MALIGNANT TUMOR H & N Flashcards
(27 cards)
1
Q
Most malignant tumors that develop above the clavicles are
A
Squamous Cell Carcinomas
2
Q
Differences in the natural history of tumors arising from different sites:
A
- Blood supply
- Lymphatic drainage
- Histologic variation specific to the area
3
Q
- Associated with Nasopharyngeal carcinoma
- Infection is prevalent in nasopharyngeal carcinoma
> Elevated serum levels of EBV titers = increased risk
A
Epstein Barr virus
4
Q
- Signs and Symptoms:
> Formication
+ Prograde neural symptom
+ Feeling of ants crawling along the lips or cheek
+ Represent mental or infraorbital nerve invasion - Changes in speech
> Tethering of the tongue - 64% present with cervical or disseminated metastasis
- otalgia
A
Carcinomas
5
Q
Reffered psin in otalgia
- lingual
- glossopharyngeal
- vagus
A
lingual - auriculotemporal
glossopharyngeal - tympanic nerve
vagus - auricular nerve
6
Q
Palpation of lymph node stations in carcinomas:
A
- Submental (Level IA)
- Submandibular (Level IB)
- Jugulo-digastric (Level II)
- Mid-jugular (Level III)
- Jugulo-omohyoid (Level IV)
- Posterior triangle (Level V)
- Supraclavicular or Central lymph node
7
Q
-Sympathetic nerve fiber injury
-Anhidrosis
-Miosis
-Ptosis
-Loss of ciliospinal reflex
-Enophthalmos
A
Horner’s Syndrome
8
Q
Triple Endoscopy consist of :
A
- Bronchoscopy
- Esophagoscopy
- Direct laryngoscopy
9
Q
Definitive/curative treatment:
○ Consist of:
Early Stage (I and II)
A
- Surgery alone
- Radiotherapy alone
10
Q
Definitive/curative treatment consist of:
- Advance Stage (III, IVA and IVB)
A
- Surgery + radiotherapy ( pre-op or post-op adjuvant therapy)
- Surgery + chemotherapy ( systemically by intravenous infusion or locally by intra-arterial infusion)
- Surgery + Radiotherapy + Chemotherapy
11
Q
Lymph Node Drainage
○ Radical Neck Dissection:
A
removal of Level I-V nodes with SCM, Internal Jugular Vein and Spinal Accessory nerve
12
Q
Lymph Node Drainage
- Site of potential lymph node metastasis can be accurately
predicted by determining the site of the primary tumor
> Oral Cavity → Level I-III
> Nose, Pharynx → Level II-V
> Thyroid and Larynx → Level III, IV, and VI
A
Selective Neck Dissection
13
Q
Lymph Node Drainage
- Spinal accessory nerve, Jugular vein and the
Sternocleidomastoid muscles are preserved - Long term function is improved
A
Modified Neck Dissection
14
Q
- Common site of metastasis
- Solitary lesions may also be a primary lesion
- Resection is not recommended most of the time
A
Lung
15
Q
- Male predominance ( 20:1 )
- Lower lip is the most common site ( 95% )
> Higher exposure to sunlight - Squamous cell carcinoma = most common histology
A
Lip
16
Q
Basal cell carcinoma predominates
A
Upper lip
17
Q
Bounderies:
- soft palate
- teeth
A
- Posterior = soft palate
- Anterior and lateral = teeth
18
Q
- Most common salivary gland CA
- Classified into Low-grade, Moderate and High grade MEC
> According to mucous and squamoid appearance - More Squamoid=higher grade
- Diagnostic: FNAB
> CT Scan of the Neck with contrast
> Metastatic work-up - Tx: Total Parotidectomy + Neck Dissection
A
Mucoepidermoid CA
19
Q
- 10% of all salivary gland CA
- May occur in all age group
- Considered as low grade salivary gland CA but high-grade transformation exists
- Diagnostic: FNAB + CT Scan of the neck with contrast
- Metastatic work-up
- Tx: Parotidectomy + Neck Dissection
A
Acinic Cell CA
20
Q
- High-grade salivary gland malignancy
- M=F; 50-60 years old
- Known for “Perineural invasion”
- Classic histologic findings “Cribriform or Swiss cheese appearance”
- Same diagnostic work-up and treatment
A
Adenoid Cystic CA
21
Q
- Most common well-differentiated thyroid carcinoma
- 60-70% of thyroid CA
- F>M; 30-40 years old
- “Orphan Annie eye” appearance
- Psammoma bodies – 40%
- Known for lymphatic spread; usually at level VI or central neck nodes
- Tx: Total Thyroidectomy + Neck dissection + RAI
RAI for tumor > 4 cm
A
Papillary Thyroid CA
22
Q
- 10% of thyroid CA; still considered as welldifferentiated
thyroid CA - F>M; 50 years old
- Known for distant metastasis- Hematogenous spread
- Liver, Lung, Brain
- Tx: Total Thyroidectomy + Neck dissection + RAI
A
Follicular Thyroid CA
23
Q
- 5% of all thyroid CA; intermediate
- Arises from Parafollicular C Cells secreting calcitonin, carcinoembryonic antigen CEA, histaminidase, prostaglandin, and serotonin
> During work-up: Calcitonin, Calcium and CEA levels should be determined pre-op and 2-3 months post-operatively - Only type of thyroid CA that does not develop in a Thyroglossal duct cyst or Lingual thyroid that with CA formation
- Tx: Total Thyroidectomy + Neck Dissection
A
Medullary Thyroid CA
24
Q
- 5% of thyroid CA; poorly-differentiated thyroid CA
- 60-70 years old; F>M
- May develop from a pre-existing papillary thyroid CA
- Worst type of thyroid CA (very poor prognosis)
- Treatment is controversial, only palliative procedures such as tracheostomy, gastrostomy and chemo-radiation therapy
A
Anaplastic Thyroid CA
25
SITE
- Squamous Cell Carcinoma
> 85-95%
- M>F
- Clinical features:
> Supraglottic- dysphagia
> Glottic- hoarseness
> Subglottic- dyspnea
- Stridor- high-pitch sounds secondary to airway obstruction
> Inspiratory, expiratory and biphasic
Larynx
26
Risk factors OF MALIGNANCY IN THE LARYNX
- Smoking
- Alcohol intake
- Vitamin deficiency
- Radiation exposure
- HPV 16 and 18
- Laryngopharyngeal reflux
- Occupational chemicals
> Asbestos, cement, Isopropyl alcohol, Leather, Mustard gas, Sulfuric acid, Wood dust, Coal and Tar products
27
Nodal spread of CA in the larynx
- Supraglottic- Level II, III, IV
- Glottic- rare
- Subglottic- Level VI or also to level II, III, IV for large tumors
