim of management of primary site?

optimize tumour control

preserve structure and function

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How is oral cavity cancer treated and why?

surgery is mainstay of treatment:
to preserve saliva function
Patients may have more than one tumour in their life so avoid RT if possible
Aim to cure, but optimise speech and eating

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How do larynx patients present?

hoarse/ husky voice
local pain/ otalgia/ odynophagia
mass in neck
airway compromise
aspiration
weight loss

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What are the treatment options for early glottic cancer?

radiation therapy
surgery (conservative)
laser (under investigation)
- characterised by low incidence of nodes

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What is the dose for radiation therapy of Early glottic cancer and T3 glottic cancer?

T1: 63Gy/ 28#
T2: 66Gy/ 33#
T3: 66-70Gy/33-35#

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What is the field arrangement used for Early Glottic Cancer?

opposed laterals (may require obliques for short neck)
require anterior overshoot, treating the glottis with a margin

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What is the treatment for T3 glottic cancer?

surgery (because local control is better with surgery)

However, selected patients may be offered RT

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Why would T3 glottic cancer patients benefit from radiation therapy over surgery and what patients can it be offered to?

Laryngectomy: may compromise voice box function
Good airway
compliant with follow-up
easy to examine
cords fixed because of bulk of tumour
understand they have a higher risk of recurrence
understand that laryngectomy may be recommended in suspected recurrence and may not be confirmed histologically

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How is advanced glottic cancer (T3-4,N1-3,M0) treated?

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1) laryngectomy +/- PORT +/- CT
2) Radiation therapy (rare)
3) Chemoradiation

When would you treat a stoma in advanced glottic cancer?

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subglottic extension, or emergency tracheostomy

What is supraglottic cancer characterised by and treated?

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high incidence of nodes a presentation
sub-clinical nodal involvement
(bilateral necks treated)

How is T1N0M0 supra-glottis cancer treated?

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radical radiation (good airway)
supra-glottic laryngectomy (require good airway reserve, as need to learn to swallow again &amp; @ risk of aspiration)

How is advanced disease for supra-glottis cancer treated?

surgery +/- post-op RT +/- CT chemoradiation Radiation alone (if surgery refused or comorbidity precludes surgery)

RT for Supra-glottis Cancer?

63-66Gy/ 30-33# | Bulk disease 70Gy/35# and consider surgery for residual disease

What are the potential surgery complications for sub-glottic cancer

``` infection DVT +/- PE (Deep Vein Thrombosis +/- Pulmonary Embolism) Flap necrosis Carotid rupture Death ```

What are the potential Radiation therapy complications for sub-glottic cancer?

``` Chondritis (cartilage inflammation) Osteoradionecrosis Chondronecrosis Oedema Virtually no risk of death ```

What are the three areas of hypo pharynx?

posterior pharyngeal wall piriform fossae post-cricoid space

What are the clinical presentation hypo pharyngeal lesions?

``` sore throat dysphagia hot potato voice weight loss referred otalgia (ear-ache) Stridor (high-pitched weeping sound) ```

How is piriform fossa of hypopharyngeal cancer treated?

rarely present early, therefore few treated with RT or Surgery alone Partial pharynx-larynectomy may be an option for early stage disease Advanced disease: pharyngo-laryngectomy +post-op RT +/- CT CT/RT RT alone (rarely)

How is the pharyngeal wall of hypo pharyngeal cancer treated?

early disease managed surgically (tends to spread sub-mucosally therefore requires large margins) Locally advanced disease: majority Surgery + PORT +/- CT RT or CT/RT if not fit for surgery

How are post-cricoid tumours of hypophargyneal cancer treated?

rare tumours generally locally advanced at presentation associated with Fe deficiency RT need to treat upper mediastinum Majority need pharyngo-larynectomy + RT +/- CT

What are the three salivary glands?

parotid gland submandibular glands (paired) sublingual glands

What is the histology of salivary gland cancer?

1) benign lesions: pleomorphic adenoma, oncocytoma, Warthin's tumour 2) Malignant lesions: adenocarcinoma SCC muco-epidermoid Adenoid cystic

What are the treatment options for salivary gland cancer?

surgery +/- PORT Usually conserve the facial nerve volume: parotid bed +/- ipsilateral neck nodes

For pleomorphic adenoma "pseudopodia" salivary tumours how are they treated?

RT if tumour spill requires a parotidectomy not "shelling it out" long natural history, late recurrences

How are low grade salivary tumours treated?

surgery alone (generally)

What is the aetiology and pathology for nasal cavity tumours?

``` aetiology: wood-workers Pathology: SCC NHL Plasmacytoma Melanoma Inverting papillom Mid-line granuloma ```

What is the clinical presentation of Nasal cavity?

Epistaxis (nose bleed) & nasal obstruction during sleep (OBS)

What is the main treatment for nasal cavity cancer?

Surgery is the mainstay of treatment +/- RT Radiation therapy: volume (primary + margin) Dose: dependent on the histology

Nasopharyngeal cancer aetiology?

Chinese origin Males>females Aetiology: EBV (Epstein- Barr Virus)

What are some characteristics of nasopharyngeal cancer?

``` Well supplied with lymphatics: clinical nodal involvement is common frequently bilateral high incidence of occult nodal mets include posterior spinal nodes ```

How do nasopharyngeal carcinoma patients clinically present?

``` painless neck lump nasal obstruction sore throat facial pain proptosis (bulging of the eyes) Cranial nerve defects unilateral otitis media (in adults) ```

How are nasopharyngeal tumours treated?

RT is standard Chemotherapy: appears distinct to other H&N CA, more chemo-sensitive -synchronous CT/RT improves survival in advanced disease

What is the dose to the primary lesion for nasopharyngeal tumours?

63-70Gy

How is neck cancer managed?

- observation with delayed neck dissection for recurrence - surgery (elective +/- post-op RT +/- CT) OR (Therapeutic +/- post-op RT +/- CT) - radiation therapy +/- neck dissection for persisting disease

What does choice of therapy for neck depend on?

likelihood of nodal involvement management of primary lesion Dose: N0 neck, 50Gy/ 25# Extra-capsular spread: increased risk LR, requires post-op RT, requires higher dose, consider PORT/ CT

What are the different types of neck dissection?

radical neck dissection modified radical neck dissection functional neck dissection supra-omohyoid neck dissection

What are the complications neck dissection?

``` nerve vascular lymphatic pulmonary infection flap necrosis lymphoedema death ```

Hats and Scarves 1 Flashcards

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