ENT Neoplasms Flashcards
ENT neoplasms
-risk factors
- smoking
- alcohol
- viral (EBV, HPV, HIV)
- occupational exposure (dry cleaning agents, pesticides, plastic and rubber products, hair dressers)
- radiation
- poor oral hygiene and periodontal disease
What are the types of oral tumors?
- mucosal
- salivary gland
mucosal
- leukoplakia
- erythroplakia
- oral lichen planus
- oral carcinoma
salivary gland
- parotid
- warthlin’s tumor
- pleomorphic adenoma
Mucosal: Leukoplakia
- what
- what % progress to carcinoma within 10 years?
- common in people who use what?
- dx
what
-precancerous lesion that presents as white patches or plaques on oral mucosa that cannot be removed by rubbing/scraping
-between 1 and 20% of lesions progress to carcinoma within 10 years
common in
-smokeless tobacco users
dx
-biopsy to rule out SCC
Mucosal: Erythroplakia
- what
- what % of cases are dysplasia or carcinoma
- specific risk factors
- dx
what
-similar to leukoplakia except it has a red erythematous component
-90% of cases are dysplasia or carcinoma
risk factors
-alocohol/tobacco
dx
-bx to confirm
Mucosal: Oral Lichen Planus
- what
- presentation
- dx
- tx
What
-chronic inflammatory autoimmune disease
Presentation
- lace-like white patches on buccal mucosa
- erosions on gingival margin
Dx
-bx or exfoliative cytology
tx
- aimed at managing pain and discomfort
- corticosteroids
Mucosal: Oral Cancer
- MC type
- MC locations
- sx
MC type
-90% of all oral cancers of squamous cell carcinoma
MC location
-tongue, tonsils, gums, floor of mouth
Sx
- MC is sore in mouth that does no heal
- red or white patch in mouth
- persistent sore throat or something caught in throat
- hoarseness or change in voice
- may have chronic bad breath, difficulty moving tongue and jaw
Mucosal: Oral Cancer
- Dx
- Tx
Dx
- Good history for risk factors
- close insepction of the oral cavity
- endoscopy
- bx (fine needle aspiration, open biopsy, oral brush)
- CT/MRI/US
Tx
- Surgery
- radiation
- -combo or primary tx, used for pts that cant undergo surgery
Salivary Gland Tumors
- MC site
- other sites
- MC type of benign salivary gland tumor?
- MC type of malignant salivary gland tumor?
MC site
-parotid (80-85%)
other sites
-submandibular gland, sublingual, minor salivary glands
MC type of benign salivary gland tumor?
-Pleomorphic adenoma (parotid)
MC type of malignant salivary gland tumor?
-mucoepidermoid carcinoma and adenoid cystic carcinoma
What is the only salivary gland tumor associated with smoking?
Warthin’s tumor
Salivary Gland Tumors
- Presentation
- workup
Presentation
- painless mass or swelling of the salivary glands
- depending on location: nasal obstruction, congestion, vision changes, trismus
*minor salivary glands arising within oral cavity present: sub-mucosal mass, mucosal ulceration of the palate, lips, or buccal mucosa
Workup
- Good hx, PE
- CT/MRI/US (with Warthin need to image both parotid glands, tendency to be bilateral)
- bx (fine needle aspiration cytology, ultrasound guided core bx)
Salivary Gland Tumors
- Tx
- Parotid
- pleomorphic adenoma
- warthin’s tumor
- Submandibular glands
- Sublingual glands
- Minor salivary glands
Tx
-Usually surgery, radiation, or combo
- Parotid Gland:
- -depends on size, involvement, benign, malignant, or facial involvement
- -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
- Pleomorphic adenoma=superficial resection
- Warthin’s tumor=conservative
- Submandibular glands
- -submandibular sialoadenectomy and resection of submandibular gland
- -Benign=simple excision of gland
- Sublingual glands
- -resection of floor of mouth and involved sublingual gland, as well as ipsilateral submandibular gland
- Minor Salivary gland
- -Surgical resection with radiation preferred
Salivary: Pleomorphic Adenoma
- Tumor of what gland
- progression
- dx
- tx
-Most common benign tumor of PAROTID
Progression
-slowly growing, painless, solitary, firm, smooth, moveable mass without nerve involvement
Dx
-CT/MRI/FNA (fine needle aspiration)
Tx
-Superficial parotidectomy
Salivary: Warthin’s Tumor
- Tumor of what gland
- bilateral or unilateral
- risk factor
- common in what age group
- Tx
Tumor of what gland
-PAROTID
bilateral or unilateral
-tends to be bilateral
risk factor
-SMOKING (only salivary gland tumor with this risk factor)
common in what age group
-older people…
Tx
-conservative resection
Nasal and Sinus Tumors
- MC site?
- other sites
- causes and risk factors
MC site
-maxillary sinus
Other sites
- nasal cavity
- ethmoid sinuses
- sphenoid or frontal sinus (rare)
Causes/Risk factors
- smoking and tobacco smoke
- exposure to dust from wood
- leather or textiles
- inhaling vapors from glue
- formaldehyde
- solvents
- nickel
- HPV particles
Nasal and Sinus Tumors
- signs and sx
- dx
- tx
Signs and sx
- persistent nasal congestion, especially on one side
- pain in the forehead, cheek, nose, or around the eyes or ear
- post nasal drip
- frequent/persistent nose bleeds
- present late stage
Dx
- hx and PE
- small fiberoptic scope may be used to look in the nasal cavity and sinuses
- bx (FNA, open bx)
- CT/MRI/PET
Tx
- Surgery +/- radiation or chemo
- radiation
- chemo
Nasal and Sinus Tumors
- types of malignant
- types of benign
Malignant
- Squamous Cell Carcinoma (SCC) is MC
- Adenocarcinoma (occurs in sinus lining)
- Lymphomas
- Esthesioneuroblastoma (develop from nerves at base of skull where they enter the nasal cavity and provide sense of smell)
Benign
- Osteomas (usually do not cause sx, can impede frontal, ethmoid, or maxillary sinuses)
- viral infections (HPV) can cause papillomas (wart-like growths in the nose or sinus)
Pharyngeal Tumors: Nasopharyngeal cancer
- Common in what populations
- strongly correlated with what virus
- most common type of nasopharyngeal cancer
- preferred tx
Common in what populations
-asians and southeastern asian
strongly correlated with what virus
-EBV
most common type of nasopharyngeal cancer
-SCC
preferred tx
-radiotherapy
Pharyngeal Tumors: Nasopharyngeal cancer Describe: -Keratinizing -non-keratinizing -undifferentiated subtype
Keratinizing
- well differentiated cells that produce keratin
- common in the US
non-keratinizing
-tends to metastasize to regional lymph nodes
undifferentiated subtype
- often occurs in conjunction with high numbers of lymphocytes
- more common in Asia
- tends to metastasize to regional lymph nodes
Pharyngeal Tumors: Nasopharengeal Cancer
-Signs and sx
- lump in nose or neck
- sore throat
- trouble breathing or speaking
- nosebleeds
- trouble hearing
- pain or ringing in ears
- headaches
Pharyngeal Tumors: Oropharyngeal cancer
- Most common type
- sites
- risk factors
Most common type
-SCC
Sites
- Base of tongue
- tonsillar region *most common site for primary cancers of the oropharynx
- soft palate/uvula
- pharyngeal wall
Risk Factors
- Tobacco
- poor nutrition
- heavy alcohol consumption
- Eastern Asian descent
- HPV
Pharyngeal Tumors: Oropharyngeal cancer
signs and sx
- sore throat that does not go away
- lump in back of mouth, throat, or neck
- dull pain behind the breastbone
- cough
- trouble swallowing
Pharyngeal Tumors: Hypopharyngeal cancer
- Most common type
- risk factors
- signs and sx
Most common type
-SCC
(although hypopharyngeal cancer is the least common type of pharyngeal cancer)
Risk Factors
- Excessive drinking
- smoking
- poor nutrition
- male gender
- HPV
Signs and sx
- sore throat that does not go away
- ear pain
- lump in neck
- painful or difficulty swallowing
- change in voice
Pharyngeal Tumors
- Dx
- Nasopharengeal cancer dx
- hypopharengeal cancer dx
- Tx
Dx
- Hx and PE
- Head, neck, and chest Xrays
- CT/MRI/PET
- Endoscopy
- Bx (FNA, open bx)
- HPV testing
Nasopharengeal cancer dx
- nasoscopy
- EBV test
Hypopharengeal cancer dx
- Barium esophagogram
- esophagoscopy
- brochoscopy
Tx
- Surgery is mainstay*
- -exception: nasopharyngeal cancer is primarily treated with radiation
- -The keratinizing form is much less responsive to radiotherapy than non-keratinizing forms that benefit from surgery
- radiation (alone or with chemo)
- chemo
Laryngeal Tumors
- most common type
- commonly arise from what region
- most pts have a hx of what?
Most common type
-SCC
Commonly arise from what region
-Glottic (vocal cords)
Most pts have a hx of what?
-smoking and alcohol use
