Head and Neck CA Flashcards
Most types of head and neck cancers are _______________. The median age for diagnosis is ____ years but the incidence in adults ____________ is increasing. This is particularly for __________ and _____________ SCC. ____________ are more likely to develop it. Higher incidence in ________________.
squamous cell carcinoma of heart and neck (SCCHN)
62 years
<45
base of tongue, tonsilar
Men.
African Americans
What are the most common types of head and neck CA?
over 90% malignancies in oropharynx
3-6% are nasopharyngeal carcinomas (NPC)
1-3% are salivary cancers
What is a major risk factor for head and neck CA?
HPV (tobacco and alcohol are synergistic risk factors)
Almost all sexually active men and women will have __________ at some point in their life. If the person has active HPV infection, most will clear in ___________ and in some cases it persists.
HPV
6-12 months
There are 120 types of HPV but oncogenic types include ______, ______, ______, and ______. HPV _______ accounts for most causes in ____________ tumors.
16,18, 39, 59
16, oropharyngeal (palatine and lingual tonsils)
HPV positive tumors represent a distinct clinical subset of tumors. Patients are _______ and less likely to ________. The tumors are more likely _______ and _________. These patients have a better prognosis.
younger, smoke/drink.
basaloid, poorly diff
What is the most common symptoms of head and neck CA?
swelling or sore throat that does not heal.
_______ + ________ = tongue CA
hoarseness, ear pain
What are the other s/s of head/neck CA?
red/white patch in the mouth that doesnt heal
lump, bump, or mass in the head or neck area with or without pain
persistent sore throat
foul mouth odor not explained by hygiene
hoarseness/change in voice
difficulty breathing
pain or difficulty chewing, swallowing, or moving jaw or tongue
ear and or jaw pain
blood in saliva or phlegm, which is mucus discharge in the mouth from respiratory passages
loosening of teeth
dentures that no longer fit
unexplained weight loss
fatigue
80% of neck masses in adults, ___________ are malignant. Of those, 80% will be _____________. Of those, 80% will be in the ____________ and ____________ region.
more than 40%
squamous cell carcinoma
head and neck
What is the primary work up for squamous cell carcinoma of the neck?
The goal is to identify the primary source of CA.
Determine HPV status of needle biopsy of neck mass (if HPV+, >95% primary tonsil/BOT)
History: symptoms, skin CA hx, smoking status, sexual hx
Complete PE, including scope exam
PET scan
Biopsies/tonsillectomy
Can ID primary site 50-90% of the time
The ____________ system is used for staging the cancer.
TNM (higher=worse)
T= primary tumor
N= lymph nodes
M= metastasis
What are the treatment options for the cancer?
Surgical
-organ preservation has improved but organ function is often lost
Nonsurgical
-radiation/chemo
What are the treatment options for oral cancer? What is the first line treatment?
Surgical resection (first line treatment)
1. Partial or total glossectomy + neck dissection (1-3)
2. Floor of mouth resection + neck dissection (1-3)
Neck dissection (helps prevent spread)
-removal of lymph nodes and surrounding tissue from the neck for the purpose of CA treatment
____________ is one of the strongest prognostic predictors. (50% reduction in survival). ____________ spread further reduces survival. What are other predictors?
cervical nodal involvement.
extrascapular
other predictors:
-nodal burden
-perineural invasion
- histologic grade
-extent of necrosis
-positive tumor margins
What is the first line treatment for oropharyngeal cancer?
radiation and chemo.
-tonsil or base of tongue cancer
If the CA is recurrent it is treated with surgery
What is the first line treatment for laryngeal and hypopharyngeal cancer?
early stage: radiation and chemo
advanced: surgery (laryngectomy, pharyngectomy)
recurrent: surgery
What is a total laryngectomy? What does a removal of these structures have an effect on?
It is done in the case of a patient having laryngeal/hypopharyngeal cancer. You remove the hyoid bone, thyroid cartilage, vocal folds, cricoid cartilage, epiglottis, upper 2-3 rings of trachea, all intrinsic muscles of the larynx and extrinsic laryngeal muscles (based on pt specific patho)
respiration, swallowing, speech, phonation not possible
What are the goals for laryngeal reconstruction?
close surgical defect
optimize function outcome
-speech
-swallowing ability
optimize cosmetic appearance
What is the reconstructive ladder as it pertains to a total laryngectomy?
healing by secondary intention > primary closure > skin graft > local flap > regional flap > free flaps
What are some functional impairments?
swallowing
speech
dry mouth
taste
chewing
cervical and oral pain
fatigue
weakness
neck and shoulder dysfunction
ADL/work/recreational restrictions
lymphedema
anxiety/depression
What is lymphedema? It can be from ____________ or __________. What does it cause?
tissue swelling caused by an accumulation of protein rich fluid.
removing lymph nodes, radiation.
restricted ROM, infections, fibrosis of the skin
What are the treatment options for lymphedema?
- Kinesio taping- helps lift tissue to promote improved circulation and lymphatic flow with lymphedema
- compression garment
- manual lymph drainage
- Graston technique- soft tissue therapy that helps to break up scar tissue. alternative to massage.
What is dry needling used for?
to treat fibrosis, trismus (trouble opening jaw/mouth) (PT is also good for trismus)
This type of surgery is indicated for patients that had a total laryngectomy. Explain what occurs when the larynx is removed and what the TEP surgery does.
Tracheoesophageal puncture (TEP) surgery
when the larynx is removed, the connection between the trachea and the mouth is severed. the bottom half of the windpipe is rotated forward forward and connects to the skin, creating a permanent opening in the neck called a stoma.
The TEP surgery creates a pencil eraser sized hole between the trachea and esophagus. A one way valve called a tracheoesophageal voice prosthesis, directs air into the esophagus when the patient covers the stoma. The air causes the esophagus to vibrate producing a new tracheoesophageal voice.
