ENT Neoplasms Flashcards
Risk factors for ENT neoplasms
- Smoking
- Alcohol
- EBV (hair cell leukoplakia)
- HPV 16 (young men)
- HIV (SSC)
- Occupational exposure
- Radiation (thyroid cancer, salivary gland tumors, SSC and sarcomas)
- Poor oral hygiene and periodontal disease
What are the musocsal oral tumors?4
What are the salivary gland oral tumors? 3
Mucosal 1. Leukoplakia 2 Erythroplakia 3. Oral lichen planus 4. Oral carcinoma
Salivary glands
- Parotid
- Warthlin’s tumor
- Pleomorphic adenoma
- What is leukoplakia?
- Common in what population?
- What do we need to rule out and how?
- Precancerous lesion that presents as white patches or plaques on oral mucosa that cannot be removed by rubbing
- Common in smokeless tobacco users
- Biopsy to rule-out SCC (2-6% change)
CANT BE REMOVED BY RUBBING
- What is erythroplakia?
- 90% of cases are what type? 2
- Risk factors? 2
- how do we confirm the diagnosis?
- Similar to leukoplakia except it has a red erythematous component
- 90% of cases are dysplasia or carcinoma
- Alcohol/Tobacco risk factors
- Needs biopsy to confirm
- Oral lichen planus is what?
- How does it present? 2
- Diagnosis? 2
- Therapy?
- Chronic inflammatory autoimmune disease
- Presentation
- Lace-like white patches on buccal mucosa
- Erosions on gingival margin - Exfoliative cytology or biopsy
- Therapy aimed at managing pain and discomfort
- Corticosteroids
- 90% of oral cancers are what?
2. Most common locations? 4
- squamous cell carcinoma (scc)
- Most common locations
- Tongue
- Tonsils
- Gums
- Floor of mouth
Signs and symptoms of oral cancer?
4
(what is the most common)
- Most common is sore in the mouth that does not heal
- Red or white patch in mouth
- Persistent sore throat or something caught in the throat
- Hoarseness or change in voice
Oral cancer Diagnostics
5
- Good history for risk factors
- Exam
- -Close inspection of the oral cavity - Endoscopy
- Biopsy
- -Fine needle aspiration (FNA)
- -Open biopsy
- -Oral brush - CT/MRI/US
Treatment of oral cancer?
2
Surgery
Radiation
- -Sometimes in combo or primary treatment
- -Used for patients who can’t undergo surgery or the surgery causes severe impairment
- What is the most frequent site of salivary tumors?
- More common malignant tumor areas? 3
- Most common benign?
- Most common type of malignant tumors? 2
- Parotid most frequent site of salivary gland tumors 80-85%
- In contrast to parotid for malignancy
- 40-45% submandibular gland
- 70-90% suglingual
- 50-70% minor salivary glands - Most common type of benign salivary gland tumor is Pleomorphic adenoma (parotid)
- Most common type of malignant tumors include
- mucoepidermoid carcinoma
- adenoid cystic carcinoma
Risk factors for salivary glands?
4
- Radiation exposure
- Smoking
- Virus infection
- Industrial exposure
Only salivary tumor associated with smoking?
Salivary tumors associated with Virus are causes commonly by?
Industrial exposures such as? 3
- Warthin’s tumor only salivary tumor associated with smoking
- HIV
- Rubber manufacture
- Hair dressers
- Nickle compounds
Presentation of salivary gland tumors?
6
- Painless mass or swelling of the salivary glands
- Minor salivary glands arising within oral cavity present:
- -Sub-mucosal mass
- -Mucosal ulceration of the palate, lips, or buccal mucosa
Depending on location:
- Nasal obstruction
- Congestion
- Vision changes
- Trismus
Workup of salivary gland tumors: History? 3 PE? 3 Imaging? 3 Biopsy? 2
Good history about mass
- How long its been there
- Getting bigger
- Any history of skin cancer (SCC/Melanoma)
PE
- Important close inspection of oral cavity
- Palpation of neck
- Facial nerve paralysis
Imaging 1. CT 2. MRI 3. US With Warthin tumor need to image both parotid glands, tendency to be bilateral
Biopsy
- Fine needle aspiration (FNA) cytology
- Ultrasound guided core biopsy
Treatment of salivary gland tumors?
Usually surgery, radiation, or combo
What kind of surgeries are involved in treatment of salivary glands?
- Conservative
Partial parotidectomy without fully dissecting facial nerve - Superficial
Parotidectomy of entire superficial lobe and dissection along facial nerve - Total
Removal of entire lobe and surrounding tissue with preservation of the facial nerve
For Benign disease and tumors of the salivary glands what treatment would we do for the following:
- Pleomorphic adenomas
- Warthin’s tumors
- Superficial resection
2. Conservative
What surgery for the submandicular glands:
Malignant?
Benign?
Malignant:
Submandibular sialoadenectomy and resection of submandibular gland
Benign:
Simple excision of gland
What surgery for the Sublingual glands?
Resection of floor of mouth and involved sublingual gland, as well as ipsilateral submandibular gland
Minor salivary gland disease treatment?
Surgical resection with radiation preferred
Whats the most common benign tumor of the parotid?
Pleomorphic Adenoma
Pleomorphic Adenoma
- Grows how?
- painful?
- shape?
- mobility?
- Slowly growing,
- painless,
- solitary, firm, smooth,
- moveable mass without nerve involvement
- Diagnosis of Pleomorphic Adenoma? 3
2. Treatment?
- CT/MRI/FNA
2. Superficial parotidectomy
Warthin’s tumor
- Has a tendency to be what?
- population?
- location?
- risk factor?
- treatment?
- Tendency to be bilateral, parotid gland only
- Older age group
- Superficial location
- Smoking is a risk factor
- -Only salivary gland tumor with this risk factor - Conservative resection
Cancerous nasal cavity or sinus tumors are rare
About 2000 cases diagnosed in the US each year
Most of these tumors occur in the what?
maxillary sinus (60-70%)
Nasal and Sinus Tumors
risk factors? 7
- Smoking and tobacco smoke
- Exposure to dust from wood
- Leather or textiles
- Inhaling vapors from glue
- Formaldehyde
- Solvents
- Nickel
Signs and Symptoms
of nasal and sinus tumors?
4
- Persistent nasal congestion , especially on one side
- Pain in the forehead, cheek, nose or around the eyes or ear
- Post-nasal drip at the back of the throat
- Frequent and persistent nosebleeds
Nasal and Sinus Tumors
diagnosis?
4
- Medical history and PE of the head and neck
- Small fiberoptic scope may be used to look in the nasal cavity and sinuses
- Biopsy
- -FNA
- -Open biopsy - CT/MRI/PET
Nasal and Sinus Tumors treatment?
3
- Surgery
+/- radiation or chemo - Radiation
- Chemotherapy
Types of nasal and sinus tumors
Malignant types? 4
1. Squamous cell carcinoma (Most common) 2. Adenocarcinoma (Occurs in sinus lining) 3. Lymphomas 4. Esthesioneuroblastomas
Esthesioneuroblastomas develop from where?
Develop from nerves at base of skull where they enter the nasal cavity and provide sense of smell
Types of nasal and sinus tumors
Benign
2
- Osteomas
2. Viral infections HPV
Osteomas:
- Usually do not cause symptoms, but can cause symptoms how?
- If does cause these symptoms what do we need to do?
- impede the frontal, ethmoid, or maxillary sinunes
2. an obstruction it need to be removed surgically
What can viral HPV cause and what are they?
Can cause papillomas
Wart-like growths in the nose or sinus
10% are cancerous, most are benign
Nasopharyngeal cancer
- Common in what populations?
- Strongly correlated with what?
- preferred treatment?
- Most common type?
- Much more common with Asians and Southeastern Asian populations
- Strongly correlated with the Epstein-Bar virus (EBV)
- Some types are highly radiosensitive and radiotherapy is the preferred treatment
- Most nasopharyngeal cancers are SCC
Different forms of nasopharyngeal cancers
3
- Keratininzing
- Non-keratinizing
- Undifferentiated subtype
- Describe keratinizing nasopharyngeal cancers?
- More common wear geographically?
- Less associated with what?
- May be associated with what?
- reaction to radiation?
- Well-differentiated cells that produce keratin
- More common in the US, less in Asia
- Less associated with EBV
- May be associated with tobacco use
- Less radiosensitive and more radioresistant
Non-keratinizing nasopharyngeal tumors:
- Tends to metastasize where?
- reaction to radation?
- Linked to?
Undifferentiated subtype
- Often occurs in conjunction with high numbers of what?
- More common geographically where?
- Most often associated with what?
- Tends to metastasize where?
- reaction to radiation?
Non-keratinizing
- Tends to metastasize to regional lymph nodes
- Variable radiosensitivity
- Often linked to EBV infection
Undifferentiated subtype
- lymphocytes
- More common in Asia
- Most often associated with EBV
- Tends to metastasize to regional lymph nodes
- Very radiosensitive
Nasopharyngeal Tumors
signs and symptoms? 7
- A lump in the nose or neck
- Sore throat
- Trouble breathing or speaking
- Nosebleeds
- Trouble hearing
- Pain or ringing in the ears
- headaches
Oropharyngeal cancer
1. most common are what type?
2. Areas for cancer are?4
(most common)
- Most are SCC
- Areas for cancer are
-Base of tongue
-Tonsillar region
(Most common site for primary cancers of the oropharynx)
-Soft palate/uvula
-Pharyngeal wall
Oropharyngeal Tumors
risk factors? 5
- Tobacco (both chewed and smoked)
- Poor nutrition
- Heavy alcohol consumption
- Eastern Asian decent
- HPV
Oropharyngeal Signs and Symptoms 5
- A sore throat that does not go away
- A lump in the back of the mouth, throat or neck
- Dull pain behind the breastbone
- Cough
- Trouble swallowing
Hypophayngeal cancer
Least common type of pharyngeal cancer.
1. Whats the most common type?
- Risk Factors? 5
- SCC
- Excessive drinking (ETOH)
- Smoking
- Poor nutrition
- Male gender
- HPV
Hypopharyngeal cancer
Signs and Symptoms
5
- A sore throat that does not go away
- Ear pain
- A lump in the neck
- Painful or difficulty swallowing
- A change in voice
Diagnosis of pharyngeal cancers?
6
- History and physical exam
- Head, neck and chest x-rays
- CT/MRI/PET
- Endoscopy
- Biopsy
- FNA
- Open biopsy - HPV testing
Diagnosis for nasopharyngeal cancers also includes? 2
Diagnosis for hypopharyngeal cancers also includes? 3
Nasopharyngeal cancer
- Nasoscopy
- EBV test
Hypopharyngeal cancer
- Barium esophagogram
- Esophagoscopy
- bronchoscopy
Treatment of pharyngeal cancers?
3
- Surgery is mainstay of treatment for most pharyngeal cancers**
- Radiation
- -Alone or with chemo - Chemotherapy
Surgery is mainstay of treatment for most pharyngeal cancers
Exceptions?
- Nasopharyngeal cancer: is primarily treated with radiation
The keratinizing form is much less responsive to radiotherapy than non-keratinizing forms that benefit from surgery
- More than 95% of laryngeal tumors are what?
- Most commonly arise from wher?
- Majority of patients have history of what? 2
- SCC
- glottic region (vocal cords)
- smoking and alcohol use
SCC divided into 4 subtypes
for laryngeal cancers?
(describe each)
- Glottic carcinoma: involves true vocal cords (50-60%)
- Supraglottic carcinoma: confined to supraglottic area (30-40%)
- Subglottic carcinoma: arise more than 10mm below free margin of vocal cords (5%)
- Transglottic carcinoma: cross ventricle from supraglottic area to involve true and false vocal folds
Other laryngeal cancer types?
5
- Carcinoma in situ
- Verrucous (spindle cell and basaloid SCC)
- Undifferentiated carcinoma
- Adenocarcinoma
- Sarcomas
Laryngeal Tumors
risk factors?
4
- Tobacco/Alcohol
- Poor diet and oral hygiene
- HPV
- GERD
Laryngeal Tumors
Comprises 2-5% of all malignant disease
Highest in men aged 55-65
Male to female ratio 5-20:1
Presentation? 4
- Progressive continuous hoarseness is cardinal symptom
- Dyspnoea
- Stridor
- Dysphagia
Laryngeal Tumors Workup
4
- CT/MRI/PET
- Chest x-ray
- Direct laryngoscopy
- -Can obtain biopsy - FNA cytology
Biggest giveaway that you may have oral cancer?
sore in the mouth that wont heal
Laryngeal Tumors treatment:
- Early? 2
- Advanced? 3
- Early stages are treated with either
- radiation or
- surgical techniques to preserve laryngeal function - Advanced stages are treated with
- total laryngectomy,
- reconstruction
- postoperative chemoradiation therapy
Giveaway that you have pharyngeal cancers?
Sore throat that wont go away
