ENT Neoplasms Flashcards
Which gender is at greater risk for H&N CA?
Men
Risk Factors for H&N CA
Smoking Alcohol Viral Infection (EBV, HIV) Occupational exposure HPV Radiation Poor oral hygiene Periodontal disease
Mucosal Oral Tumors
Leukoplakia
Erythroplakia
Oral lichen Plans
Oral carcinoma
Salivary Gland Oral Tumors
Parotid
Warthlin’s tumor
Pleomorphic adenoma
What is Leukoplakia?
Precancerous lesion that presents as white patches or plaques on oral mucosa that cannot be removed by rubbing
Common in smokeless tobacco users
What is Erythroplakia?
Precancerous lesion that presents asa red erythematous component on oral mucosa that can’t be removed by rubbing
Risk Factors & Diagnostics of Erythroplakia
Alcohol/tobacco use
Need biopsy
What is Oral Lichen Planus?
Chronic inflammatory autoimmune disease
Presentation of Oral Lichen Planus
Lace-like white patches on buccal mucosa
Erosions on gingival margin
Diagnostics & Therapy for Oral Lichen Planus
Exfoliative cytology or biopsy
Therapy: Corticosteroids
Most Common Locations of Oral Cancer
Tongue
Tonsils
Gums
Floor of Mouth
Signs & Symptoms of Oral Cancer
Sore in the mouth that doesn’t heal
Red/white patch in mouth
Persistent sore throat
Hoarseness or change in voice
Oral Cancer Diagnostics
Hx for risk factors Exam Endoscopy Biopsy CT MRI US
Oral Cancer Treatment
Surgery
Radiation
Possible Chemo
Which is the most common salivary gland tumor?
Pleomorphic adenoma- Parotid
Risk Factors for Salivary Glands
Radiation exposure
Smoking (Warthin’s tumor)
Virus infection
Industrial exposure
Presentation of Salivary Gland tumors
Painless mass of salivary gland Sub-mucosal mass/ulcerations (minor) Nasal obstruction Congestion Vision changes Trismus
Workup for Salivary Gland Tumors
Good history & PE CT MRI US Biopsy
Treatment of Salivary Gland Tumor
Surgery Radiation Combo Total Parotidectomy Conservative Parotidectomy Superficial Parotidectomy
Conservative Parotidectomy
Partial parotidectomy without facial nerve
Superficial Parotidectomy
Parotidectomy of entire superficial lobe & dissection along facial nerve
Total Parotidectomy
Removal of entire lobe and surrounding tissue with preservation of facial nerve
Reason for Superficial Resection
Pleomorphic adenomas
Reason for Conservative Resection
Warthin’s tumors
Treatment for Submandibular Glands
Submandibular sialoadenectomy
Resection of submandibular gland
Treatment of Sublingual Glands
Resection of floor of mouth and involved sublingual gland as well as ipsilateral submandibular gland
Treatment of Minor Salivary Glands
Surgical resection
Radiation preferred
Characteristics of Pleomorphic Adenoma
Slowly growing Painless Solitary Firm Smooth Moveable mass without nerve involvement
Diagnostics of Pleomorphic Adenoma
CT
MRI
FNA
Treatment of Pleomorphic Adenoma
Superficial parotidectomy
Warthin’s Tumor
Bilateral parotid gland
Older age
Superficial location
Risk Factor for Warthin’s Tumor
Smoking
Treatment for Warthin’s Tumor
Conservative resection
Where is most common place for nasal/sinus tumors?
Maxillary sinus
Causes & Risk Factors for Nasal & Sinus Tumors
Smoking & tobacco smoke Exposure to dust from wood Leather or textiles Inhaling vapors from glue Formaldehyde Solvents Nickel
Signs & Symptoms of Nasal & Sinus Tumors
Persistent nasal congestion
Pain in the forehead, cheek, nose or around the eyes or ear
Post-nasal drip
Frequent & persistent nosebleeds
Diagnostics of Nasal and Sinus Tumors
H&P of H&N Fiberoptic scope Biopsy (FNA/open) CT MRI PET
Treatment of Nasal and Sinus Tumors
Surgery +/- chemo/rads
Radiation
Chemotherapy
Types of Malignant Nasal & Sinus Tumors
SCC
Adenocarcinoma
Lymphomas
Esthesioneuroblastoma
Types of Benign Nasal & Sinus Tumors
Osteomas Viral infections (HPV)
Different Types of Nasopharyngeal Cancers
Keratinizing
Non-keratinizing
Undifferentiated Subtype
Keratinizing Pharyngeal Tumors
Well-differentiated cells that produce keratin
Less associated with EBV
RadioRESISTANT
Non-keratinizing Nasopharyngeal Cancer
Tends to metastasize
Linked to EBV
Variable radiosensitivity
Undifferentiated Subtype Nasopharyngeal Cancer
Conduction with high numbers of lymphocytes
Associated with EBV
Metastasize
RadioSENSITIVE
Signs & Symptoms of Nasopharyngeal Tumors
Lump in nose or neck Sore throat Trouble breathing or speaking Nosebleeds Trouble hearing Pain or ringing in ears Headaches
Areas for Oropharyngeal Tumors
Base of tongue
Tonsillar region
Soft palate/uvula
Pharyngeal wall
Risk Factors for Oropharyngeal Tumors
Tobacco Poor nutrition Heavy alcohol use Eastern Asian descent HPV
Signs & Symptoms of Oropharyngeal Cancer
Sore throat that doesn't go away Lump in back of mouth, throat, or neck Dull pain behind breastbone Cough Trouble swallowing
Most type of Oral, Nasal, Sinus, or Pharyngeal Cancer
SCC
Risk Factors for Hypopharyngeal Cancer
Excessive drinking Smoking Poor nutrition Male HPV
Signs & Symptoms of Hypopharyngeal Cancer
Sore throat that doesn't go away Ear pain Lump in neck Dysphagia and painful swallowing Change in voice
Diagnostics of Pharyngeal Tumors
H&P Head, neck, & chest x-rays CT MRI PET Endoscopy Biopsy HPV testing
Diagnostics of Nasopharyngeal Cancer
Naoscopy
EBV test
Diagnostics of Hypopharyngeal Cancer
Barium esophagogram
Esophagoscopy
Bronchoscopy
Treatment of Pharyngeal Tumors
Surgery
Radiation
Chemotherapy
Most common type of laryngeal tumors
SCC
4 Subtypes of SCC
Glottic carcinoma
Supraglottic carcinoma
Subglottic carcinoma
Transglottic carcinoma
Anatomic Area for Glottic Carcinoma
Involves true vocal cords
Anatomic Area for Supraglottic Carcinoma
Confined to the supraglottic area
Anatomic Area for Subglottic Carcinoma
Arise more than 10mm below free margin of vocal cords
Anatomic Area for Transglottic Carcinoma
Cross ventricle from supraglottic area to involve true and false vocal folds
Risk Factors for Laryngeal Tumors
Tobacco/Alcohol
Poor diet/oral hygiene
HPV
GERD
Presentation of Laryngeal Tumors
Progressive continuous hoarseness
Dyspnoea
Stridor
Dysphagia
Workup of Laryngeal Tumors
CT MRI PET Chest xray Direct laryngoscopy FNA cytology
Treatment for Laryngeal Tumors
Early stages: radiation or surgery
Advance stages: surgery & post-op chemoradiation
