H&N intro Flashcards
anterior triangle borders
- Inferior border of mandible
- Sternal notch
- Anterior border of SCM
structureswithin ant triangle
- Submandibular gland
- Submental nodes
- Carotoid artery
- Internal jugular vien
- Cranial nerves
posterior triangle borders
- Inf: clavicle
- Ant: post border of SCM
- Post: ant border of trapezius muscle
structures within post triangle
- part of subclavian artery
- external jugular vein
- cervical and supraclavicular LN
- brachial plexus
post triangle is divided into 2 triangles by what structure and what are the triangles called
omohyoid muscle
occipital and subclavian triangle
what are the 2 nodes commonly in H&N Tx fields
jugular/subdigastric and node of rouviere
location of node of rouviere
most sup/lat retropharyngeal LN that runs from base of skull to hyoid
which node takes in nearly all drainage from HN area
jugular/subdigastric
define brachial plexus
network of nerves formed by ant rami of the lower four cervical nerves and first thoracic nerve (C5, C6, C7, C8, and T1)
location of brachial plexus
o Extends from spinal cord, through the cervicoaxillary canal in the neck, over the first rib and into the armpit
structures with bilateral drainage
base of tongue soft palate tonsils post pharyngeal wall nasopharynx
Level 1 LN group
submental and submadibular
level 2 LN group
upper jugular group
Level 3 LN group
middle jugular group
level 4 LN group
lower jugular group
Level 5 LN group
post triangle group
Level 6 LN group
anterior compartment group
which LNG is at highest risk of mets from oral cavity, nasal cavity, nasopharynx, oropharynx, hypo-pharynx, and parotid gland
level 2
which LNG gets mets from larynx esp with glottis extension and hypopharyngeal cancers with esophageal extensions
level 6
when is there risk for retrostyloid/ junctional node involvment
ipsilateral nodal disease
when is there risk for nodes or rouviere/retropharyngeal node involvment
nasophaynx, post pharyngeal wall and pyriform sinus involvment
cuz it extends superiorly to the base of the skull and inferiorly to the hyoid bone
name some etiological factors
tobacco - smoking and smokeless weed occupational exposures UV light Rad exposure poor oral health hygiene hereditary factors viruses p16 status
what is the significance of p16 status
linked to HPV-16 common in 90% of oropharyngeal cancers; as well as many other tumours
helps determine prog, Tx strat, overall survival
how is p16 testing done
staining
prog factors
morbidity of treatment increases and prognosis decreases as the affected area progresses backwards from lip to hypo-pharynx (excludes pharynx) stage grade nutritional status tumours that cross midline SCC- non worse differentiation extend of LNI, fixed, vascular
pathologies
90% SCC arise from epithelial linings of upper digestive tract
adenocarcinoma - salivary glands
melanoma
sarcoma
what are some variants of SCC
lymphoepithelioma
spindle cell
verrucous carcinoma
undifferentiatied carcinoma
diff between endophytic and exophytic
tumours more aggressive /hard to control and can spread and grow inward
noninvasive with raised/elevated borders
what are other causes of LN swelling other than cancer
when should it be concerning
infection or injury
LN that continues to enlarge or persist for 2-4 weeks
what is the epstein-barr virus
herpes virus - children + adults
affects b cells ad therefore immunity
perssists for life
T stages
o T1 – 2cm or less o T2 - >2 or =4cm o T3 - > 4 cm o T4 -with invasion of adjacent structures T4a – resectable T4b – unresectable
N stages
o N0
o N1 – single ipsilateral ln >3cm
o N2
a - Single Ipsilateral node, > 3cm < 6cm
b – Multiple Ipsilateral nodes, none > 6cm
c – Bilateral/Contralateral , none > 6cm
o N3 – Metastasis in a lymph node > 6cm
what is en bloc resection
tumour, draining nodes, and everything between is taken out
what are some types of resection
cryotherapy electro-cautery laser partial resection resection of primary tumour
what is involved in a radical neck disection
remove LNG 1-5, SCM, internal jugular vein,spinal accessory/11th cranial nerve
what is involved in a modified neck disection
spares SCM, internal jug vein, 11th cranial nerve
still excises LVG 1-5
excises submandibular gland
why are there standard fx schedules of 5x per week
there is accelerated repop in this area esp with SCC
even allows BID
what is the typical dose/fx
typical doeses?
200cGy/fx
7000/35 + 6000/30
RT side effects?
mucositis xerostomia erythema dry eye trismus larngitis taste changes brachial plexus - muscle soreness/stiffness periodontal disease + cavities
