H and N oncology key points Flashcards
aetiology
PREV SCC cigarettes alcohol betel/pan OH diet
viruses that can contribute
HIV - Kaposi sarcoma
EBV - nasopharyngeal carcinoma
HPV - oropharyngeal and laryngeal squamous cell carcinoma
oropharynx
base of tongue
tonsil
SP
red flags for malignancy
ulcer persists >2wks from removal of any obvious causation rolled margins, central necrosis speckled appearance cervical lymphadenopathy - fixed worsening pain referred pain weight loss
LNs 1a
submental
LNs 1b
submandibular
LNs 2
upper jugular chain
LNs 3
mid jugular chain
LNs 4
lower jugular chain
Lugol’s iodine
highlights dysplastic tissues
- abnormal cells which could become malignant
WHO performance scale - 0
fully active, able to carry on all pre-disease performance without restriction
WHO performance scale - 1
restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature
WHO performance scale - 2
ambulatory and capable of all self-care but unable to carry out any work activities
up and about >50% of waking hours
WHO performance scale - 3
capable of only limited self-care, confined to bed/chair >50% waking hours
WHO performance scale - 4
completely disabled, cannot carry on any self-care
totally confined to bed/chair
WHO performance scale - 5
dead
tx options
curative vs palliative vs best supportive care nil surgery radio chemo chemoradio dual or triple modality
primary site
resection and packing resection and primary closure resection and reconstruction local flap pedicled flap free flap
donor sites
radial forearm
anterolateral thigh
fibula
composite scapula
ORN
necrotic bone in a prev radiotherapised field
hypoxia, hypocellular and hypovascularity
classification of ORN
1,2,3
1 - asymptomatic exposed bone
3 - cutaneous fistulation +/- pathological fracture
