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Skin Radiation therapy > H&N cancer in general > Flashcards

H&N cancer in general Flashcards

1
Q

nodal levels 1-7

A

Level I: submental and submandibular = submaxillary
Level II: superior spinal accessory and superior jugular = upper deep cervical
Level III: mid jugular = middle deep cervical
Level IV: inferior jugular = lower deep cervical
Level V: inferior spinal accessory = posterior cervical, transverse cervical = supraclavicular chain
Level VI: prelaryngeal = delphian
Level VII: contains lymph nodes inf to the SSN

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2
Q

what contrast is used for H&N CT scans

A

IV contrast is use to delineate the LN and blood vessels

GFR is calculated before giving IV contrast, ensure the GFR is >60 css/min

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3
Q

CT scanning limits for H&N cancer

A

SUP: top of skull
INF: to carina

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4
Q

RINGS IMRT

A

As many rings as needed
Target volume would have a max dose of the needed dose ex. 70 Gy
**if you aren’t achieving proper coverage, bump the max up to 105% to allow the target to be covered
5-7% of dose can be dropped per mm for IMRT and VMAT planning
The strongest weighting will be set on objectives for PTV coverage in order to achieve an ideal distribution around the volumes of interest. Medium weighting will be set on objectives to spare organs at risk, and lighter weighting will be set on Rings in order to help shape the overall distribution

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5
Q

XRT DOSES

A 
60 Gy/25
60 Gy/30 POST-OP
66 Gy/33 POST-OP
70 Gy/30 in 6wks
70 Gy/35 in 7wks
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6
Q

Dysphagia/ odonophagia

A

Begins 2-3 weeks
Resolves 2-4 weeks post XRT
Increase fluid intake to avoid dehydration
Eat food high in protein and calories
Eat foods that are easy to chew and swallow

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7
Q

what are the IMRT matches after CBCT

A

Bony match for image matching: use the vertebral bodies near the PTV
Verify coverage of target volume *generally anatomy within 95%

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8
Q

what happens when there is gas in the patients shell

A

Assess for gaps in shell on a daily basis
Consult a planner when gap in shell occurs especially under bolus placement
If there is a discrepancy great than 2 mm between the RT and LT TP0+ during laser alignment, verify set-up and reposition the mask on the patient if necessary
If AP+ does not align with LAT+ in the SUP/INF direction, ensure patient’s chin and forehead are well positioned in the shell

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9
Q

mucositis

A

Begins week 1
Resolves 3 weeks post XRT
Increase fluid intake and mouth care routine
Clean mouth after meals and use soft toothbrush
Avoid alcohol, smoking, spicy food and citrus
Try to eat high protein and high calorie foods

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10
Q

xerostomia

A

Begins week 1
Resolves 6 months or later (variable)
Use mouthwashes regularly and frequent sips of water
Avoid alcohol, smoking, spicy food and dry food
Avoid coarse foods and add moisture to solid foods (gravies, etc.)
Use foods and drinks that promote salivary production

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11
Q

dysgeusia

A

Begins week 1-2
Resolves 2-4 months post XRT
Eat small frequent meals that are high protein and calorie foods
Try a nutritional supplement
Try fresh fruit, sugarless candies, tart flavours and other citrus food
Try marinating food and experiment with spices

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12
Q

Erythema/ moist/ dry desquamation

A

gentle cleansing, avoid sun exposure, lotion without irritants should be applied
Hydrocortisone cream for red/itchy- unopened skin
Those with moist desquamation: wound dressing with nonstick bandaging, Silvadene (silver sulfadiazine) is often prescribed to promote healing and avoid infection
Flamazine may also be used for

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13
Q

chronic side effects of XRT

A

Permanent xerostomia
Soft tissue fibrosis
Hyper and hypo pigmentation
Hair loss (whiskers) back of skull

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14
Q

OTC medications for Side effects

A

Aspirin (acetylsalicylic acid)- analgesic antipyretic, anti-inflammatory
used only if not on chemo
Tylenol (acetaminophen)- analgesic, antipyretic
used only if not on chemo
Biotene- relief of xerostomia and saliva substitute
Liquid Lidocaine - topical anaesthetic
Maalox- Antacid, used to coat the throat and ease swallowing
Magic Mouthwash- liquid lidocaine, Benadryl and Maalox

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15
Q

prescription for side effects

A

Salagen (pilocarpine HCl)- cholinomimetic agent; used for xerostomia
Mycostatin (Nystatin) - treatment of candidal infection of the mouth, related to XRT; anti-fungal
Xylocaine viscous 2% - topical anaesthetic

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16
Q

H&N CT sim scan parameters

A

from top of th head to carina

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17
Q

who s/b consulted when there is a gap in the shell

A

consult planners

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18
Q

what happens when there is discrepancy in TPO of the shell… how much discrepancy warrants action?

A

2 mm or greater warrants action, you reposition and set up the patient and ensure pt position and reposition the mask

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19
Q

if AP TP0 is off but the lats are on what action is taken?

A

issue in SUP/INF position ensure patient chin and forehead are in the mask correctly

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20
Q

what is the most common salivary gland tumour

A

parotid followed by submandibular

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21
Q

many H&N cancers are associated with smoking and or alcohol, this is not the case for this subtype….

A

salivary gland cancer

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22
Q

which H&N cancer is diagnosed at the youngest age?

A

sailvay gland tumours
45 yo for benign tumours
54 for malignant tumours

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23
Q

a 50 year old female patient with prior H&N lymphoma presents to the XRT department with a painless mass, what is her most likely primary?

A

a salivary gland tumour

-female gender could be an indication of a benign parotid tumour

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24
Q

70% of saliva is made by this structure….

A

submandibular glands

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25
Q

how long does it take for xerostomia to occur

A

after 1 week of tx 10 GY

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26
Q

what H&N cancer may use bulls eye technique

A

salivaRY GLAND cancer- specifically parotid gland

also paranasal sinus/ nasal cavity

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27
Q

what type of tumour is mucoepidermoid carcinoma

A

1 malignant parotid gland tumour

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28
Q

what type of tumour is adenoid cystic

A

malignant salivary gland tumours (except parotid gland)

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29
Q

what cancer type is often associated with occupational exposures?

A

paranasal sinus and nasal cavity

assoc with sawmill dust and nickel exposure

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30
Q

the septum divides me into left and right halves… what am I?

A

Nasal Cavity

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31
Q

i am the largest paranasal sinus? Who am I?

A

maxillary sinus

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32
Q

I am the most posterior sinus? Who am I?

A

i am the sphenoid sinus

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33
Q

A 62 year old man who is a retired nickel mine worker presents to the XRT department with facial swelling and pain, what is his diagnosis?

A

He has a paranasal sinus tumour-> maxillary sinus tumour SCC
SCC is associated with nickel exposure
Maxillary sinus presents with facial swelling and pain in late stages

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34
Q

A 61 y.o. man with a 30 pack year history presents to the radiation department with a crusty, scaly asymptomatic plaque, What is his primary?

A

This patient probably has a Nasal vestibule SCC

  • nasal vestibule presents with asymptomatic plaque
  • SCC is associated with smoking
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35
Q

A 64 y.o. male who is a retired Sawmill worker presents to the radiation department with epistaxis and nasal discharge, what is his primary?

A

this patient has an adenocarcinoma of the nasal cavity

  • Adenocarcinoma is associated with working in a sawmill
  • The presenting symptoms of epistaxis and nasal discharge (nasal polyp like S&S) are associated with nasal cavity tumours
36
Q

Cancer most common in Japan and South Africa?

A

paranasal Sinuses

37
Q

Cancer common in China, Saudia Arabia, north Africa

A

nASOPHARYNX

38
Q

What is trismus

A

lock jaw can be SE or symptom of H&N cancer

39
Q

What H&N cancer has different staging system than all other H&N ca?

A

NASOPHARYNX IS DIFFERENT THAN ALL OTHER H&N CA

40
Q

cranial nerve 3-6 is most commonly involved in which H&N cancer

A

NPC

41
Q

A 55 year old patient with a 35 pack year history, who drinks 4 drinks/ day, and has a diet high in salted meats presents with cold like symptoms. What is his most likely primary?

A

NPC

42
Q

this cancer is diagnosed late because it manifests with cold like S&S

A

NASOPHARYNX

43
Q

What cancer has more superior IMRT borders than other H&N cancer?

A

nasopharynx

44
Q

what H&N cancer is associated with HPV

A

OROPHARYNX

45
Q

a 32 y.o. female with a history of HPV presents at the cancer centre with a neck mass, what is her primary?

A

Oropharynx cancer— can be associated with HPV in younger pts

46
Q

a 57 y.o. male with a 43 pack year and 5 alcoholic drinks/ day presents at the radiation department with trismus and necrotic smell, what is his most likely primary?

A

Oropharynx

47
Q

erythroplakia vs leukoplakia

A

leukoplakia is a white patch erythroplakia is a red patch

48
Q

what cancers are preceeded by erythroplakia or leukoplakia

A

oral cavity cancers

49
Q

snuff, betel nut chewing are etiological factors for what H&N cancer

A

oral cavity

more specifically the buccal mucosa, gingiva, lip and floor of mouth

50
Q

a 54 y.o. man with a 30 pack year and 6 ounces of alcoholic drinks/ day presents to the radiation department with white patches in his mouth, what is his primary, what are the white patches?

A

the white patches are leukoplakia which is an indication of oral cavity cancer- this occurs more often in FOM. buccal mucosa tongue and retromolar trigone

51
Q

salivary origin tumour is the primary histology for what H&N cancer

A

hard palate of the oral cavity

52
Q

why are teeth removed before XRT

A

to avoid osteoradionecrosis

53
Q

which subsite is surgery most important for?

A

surgery is primary treatment for oral cavity cancer - oral cavity cancers are harder to control with XRT

54
Q

brachy and electrons may be used for what site?

A

oral cavity cancers

55
Q

ill fitting dentures can cause what cancer?

A

oral cavity- the hard palate

56
Q

What agent is used for H&N brachy

A

Ir-192

57
Q

brachy is used LDR/HDR? remote or manual afterloading?

A

typically LDR and is remote afterloading

58
Q

loose teeth could be an indication of what

A

late stage oral cavity cancer

59
Q

what is the most common site of H&N cancer

A

larynx

60
Q

endophytic tumour

A

tending to grow inward into tissues in fingerlike projections from a superficial site of origin —used of tumors

61
Q

exophytic tumour

A

Exophytic tumors grow out from the mucosal surface in cauliflower-like clusters, and rapidly become symptomatic. Thus, these tumors are usually diagnosed earlier in the course of the disease

62
Q

what tumour types present early?

A

most tumour type present late except for oral cavity and larynx cancers

63
Q

what site most commonly gets mets?

A

the hypopharynx

64
Q

this cancer is associated with voice changes?

A

supraglottic cancer

65
Q

a 58 y.o. male patient with a history of smoking and drinking presents to the XRT department with voice changes, what is his primary?

A

larynx- more specifically the supraglottis, th epiglottis as its associated with voice changes

66
Q

a 63 y.o. retired speaker of the house presents at the radiation department with hoarseness, what is their primary?

A

larynx- can be any part of the larynx as hoarseness is most common s&s however, most likely of the glottis as its the most common site

67
Q

plummer vinison syndrome causes what H&N cancer

A

hypopharynx

68
Q

EBV is associated with what subtpye?

A

nasopharynx—- STRONG ASSOCIATION

69
Q

parotid drains from what ducts

A

stensons ducts

70
Q

submandibular gland drains from what ducts

A

whartons ducts

71
Q

subsites for larynx

A

glottis, subglottis and supraglottis

72
Q

subsites for nasopharynx

A

Posterosuperior and lateral pharyngeal wall
Eustachian tube orifice
Adenoids

73
Q

subsites nasal cavity and paranasal sinus

A

Maxillary, frontal, ethmoid and sphenoid

74
Q

subsites orpopharynx

A

tonsil, BOT, soft palate and post pharyngeal walls

75
Q

oral cavity subsites

A

buccal mucosa, gingiva, lips, ant 2/3 of tongue, hard palate, retromolar trigone, FOM

76
Q

HYPOPHARYNX SUBSITES

A

POST CRICOID, POST PHARYNGEAL WALL AND PIRIFORM FOSSA

77
Q

Nickel exposure is associated with what H&N cancer

A

sinuses- SCC- most commonly in maxillary sinus

78
Q

wood dust is associated with what cancer subtype

A

adenocarcinomas of the paranasal sinuses- ethmoid sinus

79
Q

presentation oral cavity

A

erythroplasia leukoplakia

80
Q

presentation ooropharynx

A

painful swallowing and otalgia (ear pain)

81
Q

presentation hypopharynx

A

dysphagia, painful neck Ln

82
Q

presentation nasopharynx

A

bloody discharge, difficulty hearing

83
Q

presentation larynx

A

hoarseness and stridor

84
Q

presentation maxillary sinus

A

sinusitis, nasal obstruction and bloody discharge

85
Q

what site is cranial nerves most commonly involved in?

A

nasopharynx

Skin Radiation therapy (40 decks)

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