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Pete 3 > Hats and Scarves 1 > Flashcards

Hats and Scarves 1 Flashcards

1
Q

What are the Diagnosis investigation tools?

A 
FNABX (Fine-needle aspiration biopsy)
Core biopsy
Incisional biopsy
Excisional Biopsy
Histology
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2
Q

What are the types of treatment options for Head and neck cancer?

A

Surgery
Radiation therapy (preserve structure and function)
Surgery + post-op RT +/- chemotherapy
Chemo-radiation +/- surgery for residual disease

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3
Q

What are the indications for post-op RT?

A 
Locally advanced disease
Close/positive margins
≥ 3 nodes involved
Extra-capsular spread
Lymph-vascular or peri-neural spread
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4
Q

What are the indications for post-op CT/RT?

A

Positive margins

Extracapsular spread

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5
Q

What are the different RT doses for the different stages?

A 
T1-2 disease: 60-66Gy/30-33#
T3/4 disease: 70Gy/35#
N0 neck 50Gy/30# 
N1 neck 60Gy/ 30#
Post-op neck 60Gy/30#
Post-op neck ECS (extracapsular spread), close/ +ve margins 66Gy/33#
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6
Q

What things do we check during follow-up?

A

Detect recurrence (and allow salvage therapy)
Side-effects of therapy
Speech therapy
Rehabilitation

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7
Q

What are the different histology types of head and neck cancer?

A 
SCC
Adeno-carcinoma
Adenoid cystic
Muco-epidermoid
Other (plasmacytoma, lymphoma, melanoma)
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8
Q

Acute side effects of Head & neck RT?

A 
lethargy
nausea and vomiting
skin changes
mucousitis
alteration in taste
dysphagia
odynophagia 
Alteration in saliva consistency
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9
Q

Late side effects of Head & Neck RT?

A 
xerostomia
radiation caries (tooth decay that results from radiation-induced dry mouth (xerostomia)
second malignancy
mucosal fragility
alopecia
loss of sweating
trismus
atrophy of SC tissues
Endocrine abnormalities
osteoradionecrosis
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10
Q

What is the monitoring of Head & neck cancer?

A

Daily review by RT’s, nurses
Weekly review by medical staff
Allied health review (dietician, speech pathology, social work, occupational therapy, physiotherapy)

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11
Q

What are the main chemotherapy agents used for chemo radiation?

A

cisplatin

5 fluorouracil

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12
Q

What are the aetiology factors of H&N cancer?

A

male >female
smoking
alcohol (synergistic)
marijuana

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13
Q

What is the principle aim of management of primary site?

A

optimize tumour control

preserve structure and function

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14
Q

How is oral cavity cancer treated and why?

A

surgery is mainstay of treatment:
to preserve saliva function
Patients may have more than one tumour in their life so avoid RT if possible
Aim to cure, but optimise speech and eating

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15
Q

How do larynx patients present?

A 
hoarse/ husky voice
local pain/ otalgia/ odynophagia
mass in neck
airway compromise
aspiration
weight loss
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16
Q

What are the treatment options for early glottic cancer?

A

radiation therapy
surgery (conservative)
laser (under investigation)
- characterised by low incidence of nodes

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17
Q

What is the dose for radiation therapy of Early glottic cancer and T3 glottic cancer?

A

T1: 63Gy/ 28#
T2: 66Gy/ 33#
T3: 66-70Gy/33-35#

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18
Q

What is the field arrangement used for Early Glottic Cancer?

A 
opposed laterals (may require obliques for short neck)
require anterior overshoot, treating the glottis with a margin
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19
Q

What is the treatment for T3 glottic cancer?

A

surgery (because local control is better with surgery)

However, selected patients may be offered RT

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20
Q

Why would T3 glottic cancer patients benefit from radiation therapy over surgery and what patients can it be offered to?

A

Laryngectomy: may compromise voice box function
Good airway
compliant with follow-up
easy to examine
cords fixed because of bulk of tumour
understand they have a higher risk of recurrence
understand that laryngectomy may be recommended in suspected recurrence and may not be confirmed histologically

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21
Q

How is advanced glottic cancer (T3-4,N1-3,M0) treated?

A

1) laryngectomy +/- PORT +/- CT
2) Radiation therapy (rare)
3) Chemoradiation

22
Q

When would you treat a stoma in advanced glottic cancer?

A

subglottic extension, or emergency tracheostomy

23
Q

What is supraglottic cancer characterised by and treated?

A

high incidence of nodes a presentation
sub-clinical nodal involvement
(bilateral necks treated)

24
Q

How is T1N0M0 supra-glottis cancer treated?

A 
radical radiation (good airway)
supra-glottic laryngectomy (require good airway reserve, as need to learn to swallow again & @ risk of aspiration)
25
Q

How is advanced disease for supra-glottis cancer treated?

A

surgery +/- post-op RT +/- CT
chemoradiation
Radiation alone (if surgery refused or comorbidity precludes surgery)

26
Q

RT for Supra-glottis Cancer?

A

63-66Gy/ 30-33#

Bulk disease 70Gy/35# and consider surgery for residual disease

27
Q

What are the potential surgery complications for sub-glottic cancer

A 
infection 
DVT +/- PE (Deep Vein Thrombosis +/- Pulmonary Embolism)
Flap necrosis 
Carotid rupture
Death
28
Q

What are the potential Radiation therapy complications for sub-glottic cancer?

A 
Chondritis (cartilage inflammation)
Osteoradionecrosis 
Chondronecrosis
Oedema
Virtually no risk of death
29
Q

What are the three areas of hypo pharynx?

A

posterior pharyngeal wall
piriform fossae
post-cricoid space

30
Q

What are the clinical presentation hypo pharyngeal lesions?

A 
sore throat 
dysphagia
hot potato voice
weight loss
referred otalgia (ear-ache)
Stridor (high-pitched weeping sound)
31
Q

How is piriform fossa of hypopharyngeal cancer treated?

A

rarely present early, therefore few treated with RT or Surgery alone
Partial pharynx-larynectomy may be an option for early stage disease
Advanced disease:
pharyngo-laryngectomy +post-op RT +/- CT
CT/RT
RT alone (rarely)

32
Q

How is the pharyngeal wall of hypo pharyngeal cancer treated?

A

early disease managed surgically (tends to spread sub-mucosally therefore requires large margins)
Locally advanced disease:
majority Surgery + PORT +/- CT
RT or CT/RT if not fit for surgery

33
Q

How are post-cricoid tumours of hypophargyneal cancer treated?

A

rare tumours
generally locally advanced at presentation
associated with Fe deficiency
RT need to treat upper mediastinum
Majority need pharyngo-larynectomy + RT +/- CT

34
Q

What are the three salivary glands?

A

parotid gland
submandibular glands (paired)
sublingual glands

35
Q

What is the histology of salivary gland cancer?

A

1) benign lesions:
pleomorphic adenoma, oncocytoma, Warthin’s tumour

2) Malignant lesions: adenocarcinoma
SCC
muco-epidermoid
Adenoid cystic

36
Q

What are the treatment options for salivary gland cancer?

A

surgery +/- PORT
Usually conserve the facial nerve
volume: parotid bed +/- ipsilateral neck nodes

37
Q

For pleomorphic adenoma “pseudopodia” salivary tumours how are they treated?

A

RT if tumour spill
requires a parotidectomy not “shelling it out”
long natural history, late recurrences

38
Q

How are low grade salivary tumours treated?

A

surgery alone (generally)

39
Q

What is the aetiology and pathology for nasal cavity tumours?

A 
aetiology: wood-workers
Pathology:
SCC
NHL
Plasmacytoma
Melanoma
Inverting papillom
Mid-line granuloma
40
Q

What is the clinical presentation of Nasal cavity?

A

Epistaxis (nose bleed) & nasal obstruction during sleep (OBS)

41
Q

What is the main treatment for nasal cavity cancer?

A

Surgery is the mainstay of treatment +/- RT
Radiation therapy: volume (primary + margin)
Dose: dependent on the histology

42
Q

Nasopharyngeal cancer aetiology?

A

Chinese origin
Males>females
Aetiology: EBV (Epstein- Barr Virus)

43
Q

What are some characteristics of nasopharyngeal cancer?

A 
Well supplied with lymphatics:
clinical nodal involvement is common
frequently bilateral
high incidence of occult nodal mets
include posterior spinal nodes
44
Q

How do nasopharyngeal carcinoma patients clinically present?

A 
painless neck lump
nasal obstruction
sore throat
facial pain
proptosis (bulging of the eyes)
Cranial nerve defects
unilateral otitis media (in adults)
45
Q

How are nasopharyngeal tumours treated?

A

RT is standard
Chemotherapy: appears distinct to other H&N CA, more chemo-sensitive
-synchronous CT/RT improves survival in advanced disease

46
Q

What is the dose to the primary lesion for nasopharyngeal tumours?

A

63-70Gy

47
Q

How is neck cancer managed?

A
  • observation with delayed neck dissection for recurrence
  • surgery (elective +/- post-op RT +/- CT) OR (Therapeutic +/- post-op RT +/- CT)
  • radiation therapy +/- neck dissection for persisting disease
48
Q

What does choice of therapy for neck depend on?

A

likelihood of nodal involvement
management of primary lesion
Dose: N0 neck, 50Gy/ 25#
Extra-capsular spread: increased risk LR, requires post-op RT, requires higher dose, consider PORT/ CT

49
Q

What are the different types of neck dissection?

A

radical neck dissection
modified radical neck dissection
functional neck dissection
supra-omohyoid neck dissection

50
Q

What are the complications neck dissection?

A 
nerve
vascular
lymphatic
pulmonary
infection 
flap necrosis
lymphoedema
death

Pete 3 (11 decks)

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