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NM By Myself > Head And Neck Cancer NM > Flashcards

Head And Neck Cancer NM Flashcards

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1
Q

Lip and oral cavity cancer most common type

A

Tobacco and alco - - SCC 95%

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2
Q

Lip and oral cavity cancer
Most common location

A

Tongue (oral tongue more likely LN)
FOM (more likely LN)
Gingiva

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3
Q

Lip and oral cavity cancer
Premalignant

A

Leukoplakia
Erythroplakia

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4
Q
A

Lip and oral cavity cancer T1

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5
Q
A

Lip and oral cavity cancer T2

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6
Q
A

Lip and oral cavity cancer T3

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7
Q
A

Lip and oral cavity cancer T4a

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8
Q
A

Lip and oral cavity cancer T4b

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9
Q

Lip and oral cavity cancer N

A
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10
Q

Lip and oral cavity cancer M

A

Lung
Bone
Liver

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11
Q

Ca of lip LN

A

IA
IB

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12
Q

CA of alveolar ridge or hard palate LN

A

Low potential for MTS
IB
II-IV
retropharyngeal - less common

Level VII = ant sup mediastinal still regional

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13
Q

Lip and oral cavity cancer CT limit

A

Small lesions
Mucosal surface
Dental amalgam streak artifact

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14
Q

Lip and oral cavity cancer PET/CT

A

Unknown primary
False positive: muscle, brown fat, lymphoid tissue, mucosa

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15
Q

Oropharynx p16- risk

A

Tobacco
Alco
Men
Elderly

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16
Q

Oropharynx p16- subsites

A

Base of tongue (lingual tonsil)
Palatine tonsils
Pharyngeal walls
Soft palate and uvula

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17
Q

Hypopharynx T3

A

Hemilarynx fixation

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18
Q

Oropharynx cancer M

A

Lung
Bone
Liver

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19
Q

Oropharynx p16- most important prognostic factor

A

Regional LN
Palatine tonsils and base of tongue - - II, III, retropharyngeal
Posterior pharyngeal wall - - retropharyngeal
Base of tongue - - bilateral
Also I, IV and V

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20
Q

Oropharynx p16 important

A

Keratizing
Mucosal ulceration
Resistant
Poor response
Worse prognosis
Higher rate of M
Locoregional recurrence

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21
Q
A

Oropharynx p16- T1

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22
Q
A

Oropharynx p16- T2

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23
Q
A

Oropharynx p16- T3

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24
Q
A

Oropharynx p16- T4a

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25
Oropharynx p16- T4b
26
Oropharynx p16+ most common location
Base of tongue (lingual tonsil) Palatine tonsil
27
Oropharynx p16+ risk
Younger men No tobacco or alco High status Increased number of partners HPV type 16 Also types 18, 31, 33
28
Oropharynx p16+ N
29
Oropharynx p16+ regional LN
More significant than p16- II and III
30
Oropharynx p16+ important
Non keratizing Cystic nodes - - negative on PET Better prognosis, respond More M1, atypical sites
31
Adult with new cystic lymphadenopathy in upper neck
Oropharynx p16+
32
Oropharynx p16+ T1
33
Oropharynx p16+ T2
34
Oropharynx p16+ T4a
35
Oropharynx p16+ T4b
36
Oropharynx p16+ T3
37
Hypopharynx
95% SCC
38
Hypopharynx subsites
Sinus pyriformis - - encase ICA - - >270° Hypopharyngeal wall (lateral and posterior) Postcricoid region - - Plammer-Vinson sy, Paterson-Kelly sy
39
Hypopharynx M
Lung Bone Liver
40
Hypopharynx regional LN
Early dissemination 75% at presentation 20-40% contralateral Nodal MTS at diagnosis II-IV Retropharyngeal VI Medistianal nodes (VII) are still regional 40% of clinically N0 - - pathologically N+
41
Hypopharynx PET
Staging Prior to endoscopy
42
Hypopharynx important
60% keratizing "hot potato" voice Poor survival Worst prognosis of all head and neck SCC
43
Hypopharynx risk
Men Tobacco Alco Fe def Vit C def
44
Hypopharynx T1
45
Hypopharynx T2
46
Hypopharynx T3
47
Hypopharynx T4a
48
Hypopharynx T4b
49
Hypopharynx T4b
50
Hypopharynx T4b
51
Oropharynx p16+
52
Nasopharynx keratizing SCC
Smoke, HPV Locally advanced at presentation
53
Nasopharynx non keratizing SCC
Differentiated type Undifferentiated type - most common 90% EBV Better prognosis
54
Nasopharynx basaloid SCC
Men, 30-40, 50-60 China endemic
55
Nasopharynx T
56
Nasopharynx N
57
Nasopharynx M
Bone Lung Liver Rare High potential Poor prognosis
58
Highest rate of LN MTS among all SCC of head and neck
Nasopharynx
59
Nasopharynx regional LN
80-90% at presentation Retropharyngeal 70% II 70% Spinal accessory chain V Well controlled by radiation unlike other SCC
60
Nasopharynx CT
Mass in lateral pharyngeal recess of nasopharynx with deep extension and cervical adenopathy Most frequent - lateral wall = fossa of Rosenmueller
61
Nasopharynx PET
Strong avidity Submucosal tumor Perineural spread - - mandibular nerve Superior in restating and evaluating treatment effectiveness
62
Nasopharynx T0
Malignant cervical lymphadenopathy +EBV
63
Nasopharynx presentation
Unilateral hearing loss Painless upper cervical lymphadenopathy
64
Nasopharynx stage I-II treatment
Radio Cures 60-90%
65
Nasopharynx most powerful prognostic factor
Stage at presentation
66
Nasopharynx T1
67
Nasopharynx T2
68
Nasopharynx T3
69
Nasopharynx T4
70
Nasopharynx
71
Maxillary sinus cancer
Most common Tumor arise from mucosa - - nodule or mass Small tumor - - nasal congestion From inverted papilloma - - HPV - - good prognosis
72
Maxillary sinus T
73
Maxillary sinus, nasal cavity and ethmoid sinus M
Bone Lung Liver Low incidence
74
Maxillary sinus, nasal cavity and ethmoid sinus regional LN
Low incidence Usually unilateral IB, II, retropharyngeal
75
Maxillary sinus, nasal cavity and ethmoid sinus PET
SUV correlate with tumor grade Strong avidity in metastatic LN
76
Maxillary sinus, nasal cavity and ethmoid sinus risk, important
Occupational exposure Tobacco, alco HPV, EBV Men, > 45y Keratizing SCC 80% - - worse prognosis Adenocarcinoma - - better prognosis
77
Olfactory neuroblastoma
ENB - - unilateral nasal obstruction Female "<20,>50
78
Nasal cavity and ethmoid sinus T
79
ENB CT
Superior part of tumor in intracranial fossa Inferior part in upper nasal cavity
80
Maxillary sinus T1
81
Maxillary sinus T2
82
Maxillary sinus T3
83
Maxillary sinus T4a
84
Maxillary sinus T4b
85
Nasal cavity T1
86
Nasal cavity T2
87
Nasal cavity T3
88
Nasal cavity T4a
89
Nasal cavity T4b
90
Supraglottis
Epiglottis - - poorly resistant to tumor penetration SCC 95% Non keratizing Few early symptoms unlike others
91
Supraglottis T1-3
92
Supraglottis regional LN
Lymphatic rich Early spread to II-IV Bilateral, contralateral
93
Glottis
Most common in larynx Keratizing True cords - - hoarseness Irregular thickening of mucosa - - ulcer
94
Glottis T1-2
95
Glottis regional LN
No lymph in vocal cords - - rare
96
Subglottis
Ulcerative mucosa - - large exophytic or fungating mass 50% cartilage involvement
97
Subglottis T1-2
98
Glottis and subglottis T3
99
Larynx T4a-b
100
Larynx M
Lung Liver Diaphragm
101
Larynx PET
Complete staging of advanced laryngeal cancer Strong avidity in metastatic LN False positive: laryngeal muscle activation with contralateral vocal cord paralysis Most useful in postlaryngectomy
102
Supraglottis T1
103
Supraglottis T2
104
Supraglottis T3
105
Supraglottis T4a
106
Glottis T1
107
Glottis T2
108
Glottis T3
109
Glottis T4a
110
Subglottis T1
111
Subglottis T2
112
Subglottis T3
113
Subglottis T4a
114
Larynx T4b
115
Larynx T4b
116
Major salivary gland
Uncommon Parotid - - most common 95% Mucoepidermoid (MECa) - - low grade, rare LN, superficial parotid lobe, 1-4 cm at presentation Adenoid cystic carcinoma (ACC) - - highest incidence of distant MTS, parotid gland, 1-3 cm at presentation, MECa>ACC Submandibular ACC>MECa>adenocarcinoma Sublingual
117
Warthin tumor
Benign Female Smoker Tc pert avid
118
Major salivary gland T
119
Major salivary gland M
Lung Brain Bone Hem > lymph Lung > lymph
120
MECa M
Mandible Skull base
121
ACC M
Highest incidence of distant MTS Highest spread via perineural pathway of all head and neck tumors
122
Predictor of distant MTS Salivary gland
Tumor >3cm Solid Local recurrence N1
123
Major salivary gland regional LN
Ipsilateral Jugulodigastric level III
124
Major salivary gland PET
False positive 30% - - Warthin tumor Pleomorphic adenoma - moderste/intense uptake - - hard to dd benign vs malignant High grade salivary tumor SUV>5.0 ACC-- slow growth - - low SUV, non avid metastatic LN MECa - - no Tc pert uptake vs Warthin tumor
125
Major salivary gland presentation
Palpable painless mass Facial nerve dysfunction - - negative prognostic factor Parotid - - most positive prognostic factor
126
20 years after radiation in low dose
Parotid neoplasm
127
Major salivary gland treatment
Surgery (first choice Complication - - facial nerve damage Chemo Radio for non resectable (stage IVB/IVC)
128
Major salivary gland T1
129
Major salivary gland T2
130
Major salivary gland T3
131
Major salivary gland T3
132
Major salivary gland T4a
133
Major salivary gland T4a
134
Major salivary gland T4a
135
Major salivary gland T4a
136
Major salivary gland T4b
137
Major salivary gland T4b
138
Epiglottis carcinoma
139
Residual disease on PET
Focal and asymmetric uptake with intensity greater than surrounding normal tissue and blood vessels
140
Post radiation inflammation on PET
Diffuse uptake within radiation field
141
After chemo PET
At least 10 days Within 6 months and 1 year after initial PET
142
After radio PET
2-3 months
143
Cancer of larynx
144
Encased artery
>270° surrounded
145
Primary tonsil cancer
146
Tonsil Cancer
147
Level II LN
148
Retropharyngeal nodes level VIIa
149
Subglottis regional LN
Paratracheal Sup mediastinal
150
CT best for
Lower part of neck Osseous involvement
151
Left tonsil
152
Submental and Submandibular nodes
IA and IB - - lip cancer IB - - ca of alveolar ridge or hard palate, maxillary sinus (rare)
153
Upper jugular
Level II Ca of alveolar ridge or hard palate Oropharynx Hypopharynx Nasopharynx Maxillary sinus (rare) Supraglottis
154
Mid jugular
Level III Oral cavity oropharynx Hypopharynx Supraglottis Salivary gland
155
Lower jugular and medial supraclavicular
Level IV Oral cavity Hypopharynx Supraglottis
156
N0 + positive PET
Neck dissection, not SLNB
157
Full negative work up FDG reveal primary
20-40%
158
History of lymphoma post treatment
Physiologic uptake in Waldeyers ring
159
Hodgkins lymphoma after chemo
Thymic hyperplasia
160
Buccal cancer after left neck dissection
Physiologic uptake in right tonsil
161
Larynx cancer after surgery and chemo radio
Inflammation around tracheostomy
162
Treated breast cancer
Reactive LN
163
Tonsil
164
Elderly with lung cancer
Pleomorphic adenoma or Warthin tumor
165
Retropharyngeal
Alveolar ridge and hard palate Oropharynx p16- Hypopharynx Nasopharynx Maxillary sinus and nasal cavity
166
Cervical cancer of unknown origin
Neck dissection Tonsillectomy Radio of all mucosal sites and both sides of neck Detection of primary tumor improve survival FDG sensitivity 69%

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