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Clinical med > HEENT head and neck cancer > Flashcards

HEENT head and neck cancer Flashcards

1
Q

60 % of OP cancer is found at the

A

palatine

lingual tonsils

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2
Q

pts with HPV + will be

A

young patients

less likely to smoke or drink

tumors: basaloid and poorly diff

better prognosis

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3
Q

S/S of OP cancer

A

most common: swelling and sore that doesn’t heal

red/white patch in mouth = dont heal

persist sore throat

hoarseness or change in voice

difficult breathing

lump bump or mass with/without pain
pain/ hard to chew

loosening teeth

dentures don’t fit

unexplained weight loss

fatigue

blood in saliva

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4
Q

neck masses are found…

age?

type:

region:

A

80% adults > 40 y/o

80% SSC primary type

neck and head region

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5
Q

pt presents to your office with lump on neck. whats your next step?

A

step 1: CT of neck

step 2: Find needle aspiration

step 3: flexible laryngoscopy: to see the area

step 3: PET scan

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6
Q

What is used in PET scan

A

nuclear med. imaging to see metabolic processes in the body

it uses FDG (fludeoxyglucose) to indicate which tissue is increasing its uptake and metabolic

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7
Q

after you find out that the pt has SCC of the neck of unknown primary, what do you do?

A

determine HPV status with needle biopsy of neck mass
*HPV + …. > 95% most likely be primary Tonsil or Base of Tongue (BOT)

History
PE exam
Imaging - PET scan
biopsies/tonsillectomy

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8
Q

TNM staging system has 3 parts

A

primary tumor (T) - size
*(T1,2,3,4,)

regional lymph nodes (N)
*N0, 1, 2, 3

Distant Metastasis (M)
*M0, M1

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9
Q

nonsurgical tx options for H/N cancer?

A

radiation- radiation mask

chemotherapy

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10
Q

what is the first line treatment for oral cancer?

A

surgical resection

*ex: floor of mouth resection + neck dissection

*partial glossectomy

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11
Q

what is neck dissection and what factors play a role in it

A

removal of lymph nodes and tissues from neck

factors: type and extent of cancer - stage

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12
Q

T/F the higher the TNM stage, the worse? -

*TNM stage is a prognostic indictor

A

T

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13
Q

what is one of the strongest predictors of a 50% reduction in survival rate for head and neck cancer

A

cervical nodal involvement: 2/3 of SSCHN pts has

10% = metastasis

extracapsular spread (ECS) further reduces survival

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14
Q

other predictors for head and neck cancer

A

nodal burden

perineural invasion

histologic grade

extent of necrosis

+ tumor margin

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15
Q

1st line Tx for oropharyngeal cancer

A

radiation therapy +/- chemo

*most likely tonsils or BOT

if it reoccurs –> surgery

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16
Q

first line Tx for laryngeal and hypopharyngeal cancer in …

early stage

advanced stage

recurrent cancer

A

early stage: radiation +/- chemo

advanced stage : surgery (laryngectomy/ pharyngectomy)

recurrent cancer - treated with surgery

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17
Q

Total laryngectomy involves the removal of? and side affects?

A

removal of :
hyoid bone
thyroid and cricoid cartilage,
Vocal folds
epiglottis
upper 2 or 3 rings of the trachea
all intrinsic mm of larynx
selected extrinsic laryngeal mms

side affects
respiration
swallow
speak (no phonation)

18
Q

when someone gets a total laryngectomy, what device do they put in the hole?

A

tracheostomy tube that goes into the trachea

Most people will eventually be able to eat normally with a tracheostomy, although swallowing can be difficult at first. While in hospital, you may start by taking small sips of water before gradually moving on to soft foods, followed by regular food.

19
Q

what are 3 goals of reconstruction for neck and head cancer

A

cosmetic apperance

close surgical defect

return function like breathing and swallowing

20
Q

what is the reconstructive ladder from bottom (simple) to highest (complex)

A

healing by secondary intent –> primary closure–> skin graft –> local flap –> regional flap –> free flaps

21
Q

functional impairment of Oropharyngectomy

A

swallowing

speech

dry mouth

taste, chewing

fatigue

cervical and oral pain

weakness

neck and should dysfunction

ADL restrictions

lymphedema

anxiety/ depression

22
Q

what is lymphedema, cause, and affects?

A

tissue swelling due to accumulation of protein rich fluid

removing lymph nodes or from radiation

affects: restricted ROM, infections, fibrosis of the skin

23
Q

ways to treat lymphedema? techniques

A

kinesio tapping: lifts tissue = helps with circulation and lymphatic fluid flow with lymphedema

compression garment for neck

manual lymph drainage

graston technique: soft tissue therapy to break up scar tissue : alternative to message

24
Q

what things can you use dry needling for?

A

radiation fibrosis

trismus (can also do PT and always measure progress)

25
Q

tracheoesophageal puncture (TEP) surgery

indicated for:
process:

A

total laryngectomy: larynx is removed –>connection between mouth and trachea gone –> trachea is rotated forward and connects to the skin –> hole in neck (stoma)

TEP surgery –> puts pencil size hole between trachea and esophagus –> hole is a one way valve called TE voice prosthesis -> when pt covers the stome, air from lungs goes through the trachae and into the esopagus –> vibrates it –> creates voice

26
Q

what are two things that can help a pt talk about a total laryngectomy ?

A

electrolarynx and TEP

27
Q

what therapy should pts with larygectomy do?

A

swallowing and speech

28
Q

what type of cancer makes 95% of head and neck cancers?

age:

sex:

affects mostly?

A

SSC

age: 65 y/o —> > 45 .. BOT and tonillar SSC

sex: men > female develop and die

high incidence in AA and poorer, 20 % lower, 5 year survival rate

29
Q

Squamous cell carcinoma over …….. of malignancies of upper aerodigestive tract

a) Over 90% of malignancies in oropharynx
b) 3-6% are …..
c) 1-3% are …..

A

95%

a) oropharynx
b) nasopharyngeal carcinomas (NPC)
c) salivary cancer

30
Q

OP demographic

RF:
Age:
two year survival rate
race

A

HPV (70%)
40s-50s
95%
white males

31
Q

HPV should clear within

A

6-12 months

1-3 % women, 10 % of men = active oral HPV

32
Q

HPV oral oncogenic types

A

16, 18, 39, 59

15 = 90 % of OP SSC cancer

33
Q

congenital neck mass …

A

lymphangiomas

dermoid

thyroglossal

34
Q

developmental neck mass …

A

brachial cysts…

laryngoceles

pharyngeal

35
Q

skin and subq tissue neck mass ….

A

sabaceous cyst

lipoma

36
Q

thyroid swellings neck mass…

A

multinodular goitre

solitary thyroid nodule

37
Q

salivary gland tumors neck mass

A

pleomorphic adenoma

warthins

38
Q

tumors of the parapharyngeal space neck mass

A

deep lobe parotid

chemodectoma

39
Q

reactive neck lymphadenopathy neck mass

A

tonsilitis,

glandular fever

HIV

40
Q

malignant neck node

A

carcinoma metastases (unknown primary)

lymphoma

Clinical med (6 decks)

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