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CSB048 > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

What are some methods of diagnosis (5)

A
  • Core biopsy
  • Incisional biopsy
  • FNABX (fine needle aspiration biopsy)
  • histology
  • excision biopsy
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2
Q

What is the purpose of staging investigations

A
  1. Assess primary tumour and define the extent of spread
  2. See suitability for a particular treatment
  3. Exclude co-morbidities
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3
Q

What may be some considerations/investigations prior to RT for head and neck patients

A
  • cytology/ histology, radiology, biochem and haematology.
  • Pandescopy (biopsy)
  • OPG and dental assessment
  • Social worker
  • Speech pathology
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4
Q

What are some Tx options for Head and Neck Cancer?

A
  • Surgery
  • RT (preserves structure and function)
  • Surgery + Post op RT +/- Chemo
  • Chemo-radiation +- surgery for residual disease.
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5
Q

What are the indications for post-op RT?

A
  • Close or +ve margins
  • > = 3 nodes involved
  • extra capsular spread
  • locally advanced disease
  • lymph-vascular or perineurial spread
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6
Q

Indications for post-op RT/CT

A
  • Extra-capsular spread

- Positive margins

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7
Q

Dose fractionations head and neck?

A 
T1/2 disease: 60-66Gy in 30-33#
T2/4 disease: 70Gy in 35#
N0 Neck: 50 Gy in 30# 
N1 Neck: 60Gy in 30# 
Post op neck: 60 in 30#
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8
Q

What would you expect to happen in the ‘follow up’ stage?

A
  • Assess recurrence and if found options for salvage therapy
  • Speech pathology
  • Assess need for rehab
  • Adress the side effects of therapy.
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9
Q

How long should you wait post op to start RT

How long do you need to allow for dental extractions

A

Post op - 6 weeks

Dental Extractions - 2 Weeks

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10
Q

What are some planning considerations for H&N

A
  • Outline the CTV and GTV or HRTV if post op
  • Add expansion on the CTV of 5-10mm (consider what the impact would be if it was ill defined, need to cover BOT)
  • CTV - PTV - add another 5mm
  • Volume QA is ideal.
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11
Q

What are the acute side effects of RT for head and neck ca patients? (7)

A
  • change in salivary consistency
  • Dysphagia
  • Odonophagia
  • fatigue
  • skin reactions
  • mucositis
  • alteration in taste
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12
Q

What are the late side effects of RT for head and neck cancer patients? (10)

A
  • xerostomia
  • alopecia
  • endocrine abnormalities
  • radiation caries
  • atrophy of the SC tissue
  • reduced ability to sweat
  • 2nd malignancy
  • mucosal fragility
  • trismus
  • osteoradionecrosis
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13
Q

What are the considerations of chemo RT for H/N ca patients?

A
  • Gives an increased survival advantage but is associated with increased morbidity so not for everyone
  • Use 5FU or cisplatin given concurrently with RT.
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14
Q

What are the risk factors for H&N cancer?

A
  • Smoking
  • Alcohol
  • Marijuana
  • Male
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15
Q

What is the aim for the primary tumour site?

A
  • Optimise tumour control

- Preserve structure and function

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16
Q

What comprises the oral cavity?

A
  • Buccal cavity
  • Hard palate
  • Floor of mouth
  • Tongue
  • Alveolus
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17
Q

What is the main treatment for Oral Cavity ca?

A
  • Surgery is the mainstay because want to preserve salivary function.
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18
Q

What is the function of the larynx

A
  • Protects airway

- Vocalisation

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19
Q

What are the symptoms of Larynx ca? (6)

A
  • Horse/ husky voice
  • odonophagia/ oltagia/ localised pain
  • palpable mass
  • aspiration
  • airway compromise
  • weight loss
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20
Q

How is early glottic cancer characterised and how is it managed?

A
  • Low incidence of nodes

- Treated using: conservative surgery or RT, possibly LASER but still being investigated.

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21
Q

What are the planning considerations for early glottic cancers?

A
  • Volume the glottis with a margin
  • Usually encompassed by a 5x5, 6x6cm field
  • need overshoot anteriorly
  • Field arrangement - opposed laterals (may need obliques if short neck)
22
Q

What is the dose fractionation for EGC? (T1 and T2)

A

T1 - 63Gy in 28#

T2 - 66Gy in 33#

23
Q

What is the treatment preferred for T3 Glottic cancer, when would RT be offered (6)?

A
  • Surgery is preferred because increases local control.
  • RT may be offered to select patients who understand
    1. they will have increased recurrence risk
    2. a laryngectomy may not be advised due to suspicion that recurrence may not be confirmed histologically.
    3. people who are compliant with follow up
    4. Pts with a good airway
    5. easy to examine
    6. Cords fixed because bulk of tumour
24
Q

What is the dose fractionation for T3 Glottic Cancer

A

66-70Gy in 33-35#

25
Q

What are the tx options for locally advanced Glottic cancer?

A

1) Laryngectomy +/- PORT +/- Chemotherapy
2) RT (rare)
3) Chemoradiation

  • Treat stoma if subglottic extension or if emergency tracheostomy.
26
Q

How is the supra glottis characterised?

A
  • Increased nodes at presentation and increased subclinical nodal involvement.

Note: Because it is a midline structure it requires the bilateral tx of the neck.

27
Q

What are the Tx options for Supraglottis (Early)

A
  • Radical RT
  • Laryngectomy – this requires pts to have a good airway reserve as they are at risk of aspiration and need to learn to swallow again.
28
Q

What are the tx options for Advanced supra glottis cancer?

A
  • Surgery +- port +- Chemo
  • chemo-radiation
  • RT alone if pt refuses or has co-morbidites that prevent them from having surgery.
29
Q

Supra glottis dose #

A
  • 63-66Gy in 30-33#

- Bulk disease 70Gy in 35#, consider surgery for residual disease.

30
Q

What are the risks associated with surgery of the glottis? (5)

A
  • death
  • flap necrosis
  • infection
  • carotid rupture
  • DVT +- PE
31
Q

What are the risks associated with RT for the glottis? (5)

A
  • virtually no risk of death
  • oedema
  • chronditis
  • osteoradionecrosis
  • chrondronecrosis
32
Q

What are the three regions of the hypopharynx?

A
  • post pharyngeal wall
  • piriform fossae
  • post-cricoid space
33
Q

What are the signs and symptoms of hypopharnx cancer? (6)

A
  • hot potato voice
  • stridor
  • referred otalgia
  • weight loss
  • dysphagia
  • sore throat
34
Q

Do piriform hypo pharynx patients present early or late? How does this affect their tx?

What would be the management for an early stage hypo pharynx?

A

Most present late, therefore are rarely treated with RT or Surgery alone.

A partial pharyngo-laryngectomy may be an option for early stage disease.

35
Q

What are the treatment options for advanced pf patients?

A
  • Pharngolaryngectomy +- PORT +- Chemo
  • RT alone (rare)
  • CT/ RT
36
Q

What are the three types of salivary glands?

A
  • parotid
  • submandibular
  • sublingual
37
Q

What benign/malignant salivary gland tumours

A

Benign

  • Warthins tumours
  • pleomorphic adenoma
  • oncocytoma

Malignant

  • Adenocarcinoma
  • SCC
  • muco-epidermal
  • adenoid cystic
  • acinic cell ca
  • plasmacytoma
  • secondary SCC, melanoma, NHL.
38
Q

What is the primary tx option for salivary glad tumours? And what are some considerations ?

A

surgery +- PORT

  • usually need to conserve facial nerve
  • volume the parotid bed +-ipsilateral neck nodes.
39
Q

What group is at risk of getting nasal tumours?

A
  • Wood workers
40
Q

What is the clinical presentation of nasal cancer?

A
  • Nasal orbs & epistaxis
41
Q

What is the mainstay of treatment for nasal cancer

A

surgery +- RT

42
Q

Who is the at risk group for nasopharyngeal cancers and what are the characteristics of this disease?

A
  • Chinese/ males
  • usually bilateral disease
  • well supplied with lymphatics
  • high incidence of occult nodal groups
  • incl. spinal mets
43
Q

Signs and symptoms of nasopharyngeal tumours (7)

A
  • painless neck lump
  • proptosis
  • sore throat
  • nasal obstruction
  • facial pain
  • cranial nerve defects
  • unilateral ottis media (in adult)
44
Q

what are the tx options for NPC?

A
  • RT is the standard

- highly chemo sensitive so increased survival advantage when chemo is given to this area. (concomitant rt/ ct)

45
Q

What do you volume for NPC? and what is the #?

A

NPX + bilateral neck nodes (including the sp nodes)

63-70Gy to primary lesion (may use brachy).

46
Q

What does the choice of therapy for the neck depend on?

A
  1. Extent of nodal involvement

2. management of the primary lesion

47
Q

What is the fractionation for a node negative neck pt

A

50Gy in 25#

48
Q

What does extra capsular neck spread indicate

A

indicates that there is increased risk of local recurrence, therefore PORT is considered and higher doses will be used. Consider PORT and chemotherapy.

49
Q

What are the types of neck directions?

A
  • radical
  • modified radical
  • functional
  • supra-omohyoid
50
Q

What are the complications of a neck dissection (8)

A
  • nerves
  • vascular
  • death
  • pulmonary
  • lymphatic
  • infection
  • flap necrosis
  • lymphoma

CSB048 (8 decks)

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