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CSB048 - TREATMENT 2 > Head and Neck Cancer > Flashcards

Head and Neck Cancer Flashcards

1
Q

Aetiology

A

Male more common than female
Smoking
Alcohol
Marijuana

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2
Q

Primary aim in management of primary HN site

A

Optimise tumour control
Preserve function (e.g., can treat larynx with XRT and preserve voice)
high local control for early stage
improve survival for advanced
improve therapeutic ratio

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3
Q

Are other primaries are common?

A

Yes

Generally other primaries will be present (HN cancer will most likely not be the initial primary)

Patients typically have mortality due to other diseases/primaries rather than HN cancer

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4
Q

Diagnosis of HN Cancer

A

Core Biopsy
Incisional Biopsy (removal of portion of tumour)
Excisional Biopsy (removal of the full tumour volume) (can commit patient to XRT, therefore preferred to be avoided)
Histology
PET Scan
Head and Chest CT Radiograph
Pan-endoscopy (can locate if other primaries are located in GI/GU tract)

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5
Q

Histology of HN Cancer

A

SCC most common

Other: Adeno-carcinoma, Adenoid cyst, Muco-epidermoid, Plasmacytoma, Lymphoma, Melanoma

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6
Q

Staging of HN Cancer

A

TNM

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7
Q

Treatment Options for HN Cancer

A

Sole Modality:
IMRT (dose is localised to HN, smaller margins, spare normal tissue)
Brachytherapy
Surgery

Combined Modality:
Chemoradiation (Can provide good local control, remove microscopic residual disease) (Increase toxicity needs to be considered)

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8
Q

Chemoradiation for HN

A

Increased morbidity, therefore not appropriate for all patients

8% survival advantage at 5 years

Agents used: Cisplatin, 5FU

Given concurrently with RT

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9
Q

Indications for Post Op RT

A

Locally advanced disease
Close/positive margins
3 or more nodes involved
Extracapsular spread
Lymph vascular or peri neural spread

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10
Q

Indications for Post op CT/RT

A

Positive margins

Extracapsular spread

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11
Q

Sites RT can be used to treat

A

Primary lesion and gross nodal disease

Site of resected gross disease

Operative bed (require higher RT dose)

Treat nodes at risk of microscopic involvement

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12
Q

Acute Side Effects of Head and Neck RT

A

Lethargy
Nausea/Vomiting
Skin changes
Alteration in taste
Dysphagia
Odynophagia
Alteration in saliva consistency

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13
Q

Late Side Effects of HN RT

A

Xerostomia (dry mouth due to reduced saliva)
Radiation caries (tooth decay from radiation-induced dry mouth)
Mucosal fragility
Alopecia
Loss of sweating
Trismus
Atrophy of SC tissues

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14
Q

Right Parotid Nodes Dose Fractionation

A

T1-2 (nodes < 1cm) -> 3DCRT = 60Gy/30 / IMRT = 63Gy in 35

T3-4 (nodes > 1 cm) -> 3DCRT & IMRT = 70 Gy in 35

Site of resected disease = 3DCRT & IMRT 60 Gy in 30

Operative Bed = 3DCRT & IMRT = 54Gy in 27

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15
Q

Patient Management of HN Patients

A

Daily review (RT, nurses)

Weekly review by medical staff

Allied health review (dietician, speech pathology, social work, OT, physio)

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16
Q

Oral Cavity Anatomy

A

Comprised of Buccal Cavity, alveolus, hard palate, tongue, floor of mouth

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17
Q

Oral Cavity Treatment

A

Surgery mainstay of treatment (to preserve saliva)

Possibility of more than one tumour is high (avoid RT where possible)

Aim to cure, but optimise speech, eating

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18
Q

Function of Larynx

A

Protect airway

Vocalisation

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19
Q

Clinical Presentation of Larynx Cancer

A

Hoarse/husky voice

Local pain

Mass in neck

Airway compromise

Aspiration

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20
Q

Early Glottic Cancer Classification

A

Characterised with low incidence of nodes
T

21
Q

Early Glottic Cancer Treatment Options

A

RT
Surgery (conservative)
Laser (currently under investigation)

22
Q

RT Treatment position for Glottis Cancer

A

Supine, head first
Shell
Hands on chest/by side
Knee bolster
Head rest

23
Q

RT Planning for EGC

A

3DCRT:
- centre on glottis
- typically 5x5 or 6x6 field is used
- overshoot ant

IMRT:
- GTV + 1cm = CTV +0.5 cm = PTV

24
Q

Dose fractionation for EGC (T1 and T2)

A

T1 = 60 Gy in 28-30

T2 = 66 Gy in 30-33

25
Q

T3 Glottic Cancer

A

Local control better with surgery

26
Q

RT Planning for T3 Glottis

A

IMRT: entire larynx = CTV

Dose 60-70Gy in 33-35#

27
Q

Advanced Glottic Cancer (T3-4/N1-3/M0) Treatment Options

A

RT (rarely)
Chemoradiation
Laryngectomy +/- PORT +/- CT `

28
Q

Supraglottis node involvement

A

High incidence of nodes at presentation, subclinical nodal involvement

As it is midline structure, requires bilateral necks treated

29
Q

Treatment options for Supraglottis T1N0M0

A
  • Radical RT (requires good airways)
  • Supraglottic laryngectomy (requires good airway reserve, need to learn to swallow again, increased risk of aspiration)
30
Q

Treatment options for Supra glottis (advanced disease)

A

Surgery +/- post op RT +/- CT
Chemoradiation
Radiation alone (refused surgery or comorbidities)
5 field technique

31
Q

Hypopharynx Anatomy

A

Lies laterally to larynx

communicates superiorly with oesophagus an inferiorly with cervical oesophagus

Three parts:
- posterior pharyngeal wall
- piriform fossae
- post-cricoid space

32
Q

Clinical presentation of hypo phrayngeal lesions

A

Sore throat
Dysphagia
Weight loss
Stridor

33
Q

Hypophrayngeal Treatment Options

A

Early Stage
- Partial Pharyngo-laryngectomy
- Few treated with RT or surgery alone

If advanced (with Piriform fossa involvement)
- Pharyngo-laryngectomy + post op RT+/- CT
- CT/RT
- RT alone (rarely)

34
Q

Treatment options for Pharyngeal Wall

A

Early disease
- Surgically (due to large submucosal spread)

Locally advanced disease -
- Majority Surgery + Post Op RT+/- CT
- RT or CT/RT (if not fit for S)

35
Q

Post Cricoid Tumours treatment

A

Rare tumour
Generally locally advanced at presentation
Associated with iron deficiency

RT volume includes upper mediastinum

Treatment:
Majority = pharyngo-laryngectomy + RT +/- CT

36
Q

Differing Salivary Glands

A

Parotid gland
Submandibular gland
Sublingual

37
Q

Histology of Salivary gland tumour

A

Benign
- Pleomorphic adenoma
- Oncocytoma
- Warthins Tumour

Malignant
- Adenocarcinoma
- SCC
- Muco-epidermoid
- Adenoid Cyst

38
Q

Treatment options for Salivary Gland Tumour

A

Surgery +/- post op RT
Conserve facial nerve

Volume: parotid bed +/- ipsi-lateral neck nodes

39
Q

Nasal Cavity Aetiology, Pathology, Clinical Presentation

A

Aetiology:
- Wood workers

Pathology
- SCC, NHL, Plasmacytoma, Melanoma, Inverting Papilloma

Clinical Presentation
- Epistaxis, Nasal Obs

40
Q

Treatment Options for Nasal Cavity

A

Surgery +/- RT

RT Volume - primary plus margin (nodes not included)

41
Q

Nasopharyngeal Cancer Epidemiology

A

Chinese Origin

Males more common than females

42
Q

Nasopharyngeal Cancer Clinical Presentation

A
  • Painless neck lump
  • Nasal obstruction
  • Sore throat
  • Facial pain
  • Proptosis
  • Cranial nerve defects
43
Q

Nasopharyngeal Treatment options

A

RT is standard

Chemo/RT (synchronus improves survival in advanced disease - more chemo sensitive)

RT Volume = Nasopharyngeal + bilateral neck nodes

Dose = 63-70 Gy to primary lesion

44
Q

Treatment options for the Neck

A

Observation with delayed neck dissection for recurrence

Surgery (elective +/- post op RT +/- CT) (therapeutic +/- post op RT +/- CT)

RT +/- neck dissection for persisting disease

45
Q

Choice of therapy for neck is dependent on:

A

Nodal involvement
Extracapsular spread (increased risk of LR -> requires Post Op RT, requires higher dose)

46
Q

Different types of neck dissection

A

Radical neck dissection
Modified radical neck dissection
Functional neck dissection
Supra-omohyoid neck dissection

47
Q

Complications of Neck Dissection

A

Death
Lymphodaema
Infection
Affects nervous, vascular, lymphatic, pulmonary system

48
Q

Which glottic patients are offered RT

A

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 n
suspicion recurrence and may not be confirmed
histologically

49
Q

Complications of surgery

A

death
flap necrosis
carotid rupture

CSB048 - TREATMENT 2 (12 decks)

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