Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Larynx & Hypopharynx > Green Book Chapter 33 Larynx and Hypopharyngeal Cancers > Flashcards

Green Book Chapter 33 Larynx and Hypopharyngeal Cancers Flashcards

1
Q

What is the incidence of laryngeal cancer (LCX) in the United State?

A

~ 12,000 cases/yr of LCX (~20% of all H&N)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for developing LCX?

A

smoking, alcohol use, and voice abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the subsites of larynx?

A

supraglottic, glottic, and subglottic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is incidence/distribution of LCX according to subsites?

A

Glottic: 69%
Supraglottic: 30%
Subglottic: 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What % of premalignant lesions (leukoplakia/erythroplakia) progress to invasive laryngeal lesions?

A

20% of premalignant laryngeal lesions ultimately progress to invasive cancer (higher for erythroplakia than leukoplakia).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common LCX histology?

A

Squamous cell carcinoma (SCC) makes up > 95% of LCX. Other histologies include verrucous carcinoma (1% - 2%), adenocarcinoma, lymphoma, chondrosarcoma, melanoma, carcinoid tumor, and adenoid cystic carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the subdivisions of the supraglottic larynx?

A

Supraglottic larynx: Epiglottis (suprahyoid and infrahyoid), AE (aryepiglottic) folds, arytenoids, ventricles, and false vocal cords (FVCs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the subdivisions of the glottic larynx?

A

Glottis: Ant/Post commissures, true vocal cords (TVCs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the anatomic borders of the subglottic larynx?

A

Subglottis: 0.5 cm below the TVCs to the 1st tracheal ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the nodal drainage pathways of the various laryngeal subsites?

A

Supraglottic: levels II - IV
Glottic: virtually no drainage
Subglottic: pretrracheal and Delphian (level VI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the incidence of hypopharyngeal cancer (HPxC) in the US?

A

There are ~ 2500 cases/yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the median age at Dx for HPxC?

A

The median age at Dx is 60 - 65 yrs for HPxC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the subsites of the hypopharynx (HPX)?

A

Pyriform sinus, Postcricoid area, Posterior pharyngeal wall (“3Ps”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the anatomic boundaries of the HPX?

A

The HPX spans from C4-6 or from the hyoid bone to the inf edge of the cricoid cartilage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the sex predilection for HPxC based on the different subsites?

A

The sex predilection is predominantly male for pyriform sinus and post pharynx primaries, but predominantly female for postcricoid area tumors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the classic risk factors for the development of HPxC?

A

Smoking, alcohol, betel nut consumption, nutritional deficiency (vitamin C, Fe [Fe deficiency is associated with 70% of postcricoid cancers in northern European women]), and prior Hx of H&N cancer

17
Q

Is nodal involvement common with HPxC?

A

Yes. Nodal involvement is common due to abundant submucosal lymphatic plexus drainage to the retropharyngeal nodes, cervical LNs, paratracheal LNs, paraesophageal nodes, and SCV nodes

18
Q

What are the most commonly involved nodal stations in HPxC?

A

Levels II, III, and the retropharyngeal nodes are most commonly involved in HPxC. Level VI can also be involved and therefore should be covered when planning these cases for RT.

19
Q

What is the name for the most sup of the lat retropharyngeal nodes?

A

The most sup of the lat retropharyngeal nodes is the node of Rouviere

20
Q

What % of HPxC pts have nodal involvement at Dx?

A

~75% overall have the nodal involvement at Dx (~60% for T1)

21
Q

What is the typical histology seen in HPxC?

A

The predominant histology is SCC (>95%) –> adenoid cystic, lymphoma, and sarcoma

22
Q

What are the most common subsites of origin for HPxC?

A

The pyriform sinus: 70 - 80%
Post pharyngeal wall: 15 - 20%
Postcricoid: 5%

23
Q

At what cervical spine levels are the hyoid bone and the TVCs located?

A

The hyoid bone is at C3, whereas the TVCs are located near C5-6.

24
Q

How do pts with LCX typically present?

A

Hoarseness, odynophagia/sore throat, otalgia (via the Arnold nerve / CN X), aspiration/choking, and neck mass

25
Q

What is the typical workup for pts presenting with a possible laryngeal mass?

A

Possible laryngeal mass workup: H&P (voice change, habits, indirect/direct laryngoscopy), CXR, CT/MRI, PET, basic labs, EUA + triple endoscopy, and Bx of the primary +/- FNA of the neck mass

26
Q

What does the loss of the laryngeal click on palpation of the thyroid cartilage indicate?

A

Loss of laryngeal click on exam indicates postcricoid extension (or postcricoid tumor).

27
Q

What does pain in the thyroid cartilage indicate on exam?

A

Pain on palpation of the thyroid cartilage indicates tumor invasion into the thyroid cartilage (T4a disease)

28
Q

What imaging modality is best to assess for bony or cartilage erosion in pts with LCX?

A

CT scan is best for assessing bony/cartilage erosion (bone window)

29
Q

What is the incidence of nodal involvement for T1, T2, and T3-T4 glottic cancer?

A

T1: 0-2%
T2: 2-7%
T3 - T4: 15-30%

30
Q

What is the incidence of nodal involvement for supraglottic lesions according to T stage?

A

T1 - T2: 27% - 40%
T3 - T4: 55% - 65%

31
Q

What does total laryngectomy entail?

A

removal of the hyoid, thyroid, and cricoid cartilage, epiglottis, and strap muscle with reconstruction of the pharynx as well as a permeant tracheostomy

32
Q

What structures are removed with a supraglottic laryngectomy?

A

FVCs, epiglottis, and aryepiglottic folds

33
Q

What is the preferred surgical option for dysplastic lesions on the glottic larynx?

A

Mucosal stripping is typically curative for dysplastic lesions. Close follow-up is needed.

34
Q

What are the Tx options for Tis lesions of the glottic larynx?

A

Cord stripping/laser excision (need close f/u; cannot r/o microinvasive Dz) or definitive RT

35
Q

What are the ~5 yr LC rates for glottic CIS with the use of stripping vs. laser vs. RT?

A

Stripping: 72%
Laser: 83%
RT: 88 - 92%

36
Q

What are the advantages and disadvantages of using RT for early glottic cancer?

A

Advantages: better voice qulaity, noninvasive, organ preservation

Disadvantages: long Tx duration, RT changes could obscure post-Tx surveillance

37
Q

What is the voice quality preservation rate for early glottic tumors/pts treated with laser vs. RT?

A

The JHH data (Epstein BE et al., Radiology 1990) suggests better voice quality after RT (laser: 31%, RT: 74%, p = 0.012).

More recent RCT from Finland (Aaltonen L et al. IJROBP 2014) also suggest better voice quality with RT.

38
Q

What are the currently accepted dose fractionation and total dose Rx for CIS and T1 glottic lesions?

A

CIS: 60.75 Gy in 27 fx
T1: 63 Gy in 28 fx

at 2.25 Gy/fx

Larynx & Hypopharynx (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions