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H&N Flashcards

1
Q

Subsites of oral cavity

A

Hard palate, RMT, alveolar ridge, oral tongue, floor of mouth, buccal mucosa, mucosal lip

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2
Q

T staging oral cavity

A

T1: <2 cm with < 5mm Doi, T2: <2 cm with >5 mm DOI or 2-4 cm with DOI <10 mm, T3: 2-4 cm with DOI>10 mm or Tumor>4 cm with DOI < 10 mm, T4a: >4 cm and DOI > 10mm OR tumor invades adjacent structures, T4b: invades deeper(skull base)

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3
Q

N stage oral cavity

A

N1: single ipsi LN 3cm or smaller without ENE, N2a: single ipsi 3-6 cm, N2b: multiple ipsi < 6cm, N2c: bilateral or contralateral < 6cm, N3a: >6 cm, N3b: ENE

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4
Q

Management of Oral cavity cancer

A

Surgery with LND

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5
Q

When to use adj RT after oral cavity resection

A

T#-4, N2+, PNI/LVSI, Close margin < 5mm, LEVEL IV/Vb LN+

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6
Q

When to use adj CCRT after oral cavity SCC resection

A

Positive margin, ENE

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7
Q

Subsites of oropharynx

A

palatine tonsil, BOT, soft palate, pharyngeal wall

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8
Q

T staging P16+ HN SCC

A

T1:<2cm, T2:2-4 cm, T3: >4cm, T4: Invasion of larynx, tongue, medial pterygoid, hard palate, mandible, or beyond

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9
Q

N staging p16+ SCC

A

cN1: ipsi LN < 6 cm, cN2: contralateral or bilateral LN < 6 cm, cN3: LN>6 cm, pN1: 1-4 LN, pN2: 5+ LN

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10
Q

Management of oropharynx T1-2N0

A

TORS or RT alone (66/60/54)

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11
Q

Management of T3 or N+ SCC of oropharynx

A

CCRT 70 Gy/2Gy+HDC 100 mg/m2 q 3w

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12
Q

Subsites of hypopharynx

A

pyriform sinus, posterior pharyngeal wall, post-cricoid space

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13
Q

Glottis T staging

A

T1a: limited to one vocal cord, T!b: involving bot vocal cords ,T2: extension to supra or sub glottis or impaired vocal cord mobility, T3: invasion of inner cortex of thyroid cartilage or VC fixation, T4a: invasion through outer cortex of Thyroid cartilage, T4b: very advanced

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14
Q

Management of T1-2N0 glottic

A

cord stripping or CO2 laser or RT (Tis 60.75, T1: 63 Gy, T2: 65.25 Gy)

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15
Q

Management of cT1-2N0 Supraglottic

A

Definitve RT 70Gy/2Gy

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16
Q

Management of cT3-4N+ larynx

A

Larynx preservation if less than T4a disease with some function, 70/2 with cisplatin OR total laryngectomy + LND with adj RT vs CCRT

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17
Q

Management of cT4b larynx

A

CCRT, laryngectomy is off the table

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18
Q

Management of hypopharynx cT1N0

A

Partial laryngopharyngectomy + LND or definitive RT 70/2 DAHANCA

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19
Q

Management of cT12-4a or N+ hypopharynx

A

Total laryngopharyngectomy + LND with adj RT vs CCRT OR Definitive CCRT

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20
Q

Management of cT4b Hypopharynx

A

Definitive CCRT

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21
Q

Borders for T1 larynx field

A

Superior: top of thyroid cartilage, Inf: bottom of cricoid cartilage, Post: anterior VB, Anter: flash skin

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22
Q

Borders for T2 larynx field

A

Sup: top of hyoid, Inf: first tracheal ring, Post; anterior VB, Ant: Flash skin

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23
Q

In larynx definitive CCRT what are your CTVs

A

CTV70 is GTV + 5mm, CTV 63 Is 5 mm more and also the whole larynx and LVL II-IV in N+ neck, CTV56 to uninvolved bilateral II-IV (cover VI if subglottic extension, cover RP if hypopharynx extension.

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24
Q

Which WHO GRADE Nasopharynx SCC is associated with EBV

A

G3

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25
Q

Which WHO GRADE Nasopharynx SCC is associated with smoking

A

G1

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26
Q

T staging Nasopharynx

A

T1: confined to NPX with extension to OPHX or nasal cavity without parapharyngeal involvement, T@: extension to parapharyngeal space and/or adj soft tissue involvement, T3: invasion of bone and/or paranasal sinuses, T4: intracranial extension.

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27
Q

N staging nasopharynx

A

N1: unilateral, N2: bilateral, N3: any >6 cm or below the caudal border of cricoid cartilage

28
Q

Management of cT1N0 nasopharynx

A

RT alone (70/63/56

29
Q

Management of cT2N0 nasopharynx

30
Q

Management of cT3-4 or N+ nasopharynx

A

Induction CHT + CCRT

31
Q

What induction chemo is used for nasopharynx

A

cis 80 + gem 1000

32
Q

What is covered in CTV for nasopharynx

A

GTV+1 cm, Vomer and surrounding ethmoid sinus, Sphenoid sinus, cavernous sinus (T3-4), Clivus, Bilateral foramen ovale, rotunda, and lacera, posteirior 5mm nasal caviy and maxillary sinus, Parapharyngeal space.

33
Q

Mandible constraint

34
Q

Parotid constraint

A

Mean < 26 Gy

35
Q

What nodes should be treated in nasopharynx

A

bilateral II-V and RP and retrostyloid LN (level IV can go to lowest level)

36
Q

What are the paranasal sinuses

A

ethmoid, sphenoid, maxillary, frontal

37
Q

Management of maxillary sinus SCC

A

same as oral cavity, craniofacial resection then adj RT vs CCRT if needed

38
Q

Olfactory neuroblastoma staging system

A

Kadish staging

39
Q

Kadish staging A-D

A

Stage A: confined to nasal cavity, Stage B: extends to paransal sinuses, Stage C: Beyond nasal cavity or paranasal sinuses, Stage D: LN or DM

40
Q

Management for Stage A Olf Neuroblast

A

craniofacial resection +/- RT 60/2Gy

41
Q

Management for Stage B-D Olf Neuroblast

A

If Resectable resect then PORT, if borderline, preop chemo then resect then PORT, if unresectable, definitive CCRT

42
Q

Management of SNUC

A

Induction CHT, PR/CR: CCRT 70/2Gy, if SD/PD: craniofacial resection –> PORT 60/2 (debulk as much as possible if not complete resectable then CCRT 70/2

43
Q

What is the first CN affected in NPX carcinoma, through what route?

A

CN VI, through lacerum to cavernous sinus

44
Q

Next most common CN involvement in NPX?

A

CN V1 and V2, V1: Superior orbital fissure, V2: rotundum, V3: ovale

45
Q

What is ccrt chemo and what is adj chemo for NPX?

A

cis 100, then cis/5FU

46
Q

What is FU NPX?

A

PET CT at 12 weeks, if node positive, FNA then dissection if positive. Also consider EBV viral load, it’s prognostic

47
Q

What is T4a stage for OPX?

A

HTML (hard palate, tongue, medial pterygoid, larynx)

48
Q

What is the contralateral parotid constraint if treating unilateral neck?

A

Max < 10 Gy

49
Q

What is the management for T1-2N0-1 OPX?

A

Resection or RT alone

50
Q

What is the management of T3-4 or N2+ OPX?

51
Q

What if creatinine is high in CCRT?

A

cetuximab instead of cis

52
Q

What is the oral cavity constraint?

A

Mean < 40 Gy

53
Q

What is the larynx constraint?

A

Mean < 40 Gy

54
Q

What is the mandible max constraint?

55
Q

What is the SMG constraint?

A

Mean < 39 Gy

56
Q

What is needed for H&N follow up?

A

H&P, imaging once, TSH, regular dental, swallowing, hearing

57
Q

What is the management of T1-T2N0 supraglottic?

A

RT alone T1: 66, T2: 70

58
Q

What is the management of T3+ or N+ supraglottic?

A

chemo-RT (70Gy)

59
Q

What are considered adequate margins in oral cavity?

A

1.5 cm tongue, 1 cm everywhere else

60
Q

Who gets postop RT for salivary gland cancer?

A

Everyone except T1-2 Low grade

61
Q

What are the low grade SGC histologies?

A

low grade mucoep, acinic cell, epithelial-myoepithelial.

62
Q

What is the management of Occult primary T0N1?

A

ipsi modified radical neck dissection, observe if no ECE or RT guided by HPV and EBV

63
Q

What is the management of Occult primary T0N2-3?

A

Neck dissection–>RT vs CRT for ENE OR CCRT

64
Q

What is the T staging for melanoma?

A

T1a: <0.8mm without ulceration, T1b: <0.8 mm with ulceration, T2a/b: 1-2mm without/with ulceration, T3a/b: 2-4 mm, T4a/b: >4mm

65
Q

What are the Clark levels for melanoma?

A

I: confined to epidermis, II: invasion into papillary dermis, III: tumor filling papillary dermis and compressing the reticular dermis, IV: invasion of reticular dermis, V: invasion of subcutaneous tissue

Constraints (10 decks)

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