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NM By Myself > Head And Neck Cancer NM > Flashcards

Head And Neck Cancer NM Flashcards

1
Q

Lip and oral cavity cancer most common type

A

Tobacco and alco - - SCC 95%

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2
Q

Lip and oral cavity cancer
Most common location

A

Tongue (oral tongue more likely LN)
FOM (more likely LN)
Gingiva

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3
Q

Lip and oral cavity cancer
Premalignant

A

Leukoplakia
Erythroplakia

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4
Q
A

Lip and oral cavity cancer T1

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5
Q
A

Lip and oral cavity cancer T2

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6
Q
A

Lip and oral cavity cancer T3

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7
Q
A

Lip and oral cavity cancer T4a

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8
Q
A

Lip and oral cavity cancer T4b

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9
Q

Lip and oral cavity cancer N

A
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10
Q

Lip and oral cavity cancer M

A

Lung
Bone
Liver

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11
Q

Ca of lip LN

A

IA
IB

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12
Q

CA of alveolar ridge or hard palate LN

A

Low potential for MTS
IB
II-IV
retropharyngeal - less common

Level VII = ant sup mediastinal still regional

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13
Q

Lip and oral cavity cancer CT limit

A

Small lesions
Mucosal surface
Dental amalgam streak artifact

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14
Q

Lip and oral cavity cancer PET/CT

A

Unknown primary
False positive: muscle, brown fat, lymphoid tissue, mucosa

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15
Q

Oropharynx p16- risk

A

Tobacco
Alco
Men
Elderly

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16
Q

Oropharynx p16- subsites

A

Base of tongue (lingual tonsil)
Palatine tonsils
Pharyngeal walls
Soft palate and uvula

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17
Q

Hypopharynx T3

A

Hemilarynx fixation

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18
Q

Oropharynx cancer M

A

Lung
Bone
Liver

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19
Q

Oropharynx p16- most important prognostic factor

A

Regional LN
Palatine tonsils and base of tongue - - II, III, retropharyngeal
Posterior pharyngeal wall - - retropharyngeal
Base of tongue - - bilateral
Also I, IV and V

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20
Q

Oropharynx p16 important

A

Keratizing
Mucosal ulceration
Resistant
Poor response
Worse prognosis
Higher rate of M
Locoregional recurrence

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21
Q
A

Oropharynx p16- T1

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22
Q
A

Oropharynx p16- T2

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23
Q
A

Oropharynx p16- T3

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24
Q
A

Oropharynx p16- T4a

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25
Q
A

Oropharynx p16- T4b

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26
Q

Oropharynx p16+ most common location

A

Base of tongue (lingual tonsil)
Palatine tonsil

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27
Q

Oropharynx p16+ risk

A

Younger men
No tobacco or alco
High status
Increased number of partners
HPV type 16
Also types 18, 31, 33

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28
Q

Oropharynx p16+ N

A
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29
Q

Oropharynx p16+ regional LN

A

More significant than p16-
II and III

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30
Q

Oropharynx p16+ important

A

Non keratizing
Cystic nodes - - negative on PET
Better prognosis, respond
More M1, atypical sites

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31
Q

Adult with new cystic lymphadenopathy in upper neck

A

Oropharynx p16+

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32
Q
A

Oropharynx p16+ T1

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33
Q
A

Oropharynx p16+ T2

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34
Q
A

Oropharynx p16+ T4a

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35
Q
A

Oropharynx p16+ T4b

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36
Q
A

Oropharynx p16+ T3

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37
Q

Hypopharynx

A

95% SCC

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38
Q

Hypopharynx subsites

A

Sinus pyriformis - - encase ICA - - >270°
Hypopharyngeal wall (lateral and posterior)
Postcricoid region - - Plammer-Vinson sy, Paterson-Kelly sy

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39
Q

Hypopharynx M

A

Lung
Bone
Liver

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40
Q

Hypopharynx regional LN

A

Early dissemination
75% at presentation
20-40% contralateral Nodal MTS at diagnosis
II-IV
Retropharyngeal
VI
Medistianal nodes (VII) are still regional
40% of clinically N0 - - pathologically N+

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41
Q

Hypopharynx PET

A

Staging
Prior to endoscopy

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42
Q

Hypopharynx important

A

60% keratizing
“hot potato” voice
Poor survival
Worst prognosis of all head and neck SCC

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43
Q

Hypopharynx risk

A

Men
Tobacco
Alco
Fe def
Vit C def

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44
Q
A

Hypopharynx T1

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45
Q
A

Hypopharynx T2

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46
Q
A

Hypopharynx T3

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47
Q
A

Hypopharynx T4a

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48
Q
A

Hypopharynx T4b

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49
Q
A

Hypopharynx T4b

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50
Q
A

Hypopharynx T4b

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51
Q
A

Oropharynx p16+

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52
Q

Nasopharynx keratizing SCC

A

Smoke, HPV
Locally advanced at presentation

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53
Q

Nasopharynx non keratizing SCC

A

Differentiated type
Undifferentiated type - most common 90%
EBV
Better prognosis

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54
Q

Nasopharynx basaloid SCC

A

Men, 30-40, 50-60
China endemic

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55
Q

Nasopharynx T

A
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56
Q

Nasopharynx N

A
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57
Q

Nasopharynx M

A

Bone
Lung
Liver
Rare
High potential
Poor prognosis

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58
Q

Highest rate of LN MTS among all SCC of head and neck

A

Nasopharynx

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59
Q

Nasopharynx regional LN

A

80-90% at presentation
Retropharyngeal 70%
II 70%
Spinal accessory chain V
Well controlled by radiation unlike other SCC

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60
Q

Nasopharynx CT

A

Mass in lateral pharyngeal recess of nasopharynx with deep extension and cervical adenopathy
Most frequent - lateral wall = fossa of Rosenmueller

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61
Q

Nasopharynx PET

A

Strong avidity
Submucosal tumor
Perineural spread - - mandibular nerve
Superior in restating and evaluating treatment effectiveness

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62
Q

Nasopharynx T0

A

Malignant cervical lymphadenopathy +EBV

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63
Q

Nasopharynx presentation

A

Unilateral hearing loss
Painless upper cervical lymphadenopathy

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64
Q

Nasopharynx stage I-II treatment

A

Radio
Cures 60-90%

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65
Q

Nasopharynx most powerful prognostic factor

A

Stage at presentation

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66
Q
A

Nasopharynx T1

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67
Q
A

Nasopharynx T2

68
Q
A

Nasopharynx T3

69
Q
A

Nasopharynx T4

70
Q
A

Nasopharynx

71
Q

Maxillary sinus cancer

A

Most common
Tumor arise from mucosa - - nodule or mass
Small tumor - - nasal congestion
From inverted papilloma - - HPV - - good prognosis

72
Q

Maxillary sinus T

73
Q

Maxillary sinus, nasal cavity and ethmoid sinus M

A

Bone
Lung
Liver
Low incidence

74
Q

Maxillary sinus, nasal cavity and ethmoid sinus regional LN

A

Low incidence
Usually unilateral IB, II, retropharyngeal

75
Q

Maxillary sinus, nasal cavity and ethmoid sinus PET

A

SUV correlate with tumor grade
Strong avidity in metastatic LN

76
Q

Maxillary sinus, nasal cavity and ethmoid sinus risk, important

A

Occupational exposure
Tobacco, alco
HPV, EBV
Men, > 45y
Keratizing SCC 80% - - worse prognosis
Adenocarcinoma - - better prognosis

77
Q

Olfactory neuroblastoma

A

ENB - - unilateral nasal obstruction
Female “<20,>50

78
Q

Nasal cavity and ethmoid sinus T

79
Q

ENB CT

A

Superior part of tumor in intracranial fossa
Inferior part in upper nasal cavity

80
Q
A

Maxillary sinus T1

81
Q
A

Maxillary sinus T2

82
Q
A

Maxillary sinus T3

83
Q
A

Maxillary sinus T4a

84
Q
A

Maxillary sinus T4b

85
Q
A

Nasal cavity T1

86
Q
A

Nasal cavity T2

87
Q
A

Nasal cavity T3

88
Q
A

Nasal cavity T4a

89
Q
A

Nasal cavity T4b

90
Q

Supraglottis

A

Epiglottis - - poorly resistant to tumor penetration
SCC 95%
Non keratizing
Few early symptoms unlike others

91
Q

Supraglottis T1-3

92
Q

Supraglottis regional LN

A

Lymphatic rich
Early spread to II-IV
Bilateral, contralateral

93
Q

Glottis

A

Most common in larynx
Keratizing
True cords - - hoarseness
Irregular thickening of mucosa - - ulcer

94
Q

Glottis T1-2

95
Q

Glottis regional LN

A

No lymph in vocal cords - - rare

96
Q

Subglottis

A

Ulcerative mucosa - - large exophytic or fungating mass
50% cartilage involvement

97
Q

Subglottis T1-2

98
Q

Glottis and subglottis T3

99
Q

Larynx T4a-b

100
Q

Larynx M

A

Lung
Liver
Diaphragm

101
Q

Larynx PET

A

Complete staging of advanced laryngeal cancer
Strong avidity in metastatic LN
False positive: laryngeal muscle activation with contralateral vocal cord paralysis
Most useful in postlaryngectomy

102
Q
A

Supraglottis T1

103
Q
A

Supraglottis T2

104
Q
A

Supraglottis T3

105
Q
A

Supraglottis T4a

106
Q
A

Glottis T1

107
Q
A

Glottis T2

108
Q
A

Glottis T3

109
Q
A

Glottis T4a

110
Q
A

Subglottis T1

111
Q
A

Subglottis T2

112
Q
A

Subglottis T3

113
Q
A

Subglottis T4a

114
Q
A

Larynx T4b

115
Q
A

Larynx T4b

116
Q

Major salivary gland

A

Uncommon
Parotid - - most common 95%
Mucoepidermoid (MECa) - - low grade, rare LN, superficial parotid lobe, 1-4 cm at presentation
Adenoid cystic carcinoma (ACC) - - highest incidence of distant MTS, parotid gland, 1-3 cm at presentation,
MECa>ACC

Submandibular
ACC>MECa>adenocarcinoma

Sublingual

117
Q

Warthin tumor

A

Benign
Female
Smoker
Tc pert avid

118
Q

Major salivary gland T

119
Q

Major salivary gland M

A

Lung
Brain
Bone

Hem > lymph
Lung > lymph

120
Q

MECa M

A

Mandible
Skull base

121
Q

ACC M

A

Highest incidence of distant MTS
Highest spread via perineural pathway of all head and neck tumors

122
Q

Predictor of distant MTS
Salivary gland

A

Tumor >3cm
Solid
Local recurrence
N1

123
Q

Major salivary gland regional LN

A

Ipsilateral
Jugulodigastric level III

124
Q

Major salivary gland PET

A

False positive 30% - - Warthin tumor
Pleomorphic adenoma - moderste/intense uptake - - hard to dd benign vs malignant
High grade salivary tumor SUV>5.0
ACC– slow growth - - low SUV, non avid metastatic LN
MECa - - no Tc pert uptake vs Warthin tumor

125
Q

Major salivary gland presentation

A

Palpable painless mass
Facial nerve dysfunction - - negative prognostic factor
Parotid - - most positive prognostic factor

126
Q

20 years after radiation in low dose

A

Parotid neoplasm

127
Q

Major salivary gland treatment

A

Surgery (first choice
Complication - - facial nerve damage
Chemo
Radio for non resectable (stage IVB/IVC)

128
Q
A

Major salivary gland T1

129
Q
A

Major salivary gland T2

130
Q
A

Major salivary gland T3

131
Q
A

Major salivary gland T3

132
Q
A

Major salivary gland T4a

133
Q
A

Major salivary gland T4a

134
Q
A

Major salivary gland T4a

135
Q
A

Major salivary gland T4a

136
Q
A

Major salivary gland T4b

137
Q
A

Major salivary gland T4b

138
Q
A

Epiglottis carcinoma

139
Q

Residual disease on PET

A

Focal and asymmetric uptake with intensity greater than surrounding normal tissue and blood vessels

140
Q

Post radiation inflammation on PET

A

Diffuse uptake within radiation field

141
Q

After chemo PET

A

At least 10 days
Within 6 months and 1 year after initial PET

142
Q

After radio PET

A

2-3 months

143
Q
A

Cancer of larynx

144
Q

Encased artery

A

> 270° surrounded

145
Q
A

Primary tonsil cancer

146
Q
A

Tonsil Cancer

147
Q

Level II LN

148
Q

Retropharyngeal nodes level VIIa

149
Q

Subglottis regional LN

A

Paratracheal
Sup mediastinal

150
Q

CT best for

A

Lower part of neck
Osseous involvement

151
Q
A

Left tonsil

152
Q

Submental and Submandibular nodes

A

IA and IB - - lip cancer
IB - - ca of alveolar ridge or hard palate, maxillary sinus (rare)

153
Q

Upper jugular

A

Level II
Ca of alveolar ridge or hard palate
Oropharynx
Hypopharynx
Nasopharynx
Maxillary sinus (rare)
Supraglottis

154
Q

Mid jugular

A

Level III
Oral cavity
oropharynx
Hypopharynx
Supraglottis
Salivary gland

155
Q

Lower jugular and medial supraclavicular

A

Level IV
Oral cavity
Hypopharynx
Supraglottis

156
Q

N0 + positive PET

A

Neck dissection, not SLNB

157
Q

Full negative work up
FDG reveal primary

158
Q

History of lymphoma post treatment

A

Physiologic uptake in Waldeyers ring

159
Q

Hodgkins lymphoma after chemo

A

Thymic hyperplasia

160
Q

Buccal cancer after left neck dissection

A

Physiologic uptake in right tonsil

161
Q

Larynx cancer after surgery and chemo radio

A

Inflammation around tracheostomy

162
Q

Treated breast cancer

A

Reactive LN

163
Q
164
Q

Elderly with lung cancer

A

Pleomorphic adenoma or Warthin tumor

165
Q

Retropharyngeal

A

Alveolar ridge and hard palate
Oropharynx p16-
Hypopharynx
Nasopharynx
Maxillary sinus and nasal cavity

166
Q

Cervical cancer of unknown origin

A

Neck dissection
Tonsillectomy
Radio of all mucosal sites and both sides of neck
Detection of primary tumor improve survival
FDG sensitivity 69%

NM By Myself (25 decks)

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