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Head and Neck > Cancer of the Neck > Flashcards

Cancer of the Neck Flashcards

1
Q

Primaries causing bilateral regional mets

A
  • Base of tongue
  • Ventral tongue
  • Soft palate
  • Supraglottis
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2
Q

What if neck node FNA suggests adenocarcinoma?

A

For hight level nodal dz: ND with submandibulectomy and possible parotidectomy
For low level nodal dz: consider excisional bx

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3
Q

Initial evaluation and MAN of FNA-proven carcinoma of neck mass with unknown primary

A
  • CXR, CT/MRI, consider PET/CT
  • Complete endoscopy
  • Blind biopsy: NP, tonsils, BOT, piriforms
  • +/- tonsillectomy
  • Consider bone scan, CT chest/abd, mammo, barium swallow, thyroid scan
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4
Q

Level I neck

A

IA: submental (b/w anterior digastrics; no left and right, just one area)
IB: submandibular triangle

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5
Q

Level II neck

A

Upper 1/3 (Base of skull to hyoid/carotid bifurcation)

  • IIA (anterior to CN XI)
  • IIB (posterior to CN XI)
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6
Q

Level III neck

A

Middle 1/3 (hyoid/carotid bifurcation to omohyoid/cricoid)

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7
Q

Level IV neck

A

Lower 1/3 (Omohyoid/cricoid to clavicle)

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8
Q

Level V neck

A

Posterior triangle

  • VA (superior to omohyoid)
  • VB (inferior to omohyoid)
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9
Q

Level VI neck

A 
Central compartment (anterior neck)
Between carotid sheaths
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10
Q

Level VII nodes

A

Superior mediastinum

Suprasternal notch to anterior mediastinum

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11
Q

When to consider an elective neck dissection in the N0 neck?

A

When the risk of regional mets is >15-25%:

  • Supraglottis
  • BOT
  • Oral tongue
  • Tonsils
  • Advanced stage cancer
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12
Q

What if after w/u and blind biopsies, still have an unknown primary?

A

Early stage neck dz (N1):
-ND + adjuvant XRT to neck, waldeyer’s ring, NP
vs
-RT alone

Late stage neck dz (N2-3):

  • ND + adjuvant XRT to neck, waldeyer’s ring, NP
  • +/- chemo
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13
Q

Radical neck dissection

A
  • All node levels removed
  • SCM, IJ, CN XI removed
  • Submandibular gland and tail of parotid removed
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14
Q

Modified radical neck dissection

A
  • All node levels removed
  • Type I: spares CN XI
  • Type II: spares IJ and CN XI
  • Type III (functional, Bocca): spares SCM, IV, CN XI
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15
Q

Selective neck dissection

A

-Not all node levels are removed
Types:
-Supraomohyoid (Anterolateral ND): Levels I-III for oral CA with N0 or some N1 dz
-Lateral ND: II-IV for supraglottic, OP, hypopharyngeal (typically b/l)
-Posterolateral ND: II-V, for select posterior scalp CA

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16
Q

Indications for Radical ND

A
  • Clinically positive nodes with primary cancer that has a high risk of occult nodes
  • Advanced nodal dz
  • Presence of large matted nodes or posterior nodes
  • Involvement of SCM, IJ, CN XI, and cervical nodes
17
Q

Indications for Modified Radical ND

A
  • Clinically positive nodes with primary cancer with a lower risk of occult nodes or the N0 neck
  • No involvement of SCM, IJ, CN XI
18
Q

Neck Dissection Complications

A
  • Wound infxn
  • Wound breakdown
  • Flap necrosis
  • Shoulder syndrome
  • Injury to vagus (SLN, RLN)
  • Injury to marginal mandibular (oral incompetence)
  • Hematoma/seroma
  • Chylous fistula
  • Cerebral/facial edema (IJ sacrifice)
  • Blindness
  • Postop dyspnea (PTX, phrenic nerve, CHF, atelectasis)
  • Carotid blowout (2/2 infected wound)
19
Q

What is shoulder syndrome

A

Results from sacrifice of CN XI

  • Loss of trapezius support
  • Shoulder drop
  • Winged scapula
  • Pain (primary source of morbidity)

Tx:

  • PT
  • Early cable grafting or orthopedic recon
20
Q

Chylous fistula after ND

A
  • Typically left sided (chyLous = Left 95-97%)
  • 2/2 injury of thoracic duct
  • Milky drainage w/in first few days postop
  • Incidence 1-2%

Tx:

  • Initially conservative (pressure, elevate HOB, restrict fats, MCFA diet, manage lytes)
  • Tetracycline sclerosing Rx vs surgical re-exploration if fails or output > 600 mL/day
21
Q

Cerebral edema after ND

A

Usu from b/l IJ sacrifice
May p/w SIADH and mental status change
Address urgently with NSGY c/s, steroids, Lumbar drain, hyperventilation, hyperosmolar drugs, diuretics

Head and Neck (12 decks)

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