24 Neoplastic - OC/OP/HP/Mandible Flashcards
What is DOI for tongue SCCa that is a/w higher incidence of LN mets
4 mm (30% vs 7% if 4 mm or less invasion)
T/F: Disease-free, but not overall, survival is improved in pts with early oral tongue CA who undergo elective neck dissection
True
When SCCa grossly invades the adventitia of the carotid, how will artery resection impact survival?
It will not improve long-term survival
T/F: Hypopharyngeal CA has the worst prognosis of all H&N CA
True: 70% of pts p/w advanced dz (III and IV) and the 5-yr dz specific survival is only 33%
What are the m/c and least common sites of tumor involvement of HP
Pyriform sinus is m/c 75%
Postcricoid is least common 3-4%
How does behavior of pyriform sinus tumors differ from postcricoid and posterior pharyngeal wall tumors
Tumors of the pyriform sinus tend to infiltrate deeply at early stages, whereas those of postcricoid area and posterior pharyngeal wall tend to remain superficial until achieving an advanced stage
What features of HP tumors distinguish them from other H&N tumors
Propensity for early submucosal spread and skip lesions
What significance does this have on tx
Wide margins 4-6 cm inferior to gross, 2-3 cm superior to gross and wide RT
What is the incidence of cervical metastases at the time of presentation of pyriform sinus tumors? What percent are bilateral or fixed?
60%; 25%
T/F: size of primary lesion is related to incidence of LN mets in tumors of HP
False
Where do posterior pharyngeal wall tumors met?
Bilaterally to level II, mediastinum, superiorly to nodes of Rouviere at the skull base
Which site of the hypopharynx drains bilaterally into levels IV and VI
Postcricoid area
T/F: The involvement of the medial (as opposed to lateral) wall of the pyriform sinus significantly increases the likelihood of bilateral cervical metastasis.
True
T/F: Due to the high incidence of cervical metastases, treatment of the neck is necessary in all patients with hypopharyngeal cancer.
True
What is the incidence of a 2nd primary at the time of dx in pts with hypopharyngeal CA
5-8%
What are the m/c presenting sx in pts w/ tumor of retromolar trigone
referred otalgia and trismus
How many yrs does it take for a former smoker to have the same probability of developing an oral cavity CA as a nonsmoker
16 yrs
What is chance that a pt cured of an oral cavity CA will develop a 2nd primary if the continue to smoke
40%
What is incidence of cervical mets from BOT, tonsil, soft palate SCCa
70, 60, 40%
Incidence of malig in adults with asymmetric tonsils w/ normal appearing mucosa and no cervical LAD
5%
What percent of T3/T4 tumors of the tonsil can be salvaged after failing primary RT
50%
What are RF for osteosarcoma in mandible/maxilla
H/o ionizing RT, fibrous dysplasia, retinoblastoma, prior exposure to thorium oxide (radioactive scanning agent)
What chromosomal abnlity do osteosarcoma and retinoblastoma have in common
deletion of long arm of chromosome 13
T/F: there is a much lower risk of distant mets with osteosarcoma of H&N than that of long bones
true
What is mcc of death in osteosarc of H&N
Intracranial extension
Optimal tx for osteosarc H&N
Surg and RT
T/F: A patient with T3N2aM0 SCCA of the base of tongue has a complete response to external-beam radiation therapy both at the primary site and the neck. A planned neck dissection should be done to increase the rate of regional control.
True
3 m/c odontogenic tumor
ameloblastoma, cementoma, odontoma
3 m/c odontogenic cysts
Radicular (65%), OKC, dentigerous
What are odontomas composed of
Enamel, dentin, cementum, pulp
Where does a radicular or periapical cyst occur
along the root of a nonviable tooth, as the liquefied stage of a dental granuloma
Where do dentigerous cysts develop
around the crown of an unerupted, impacted tooth
Multiple odontogenic keratocysts are a manifestation of what syndrome
Basal cell nevus synd
What is Pindborg tumor
Calcified epithelial odontogenic tumor that is less aggressive than ameloblastoma and is a/w impacted tooth
What mandibular tumor or cyst produces white, keratin containing fluid
Odontogenic keratocyst
What is incidence of recurrence after excision of OKC
62% in first 5 yrs
