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H&N Cancer Flashcards

1
Q

Anatomic borders of Level Ia

What nodal group is contained there?

A

Superior: Mandible
Inferior: Hyoid
Lateral: anterior bellies of digastrics

Submental nodes contained there

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2
Q

Anatomic borders of Level Ib

What nodal group is contained there?

A

Superior: Mandible
Anterior: Anterior belly of digastric
Posterior: Stylohyoid or Posterior edge of submandibular gland

Submandibular nodes contained there

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3
Q

Anatomic borders of Level IIa

What nodal group is contained there?

A

Superior: Skull base
Inferior: Inf border of the hyoid
Anterior: Stylohyoid or Posterior edge of submandibular gland
Posterior: CNXI

Jugular nodes contained there

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4
Q

Anatomic borders of Level IIb

What nodal group is contained there?

A

Superior: Skull base
Inferior: Inf border of the hyoid
Anterior: CNXI
Posterior: Posterior border of SCM

Jugular nodes contained there (upper 1/3)

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5
Q

Anatomic borders of Level III

What nodal group is contained there?

A

Superior: Hyoid
Inferior: Inferior border of the cricoid
Anterior: Sternohyoid muscle
Posterior: Posterior border of SCM

Jugular nodes contained there (middle 1/3)

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6
Q

Anatomic borders of Level IV

What nodal group is contained there?

A

Superior: Cricoid
Inferior: Clavicle
Anterior: Sternohyoid muscle
Posterior: Posterior border of the SCM

Jugular nodes contained there (lower 1/3)

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7
Q

Anatomic borders of Level Va

What nodal group is contained there?

A

Anterosuperior: Posterior border of SCM
Posterosuperior: Anterior border of trap
Inferior: Level of cricoid

Spinal accessory, transverse cervical nodes contained there

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8
Q

Anatomic borders of Level Vb

What nodal group is contained there?

A

Superior: Level of cricoid
Inferior: Clavicle
Anterior: Post border of SCM
Posterior: Ant border of trap

Spinal accessory, transverse cervical, supraclavicular nodes contained there

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9
Q

Anatomic borders of Level VI

What nodal group is contained there?

A

Lateral: Carotid arteries
Superior: Hyoid
Inferior: Suprasternal notch

Paratracheal, pretracheal, prelaryngeal, Delphian, parathyroidal nodes contained here

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10
Q

What are the qualifiers to radical neck dissection

A

Modified: Preserves 1+ nonlymphatic structures (SCM, CNXI, IJ)
Selective: Preserves LN group typically removed in RND
Extended: Addition of LN groups or nonlymphatic structures

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11
Q

What is removed in RND?

What LN groups are not removed?

A

Levels I-V, parotid tail nodes, CNXI, SCM, IJ, submandibular gland,

Not removed: Postauricular, suboccipital, perifacial, buccinator, retropharyngeal, central compartment nodal groups

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12
Q

What is preserved in a MRND?

A

Any one or more of CNXI, SCM, IJ

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13
Q

Types of selective neck dissections & the corresponding levels

A

Supraomohyoid (anterolateral) ND: Levels I-III
Lateral ND: Levels II-IV
Posterolateral ND: II-V
Anterior compartment ND: Level VI

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14
Q

What neck dissection is used for OC cancer?

A

Supraomohyoid (anterolateral) ND (Levels I-III)

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15
Q

What neck dissection is used for OP, hypopharyngeal, or laryngeal cancer?

A 
Lateral ND (Levels II-IV)
Can also do central compartment if midline
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16
Q

What are the types of MRND’s?

A

Type I: Spares CNXI
Type II: Spares CNXI and IJ
Type III: Spares CNXI, IJ, and SCM

Type I spares I, type II spares II, type III spares III

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17
Q

What syndrome is caused by injury to CNXI?

A

Shoulder syndrome:

  • Shoulder drop
  • Winged scapula
  • Pain
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18
Q

What side typically sees chylous fistula?

A

Left side (chyLe; 95%)

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19
Q

Borders of oral cavity

A

Lips
Junction of hard/soft palate
Circumvallate papillae

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20
Q

Lymph drainage of the lips

A

Upper lip = unilateral levels I-III

Lower lip = bilateral levels I-III

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21
Q

Most common site of verrucous carcinoma

A

Buccal mucosa

It’s a SCCa varient with lateral warty growth & better prognosis.

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22
Q

Which OC cancers do not require elective supraomohyoid ND?

A

Early-stage hard palate or lower lip

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23
Q

What are the borders of the OP?

A

Anterior: Junction of hard/soft palate & circumvallate papillae
Superior: Hard palate
Inferior: Hyoid

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24
Q

Most common site of OP cancer

A

Tonsillar fossae

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25
Types of cancers found in the OP
SCCa Lymphoepithelioma Lymphoma (BOT & tonsillar fossae)
26
Management of the cN0 neck in OP cancers
Elective lateral ND
27
Hypopharynx borders
Hyoid bone to cricopharyngeus
28
Subsites of hypopharynx & cancer rates
``` Piriform sinus (70%) Posterior pharyngeal wall (25%) Postcricoid region ( ```
29
T staging of hypopharyngeal cancer
T1: limited to 1 subsite; 1 subsite or 2-4cm T3: >4cm or vocal fold fixation or esophageal extension T4: Invasion of adjacent structures
30
Where is Reinke's space?
It is the superifical lamina propria of the true vocal fold
31
Borders of the supraglottic larynx
Epiglottis to junction of ventricle & true vocal fold
32
What is the embryologic precursor to the supraglottis?
3rd & 4th branchial arches
33
What is the embryologic precursor to the glottis & subglottis?
6th branchial arch
34
T staging of supraglottic cancer
T1: Limited to one subsite; normal cord mobility T2: Invades mucosa of >1 adjacent subsite or outside of supraglottis; normal cord mobility T3: Vocal fold fixation or tumor invades postcricoid area, pre-epiglottic space, paraglottic space, or thyroid cartilage T4: Invasion outside of larynx
35
What are the subsites of the supraglottis?
``` Suprahyoid epiglottis Infrahyoid epiglottis* Ayepiglottic folds Arytenoids False cords ``` *Most common supraglottic site
36
What are the borders of the glottis?
Superior surface of true cords to 1cm below the true vocal folds
37
What is the most common site of laryngeal cancer?
Glottis
38
What is the histology of the laryngeal subsites?
Supraglottis/Subglottis: Pseudostratified ciliated columnar epithelium Glottis: Stratified squamous epithelium
39
T staging of glottic cancers
T1: Limited to vocal fold with normal mobility T1a: one vocal fold T1b: bilateral vocal folds T2: Tumor extends to supra/subglottis or impaired vocal fold mobility T3: Vocal fold fixation or invasion of paraglottic space or thyroid cartilage T4: Extension outside of the larynx
40
Borders of subglottis
1cm below true vocal folds to the inferior cricoid cartilage
41
T staging of subglottic cancers
T1: Limited to subglottis T2: Involves vocal folds (normal or impaired mobility) T3: Fixed vocal cord; limited to larynx T4: Outside of larynx
42
Which laryngeal cancers do not require elective ND?
T1 or T2 glottic cancers All others require elective (usually b/l) lateral ND
43
Most common presentating symptoms of nasopharyngeal cancer
1) Neck mass | 2) serous otitis media
44
Risk factors for nasopharyngeal cancer
``` Regional distribution (South Asia) EBV infection ```
45
Borders of the nasopharynx
Anterior: Choanae Superior: Skull base Inferior: Soft palate Posterior: Superior constrictors
46
Where is the Fossa of Rosenmuller?
Medial to the medial crura of the eustachian tube orifice
47
What prevents food from going up your nose when swallowing?
Passavant's ridge | superior constrictors abut the soft palate
48
T staging of nasopharyngeal cancer
T1: Confined to nasopharynx/oropharynx/nasal cavity T2: Parapharyngeal extension T3: Invasion of bony skull base or paranasal sinuses T4: Extension into cranium, CN's, hypopharynx, orbit, infratemporal fossa
49
Treatment for nasopharyngeal carcinoma
Chemoradiation No role for surgery except for salvage neck management
50
What line divides the maxillary sinuses in half?
Ohngren's line Line from medial canthus to angle of jaw. Posterosuperior to the line indicates worse prognosis.
51
Most common paranasal sinuses for cancer
1) Maxillary sinuses | 2) Ethmoid sinus
52
Contents of the pterygopalatine fossa
``` Foramen rotundum (V2) Vidian n. Sphenopalatine n. Lesser Palatine n. Greater Palatine n. Pterygopalatine ganglion Maxillary artery ```
53
Borders of the pterygopalatine fossa
Medial: Perpendicular plate of palatine bone Lateral: Pterygomaxillary fissure Anterior: Posterior wall of maxillary sinus Posterior: Medial/Lateral pterygoid plates
54
What foramina open up into the infratemporal fossa?
``` Foramen ovale (V3) Foramen spinosum (middle meningeal a.) ```
55
Where is the H-zone of the face? | Why is it important?
Eyes, ears, nose, philtrum, jawline Skin cancers here portend a worse prognosis because these are embryologic fusion plates
56
N staging of melanoma
N1: 1 LN N2: 2-3 LN's N3: 4+ nodes or satellites in transit
57
Vagus schwannoma/neurofibroma: Unilateral or bilateral? Flow voids?
Unilateral | No flow voids present
58
``` Cervical paraganglioma (carotid body tumor): Unilateral or bilateral? Flow voids? ```
Single or bilateral | Strongly enhancing with flow voids
59
How does internal jugular thrombosis look on CT?
Round, expanded hypodense lumen
60
What potential spaces are seen behind the pharynx?
``` Retropharyngeal space (buccopharyngeal & alar fascia) Danger space (alar & prevertebral fascia) Prevertebral space ``` Retropharyngeal space has a midline raphe, danger space does not
61
MR appearance of cystic hygroma
aka Lymphangioma T2 bright, T1 isointense Most often found in posterior cervical space
62
What portions of the larynx come from which bronchial arches?
Supraglottis - 3rd & 4th Glottis - 6th Subglottis - 6th 3/4, 6, 6
63
What is the minimum SUV cutoff to be suspicious for cancer?
2.5 SUV's
64
How does Warthin's tumor appear on MRI?
Restricted diffusion often T1 hyperintense Can be bilateral or multiple sites in 1 parotid
65
What imaging characteristics point toward a malignant parotid mass?
Spiculated T2 hypointense If both present then 80% PPV of malignancy.
66
What H&N cancer goes to the retropharyngeal LN's?
Nasopharyngeal Ca **can be a normal finding in children
67
Best series to see LN's on MRI?
T2 fat suppressed
68
Best diagnostic modality for salivary gland masses
FNA Incisional biopsy is contraindicated
69
What is the most common salivary gland malignancy?
Mucoepidermoid carcinoma True of both children and adults
70
What is the most common malignancy of the submandibular and minor glands?
Adenoid cystic carcinoma
71
How is the neck managed with mucoepidermoid carcinoma in a salivary gland?
Low grade: ND only if clinical nodes present | High grade: Elective supraomohyoid ND
72
What salivary gland malignancy has a predilection for perineural spread?
Adenoid cystic carcinoma
73
What are the histologic subtypes of adenoid cystic carcinoma?
Low grade: Cribriform, Cylindromatous | High grade: Solid
74
How is the neck managed with adenoid cystic carcinoma in a salivary gland?
Clinically positive nodes only
75
What are the markers used to identify the facial nerve while performing parotidectomy?
Tragal pointer (lies 1cm inferior & anterior) Tympanomastoid suture line (lies deep to the inf end) Digastric attachment
76
What causes Frey's syndrome?
AKA gustatory sweating Caused by injury to the auriculotemporal nerve (supplies the parotid). Sweating & reddening of the affected area.
77
What US characteristics of thyroid nodules are predictive of malignancy?
``` Hypoechogenicity Height > Width Irregular borders Microcalcifications Hypervascularity ```
78
5y survival rates for HNSCCa for local, locoregional, and distant mets
``` Local = 80% Locoregional = 45% Distant = 35% ```
79
What is the mechanism of cisplatin?
Alkylating agent --> DNA cross-linking
80
What are the major toxicities of cisplatin?
``` Renal toxicity Ototoxicity Peripheral neuropathy Myelosuppression Increased liver enzymes N/V ```
81
What is the mechanism of Cetuximab (Erbitux)?
mAb that blocks EGFR
82
What are the major toxicities of Cetuximab (Erbitux)?
``` Peripheral neuropathy Desquamation and acne Electrolyte abnormalities Neutropenia/Infections Transaminitis Cardiac arrest (2%) ```
83
What is the mechanism of Pembrolizumab (Keytruda)?
mAb blocks PD-1 receptor and inhibits cell death on T-cells --> reverses T-cell suppression & induces antitumor response
84
What are the major toxicities of Pembrolizumab (Keytruda)?
Hyperglycemia & DM Electrolyte abnormalities Myelosuppression Edema
85
What are the major toxicities of Paclitaxel (Taxol)?
Peripheral neuropathy Alopecia Pancytopenia Hypersensitivity
86
Subsites of the oropharynx
``` Tonsil BOT Soft palate Posterior wall Vallecula ```
87
What percent of OP cancers are P16 positive but HPV negative?
10-20%
88
What malignancies are seen in the oropharynx?
SCCa (majority) Lymphoepithelioma (tonsil) Lymphoma Sarcoma, salivary gland
89
What ND is used for oropharyngeal cancer?
Levels II-IV | Ipsilateral or bilateral

ENT (10 decks)

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