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
