Clin Med - Neoplasia/Congenital Disorders Flashcards
Choanal atresia
Congenital narrowing of the back of the nasal cavity that causes difficulty breathing. (1 or both posterior nasal cavities)
How does a choanal atresia effect a newborn?
Normal newborn is obligate nasal breather, so:
- Incapable of reflex breathing through the mouth
- Will succumb to respiratory arrest if not recognized
S/S of choanal atresia
- Cyclic respiratory distress relieved with crying
- Noisy breathing
- Feeding difficulties
Dx of choanal atresia
- Nasal endoscopy
* CT scan
Tx of choanal atresia
•Dependent upon severity
•Unilateral can be monitored if no respiratory distress or feeding issues. Nasal salinerinses.
•Bilateral must be treated as soon as possible. Surgical repair to open nasal
airway sufficiently to allow the infant to breathe on their own.
Causes of cleft palate/lip
usually unknown. suspect genetic, drugs, viruses, other toxins.
Complication of cleft palate/lip
- Appearance
- Feeding problems
- Failure to gain weight
- Poor growth
- Recurrent ear infections
- Speech difficulties
Dx of cleft palate/lip
Routine ultrasound during pregnancy
Tx of cleft palate/lip
- Early surgical repair (lip usually by 2-12 months, palate by 9-18 months)
- Prosthetic palate device to help with feeding until surgery
- Speech therapy
- Orthodontics
Nasoalveolar Molding Device (NAM)
passively molds the gums/nostrils prior to surgery. Held in place with rubber bands and tape. Slowly adjusted as the baby grows.
Reduces the size of the cleft prior to surgery, improves the position of the lip and nose, helps with feeding
papillomatosis
Benign epithelial tumors that grow inside the larynx, vocal cords, or respiratory tract
cause of papillomatosis
Caused by infection with the human papilloma virus (HPV) - but not considered a STD, transmitted during childbirth
Complications of papillomatosis
- they eventually may block the airway passage and cause difficulty breathing.
- Very rarely may undergo malignant change to squamous cell carcinoma w/ a poor prognosis
S/s of papillomatosis
Voice hoarseness and breathing difficulties most common presenting symptom
Dx of papillomatosis
• Indirect laryngoscopy • Direct laryngoscopy
Tx of papillomatosis
• Tumors have a tendency to return
• Surgery:
-May need repeated surgery for debulking
-Carbon dioxide laser surgery
inverted papilloma
•Benign unilateral tumor of the nasal passage •Often misdiagnosed as nasal polyp
etiology of inverted papilloma
- Epstein-Barr virus has been found in 65% (human herpes virus 4)
- Often contain HPV (Human papilloma virus)
S/S of inverted papilloma
•Most commonly present with recurrent epistaxis
Complication of inverted papilloma
- 10-15% will transform into squamous cell carcinoma
- Bony destruction
- Intracranial extension
Tx of inverted papilloma
Surgery, usually laser
Appearance of inverted papilloma
- Arises from the lateral nasal wall
- Typical granular “mulberry” like appearance
What is the most common site for a salivary gland mass/enlargement?
parotid gland
Salivary gland enlargement/mass commonalities
- Unilateral or bilateral: bilateral suggests benign process
- Bilateral diffuse swelling with dry mouth = Sjogren Syndrome
- Often seen with Diabetics
- Masses may be malignant or benign
S/S of salivary gland enlargement/mass
Painless slow-growing mass
Dx/Tx of salivary gland enlargement/mass
- Fine needle biopsy • CT scan to determine depth of tumor
* Surgery
Pleomorphic Adenoma
most common benign neoplasm of salivary glands, specifically of the the parotid gland
About the pleomorphic adenoma
- Female > males
- Non-painful, isolated swelling or mass
- Parotidectomy is treatment of choice
Warthin tumor
- mostly found in parotid gland
- Benign cystic tumor of the salivary glands
- Males > Females, associated with smoking
- Non-painful, slow growing, tail of the parotid near the angle of the mandible
- Complete excision with clear margins required
Vocal cord nodules aka singers or screamers nodes
- Localized, benign, superficial growths on the medial surface of the true vocal folds
- “Calluses” of the vocal cords
- Nodules are bilateral
vocal cord nodules are most common in who?
- women aged 20-50 years
- Also found commonly in children (more frequently in boys than in girls) who are prone to excessive shouting or screaming.
What is believed to be the cause of vocal cord nodules?
phonotrauma
vocal cord polyps
• Unilateral; have a broad spectrum of appearances, from
hemorrhagic to edematous, pedunculated
• Due to phonotrauma
• Can develop after an episode of hemorrhage
• Involve the free edge of the vocal fold mucosa
S/S of vocal cord polyps/nodules
- Voice change
- Generalized and persistent hoarseness • Change in voice quality
- Low, gravelly voice
- Airy or breathy voice • Increased effort in producing the voice
Out of polyps and nodules of the vocal cords, which cause a more noticeable change in the quality of the speaking/singing voice?
polyps
Tx of vocal cord polyps/nodules
- Correcting the underlying causative factors: Voice therapy and education
- Proper vocal hygiene and hydration
- Strict voice rest for 2-6 weeks
- Avoidance of vocal abuse, misuse, and overuse is a necessary baseline
- Surgical cautery/destruction of the nodule/polyp
Leukoplakia
- Diagnosis of exclusion – does not fit any other disorder
* Considered a premalignant lesion (must get biopsy) •Causes white or gray patches inside the mouth or tongue
Causes and predisposing factors of leukoplakia
- etiology is unknown
- Predisposing factors: tabacco use, alcohol consumption, chronic irritation, vitamin deficiency, endocrine disorders
S/S of leukoplakia
• Bright white patches that are sharply defined • Patches cannot be rubbed off
• Surfaces of the patches are slightly raised above the
surrounding mucosa
• Asymptomatic
Dx of leukoplakia
Physical Examination
Tx of leukoplakia
- Surgery
* Cryotherapy
Erythroplakia
•Pre-malignant condition with red patch or plaque that cannot be rubbed off •Cannot be characterized clinically or pathologically as any other disease • Less common than leukoplakia
malignant potential in erythroplakia vs. leukoplakia
Malignant potential of erythroplakia is 17
times > leukoplakia
Common area of erythroplakia
Usually found on the floor of the mouth (FOM), buccal vestibule, tongue and soft palate
Dx/tx of erythroplakia
Dx: biopsy
Tx: excision biopsy
Oral Lichen Planus
- Chronic/ recurrent inflammatory disease of the oral mucosa
- Etiology is unknown
- Has small potential to turn into squamous cell carcinoma
S/S of oral lichen planus
- Usually bilateral
- Painful lesions on buccal mucosa, tongue, and gingiva: white striations, papules, plaques. erosions, and vesicles
- Some patients report a roughness of the lining of the mouth
- Sensitivity to hot or spicy foods or oral hygiene products
- Erythematous ulcerations and vesicles may or may not be present
Cutaneous lesions that can present in oral lichen planus
Skin, scalp, nails, genital mucosa, esophageal mucosa, larynx, and conjunctivae
Tx of oral lichen planus
- No treatment is curative, as recurrence is common
- Fluocinonide topical 0.05% gel applied TID
(steroid) - Symptomatic treatment -Eat fresh fruits and vegetables
- Eliminate local exacerbating factors (tobacco and alcohol)
Smokeless Tobacco Keratosis
•White keratotic plaque which develops on oral mucosa in the area of chronic placement of
chewing tobacco or snuff.
•The lesion is a precancer, i.e. it carries a higher than normal risk of malignant transformation
Squamous Cell Carcinoma
•Represents more than 90% of all head and neck cancers
•Behavior of squamous cell cancer depends on its site of origin
Each anatomic site has its own particular spread pattern and prognosis
•Most commonly associated with the use of alcohol and tobacco
Viral etiology of Squamous Cell Carcinoma
- Epstein-Barr virus (EBV)
* Human papillomavirus (especially tonsillar carcinoma)
Environmental exposures in Squamous Cell Carcinoma
- paint fumes
- plastic byproducts
- wood dust
- Asbestos
- gasoline fumes
- Gastroesophageal reflux disease
- Irritation from poorly fitting dentures also has been implicated
S/S of Squamous Cell Carcinoma
- Usually begin as surface lesions with erythema and slight elevation
- Red lesions: Asymptomatic, need biopsy
- 1/3 of lesions are pure white (leukoplakia)
Most common sites for squamous cell carcinoma
- Posterolateral
- Floor of the mouth – juices from tobacco pool here
- Tongue
- Soft palate
- Anterior tonsillar pillar
- Lymphadenopathy
Tx of squamous cell carcinoma
- Surgery
- Radiotherapy
- Chemotherapy
- Immunotherapy and gene therapy
Nasopharyngeal Carcinoma (NPC)
•Not common cancer in Caucasians but 18% in North American
Chinese
-In China most common cancer in males, 3rd most common in females
S/S of Nasopharyngeal Carcinoma (NPC)
- Unilateral middle ear effusion in an adult
- Diplopia (CN III or VI)
- Epistaxis
- Neck mass-high in neck
- Nasal speech
Hallmark s/s of nasopharyngeal mass
unilateral SOM, in an adult (especially Asian) without history of recent URI is nasopharyngeal mass until proven otherwise
Sinus malignancy usually affects what sinus?
maxillary
What type of malignancy is common for sinus malignancy?
•Usually squamous cell carcinoma
-Malignant – can invade surrounding tissues/organs/lymph
nodes
-Can metastasize
Etiology of sinus malignancy
- Chronic infections
- Asbestos exposure
- Sawdust inhalation
- Chemical inhalation
S/S of sinus malignancy
- Similar to chronic sinusitis – delays diagnosis
- Nasal obstruction
- Pain
- Epistaxis
- Nasal discharge
- Swelling of the cheek
Dx/Tx of sinus malignancy
Dx: CT scan Tx: • Surgery for tumor debulking • +/- Radiation • +/- Chemotherapy
Types of malignant salivary tumors
- Mucoepidermoid Carcinoma
- Adenoid Cystic Carcinoma
- Acinic Cell Carcinoma
- many many more
Mucoepidermoid Carcinoma
most common type, F>M, classified as low/intermediate/or high grade, most commonly in parotid gland
Adenoid Cystic Carcinoma
most common for submandibular gland
Acinic Cell Carcinoma
most commonly found in parotid gland.
How are all of the malignant salivary tumors treated?
with complete removal of entire gland with clear margins (possibly sacrifice of the facial
nerve) and radiation
Oral Kaposi Sarcoma
Malignant neoplasm of the skin and mucus membranes
How does oral Kaposi sarcoma present?
•Red-purple to dark-blue macules
-generally no symptoms, usually not painful
Oral Kaposi sarcoma is most common in ?
•Most commonly seen in men older than 60 years and AIDS patients
Tx of oral Kaposi sarcoma
surgery, radiation, chemotherapy
Laryngeal carcinoma
- Closely correlated with smoking.
- Although alcohol is a less potent carcinogen than tobacco, alcohol consumption is a risk factor for laryngeal tumors
- In individuals who use both tobacco and alcohol, these risk factors appear to be synergistic
Clinical presentation of laryngeal carcinoma
- Supraglottic tumors: Odynophagia, mild dysphagia, mass sensation
- Glottic and subglottic tumors: Hoarseness of the voice
Tx of laryngeal carcinoma
- destruction of the tumor via cautery if possible, or surgical removal
- Pts require careful and frequent f/u for possible recurrence
- advanced cases may require total laryngectomy
S/S of esophageal cancer
- Trouble swallowing, especially solid foods – gets worse over time.
- Weight loss
- Pain or a burning feeling in the chest
- Hoarse voice
What type of cancer are the majority of esophageal cancers?
squamous cell or adenocarcinoma
about 90% of total esophageal SCC in the US are accounted for by what?
Smoking and excessive alcohol consumption
What increases the risk of esophageal SCC?
The presence of specific preexisting esophageal diseases (such as achalasia, Barrett’s esophagus and caustic strictures)
Dx of esophageal cancer
- Barium studies may suggest the presence of esophageal cancer, but the dx is established with endoscopic biopsy
- PET/CT scan for evaluation of distant metastases and surgical planning
Cancer staging is based on ?
location and size of tumor, adjacent tissue involvement, nodal involvement
Cancer staging: T
describes the size of the original (primary) tumor and whether it has invaded nearby tissue
Cancer staging: N
describes nearby (regional) lymph nodes that are involved
Cancer staging: M
describes distant metastases (spread of cancer from one part of the body another)
Tx of esophageal carcinoma
- Surgical excision if possible. May be unresectable if too large or encroaching on vital structures (large vessels, nerves, etc)
- Post-surgical radiation therapy (4-6 wks postsurg)
- Chemotherapy to improve effectiveness of radiation
- Repeat PET/CT scan 6-8 weeks after last radiation treatment to assess efficacy
