Hats and Scarves 1 Flashcards
What are the Diagnosis investigation tools?
FNABX (Fine-needle aspiration biopsy) Core biopsy Incisional biopsy Excisional Biopsy Histology
What are the types of treatment options for Head and neck cancer?
Surgery
Radiation therapy (preserve structure and function)
Surgery + post-op RT +/- chemotherapy
Chemo-radiation +/- surgery for residual disease
What are the indications for post-op RT?
Locally advanced disease Close/positive margins ≥ 3 nodes involved Extra-capsular spread Lymph-vascular or peri-neural spread
What are the indications for post-op CT/RT?
Positive margins
Extracapsular spread
What are the different RT doses for the different stages?
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#
What things do we check during follow-up?
Detect recurrence (and allow salvage therapy)
Side-effects of therapy
Speech therapy
Rehabilitation
What are the different histology types of head and neck cancer?
SCC Adeno-carcinoma Adenoid cystic Muco-epidermoid Other (plasmacytoma, lymphoma, melanoma)
Acute side effects of Head & neck RT?
lethargy nausea and vomiting skin changes mucousitis alteration in taste dysphagia odynophagia Alteration in saliva consistency
Late side effects of Head & Neck RT?
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
What is the monitoring of Head & neck cancer?
Daily review by RT’s, nurses
Weekly review by medical staff
Allied health review (dietician, speech pathology, social work, occupational therapy, physiotherapy)
What are the main chemotherapy agents used for chemo radiation?
cisplatin
5 fluorouracil
What are the aetiology factors of H&N cancer?
male >female
smoking
alcohol (synergistic)
marijuana
What is the principle aim of management of primary site?
optimize tumour control
preserve structure and function
How is oral cavity cancer treated and why?
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
How do larynx patients present?
hoarse/ husky voice local pain/ otalgia/ odynophagia mass in neck airway compromise aspiration weight loss
What are the treatment options for early glottic cancer?
radiation therapy
surgery (conservative)
laser (under investigation)
- characterised by low incidence of nodes
What is the dose for radiation therapy of Early glottic cancer and T3 glottic cancer?
T1: 63Gy/ 28#
T2: 66Gy/ 33#
T3: 66-70Gy/33-35#
What is the field arrangement used for Early Glottic Cancer?
opposed laterals (may require obliques for short neck) require anterior overshoot, treating the glottis with a margin
What is the treatment for T3 glottic cancer?
surgery (because local control is better with surgery)
However, selected patients may be offered RT
Why would T3 glottic cancer patients benefit from radiation therapy over surgery and what patients can it be offered to?
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
How is advanced glottic cancer (T3-4,N1-3,M0) treated?
1) laryngectomy +/- PORT +/- CT
2) Radiation therapy (rare)
3) Chemoradiation
When would you treat a stoma in advanced glottic cancer?
subglottic extension, or emergency tracheostomy
What is supraglottic cancer characterised by and treated?
high incidence of nodes a presentation
sub-clinical nodal involvement
(bilateral necks treated)
How is T1N0M0 supra-glottis cancer treated?
radical radiation (good airway) supra-glottic laryngectomy (require good airway reserve, as need to learn to swallow again & @ risk of aspiration)
How is advanced disease for supra-glottis cancer treated?
surgery +/- post-op RT +/- CT
chemoradiation
Radiation alone (if surgery refused or comorbidity precludes surgery)
RT for Supra-glottis Cancer?
63-66Gy/ 30-33#
Bulk disease 70Gy/35# and consider surgery for residual disease
What are the potential surgery complications for sub-glottic cancer
infection DVT +/- PE (Deep Vein Thrombosis +/- Pulmonary Embolism) Flap necrosis Carotid rupture Death
What are the potential Radiation therapy complications for sub-glottic cancer?
Chondritis (cartilage inflammation) Osteoradionecrosis Chondronecrosis Oedema Virtually no risk of death
What are the three areas of hypo pharynx?
posterior pharyngeal wall
piriform fossae
post-cricoid space
What are the clinical presentation hypo pharyngeal lesions?
sore throat dysphagia hot potato voice weight loss referred otalgia (ear-ache) Stridor (high-pitched weeping sound)
How is piriform fossa of hypopharyngeal cancer treated?
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)
How is the pharyngeal wall of hypo pharyngeal cancer treated?
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
How are post-cricoid tumours of hypophargyneal cancer treated?
rare tumours
generally locally advanced at presentation
associated with Fe deficiency
RT need to treat upper mediastinum
Majority need pharyngo-larynectomy + RT +/- CT
What are the three salivary glands?
parotid gland
submandibular glands (paired)
sublingual glands
What is the histology of salivary gland cancer?
1) benign lesions:
pleomorphic adenoma, oncocytoma, Warthin’s tumour
2) Malignant lesions: adenocarcinoma
SCC
muco-epidermoid
Adenoid cystic
What are the treatment options for salivary gland cancer?
surgery +/- PORT
Usually conserve the facial nerve
volume: parotid bed +/- ipsilateral neck nodes
For pleomorphic adenoma “pseudopodia” salivary tumours how are they treated?
RT if tumour spill
requires a parotidectomy not “shelling it out”
long natural history, late recurrences
How are low grade salivary tumours treated?
surgery alone (generally)
What is the aetiology and pathology for nasal cavity tumours?
aetiology: wood-workers Pathology: SCC NHL Plasmacytoma Melanoma Inverting papillom Mid-line granuloma
What is the clinical presentation of Nasal cavity?
Epistaxis (nose bleed) & nasal obstruction during sleep (OBS)
What is the main treatment for nasal cavity cancer?
Surgery is the mainstay of treatment +/- RT
Radiation therapy: volume (primary + margin)
Dose: dependent on the histology
Nasopharyngeal cancer aetiology?
Chinese origin
Males>females
Aetiology: EBV (Epstein- Barr Virus)
What are some characteristics of nasopharyngeal cancer?
Well supplied with lymphatics: clinical nodal involvement is common frequently bilateral high incidence of occult nodal mets include posterior spinal nodes
How do nasopharyngeal carcinoma patients clinically present?
painless neck lump nasal obstruction sore throat facial pain proptosis (bulging of the eyes) Cranial nerve defects unilateral otitis media (in adults)
How are nasopharyngeal tumours treated?
RT is standard
Chemotherapy: appears distinct to other H&N CA, more chemo-sensitive
-synchronous CT/RT improves survival in advanced disease
What is the dose to the primary lesion for nasopharyngeal tumours?
63-70Gy
How is neck cancer managed?
- 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
What does choice of therapy for neck depend on?
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
What are the different types of neck dissection?
radical neck dissection
modified radical neck dissection
functional neck dissection
supra-omohyoid neck dissection
What are the complications neck dissection?
nerve vascular lymphatic pulmonary infection flap necrosis lymphoedema death
