Head and Neck neoplasms Flashcards
1
Q
Palatal/Mandibular Tori
A
*Bony protuberances of the palate
or lingual aspect of the mandible
*Common
*Females 2:1
*Possible autosomal dominant trait
*Local stresses
2
Q
Palatal/Mandibular Tori Presentation
A
- Hard, bony mass
- Painless
3
Q
Palatal/Mandibular Tori Treatment
A
- Observation
- Surgery if needed
- Dentures
4
Q
Females are affected by this more than males as a result of hormonal changes that occur
during puberty, pregnancy, and
menopause
A
Pyogenic Granuloma
5
Q
Pyogenic Granuloma
A
- Rapidly growing, red, ulcerated,
lobulated mass - Common, benign
- Response to localized irritation or
trauma
6
Q
Pyogenic Granuloma Presentation
A
- Grows rapidly
- Bleeds easily
7
Q
Pyogenic Granuloma exam
A
- Most frequently develops on the buccal
gingiva in the interproximal tissue between
teeth
8
Q
Pyogenic Granuloma treatment
A
- The treatment of choice is conservative
surgical excision - Other options include laser therapy and
electrocautery - The recurrence rate is higher for pyogenic
granulomas removed during pregnancy
9
Q
Oral Fibroma
A
*Common
*Benign
*Fibrous tumor-like growths
*Nearly all represent reactive focal fibrous
hyperplasia due to trauma or local irritation
10
Q
Oral Fibroma exam
A
- Most often on the buccal mucosa
along the plane of occlusion of
the maxillary and mandibular
teeth - Round-to-ovoid
- Firm
- Smooth-surfaced,
- Sessile or pedunculated
- Diameter: 1 mm to 2 cm
11
Q
Leukoplakia is Considered a _____
A
premalignant lesion
12
Q
Associated with tobacco,
ETOH, human papilloma virus
(HPV)
A
Leukoplakia
13
Q
Leukoplakia presentation
A
White patch or plaque that cannot
be rubbed off and persists for 6
weeks after r/o other causes
14
Q
Leukoplakia exam
A
- Patches that are bright white and
sharply defined - The surfaces of the patches are
slightly raised above the surrounding
mucosa - Otherwise asymptomatic
15
Q
Leukoplakia treatment
A
- ENT referral
- Obtain biopsy
- Frequent clinical observation with photographic records
- Immediate biopsy on any areas that change in appearance
- ENT referral
- Obtain biopsy
- Frequent clinical observation with photographic records
- Immediate biopsy on any areas that change in appearance
16
Q
Oral Candidiasis pathophysiology
A
*More common in infants,
immunocompromised patients
*After oral antibiotic or steroid use
*Inhaled corticosteroids
17
Q
Oral Candidiasis Exam
A
*Starts as small lesions that enlarge to
white patches
*When scraped, underlying mucosa is
inflammation and may bleed
18
Q
Oral Candidiasis treatment
A
*Oral nystatin suspension
* Swish and swallow
*Clotrimazole troches
*Miconazole buccal tablets
*Fluconazole
19
Q
Erythroplakia
A
Red patch on the oral
mucosa that cannot be
accounted for by any specific
disease entity
*Premalignant
20
Q
Erythroplakia exam
A
*Red plaque or patch with
sharply demarcated borders
*Often velvety
21
Q
Erythroplakia Treatment
A
*ENT referral
*Obtain biopsy
*Frequent clinical observation with
photographic records
*Immediate biopsy on any areas
that change in appearance
*Consider surgical removal,
cryotherapy, or carbon dioxide
laser ablation
22
Q
Aphthous Ulcers
A
*Recurrent aphthous stomatitis
*“Canker sores”
*Restricted to mouth
*Up to 60% US population
*Greatest prevalence in the Middle East, Mediterranean, South
Asia
*Typically starts in childhood or adolescence
23
Q
Aphthous Ulcers Pathophysiology
A
- Not clear
- Idiopathic, multifactorial
- Does not appear to be infectious, contagious, or sexually transmitted
- Minor, major, herpetiform
- Immune mechanisms in patients with a genetic predisposition to oral
ulceration
24
Q
Minor Aphthous Ulcers presentation
A
- Minimal symptoms
- 1-6 ulcers, heal in 7-10 days
- Recur every 1-4 months
- Lips, cheeks, floor of the mouth, sulci, tongue, palate
- Little to no scarring
25
Major Aphthous Ulcers presentation
* Larger, persist longer, recur more frequently
* More painful
* Heal over 10-40 days
26
Herpetiform Aphthous Ulcers presentation
* Females
* Any oral site
* Extremely painful
* Begin with vesiculation
* Almost seem continuous
27
Aphthous Ulcers exam
*Minor
* Small round or ovoid ulcers 2-4 mm in diameter
* Ulcer floor that is initially yellowish but assumes a gray hue as healing
* Surrounded by an erythematous halo and edema
*Major
* Round or ovoid ≥ 1 cm
* ESR may be ↑
*Herpetiform
* Vesiculation proceeds rapidly to multiple,
pinhead-sized, discrete ulcers
28
Aphthous Ulcers treatment
* Eventual remission
* Good oral hygiene
* Avoid trauma
* Brush atraumatically with a small-headed, soft toothbrush
* Avoid hard/sharp foods
* Pain relief
* Magic mouthwash or viscous lidocaine
* Topical corticosteroids
* Hydrocortisone 2.5 mg x 4 times daily or triamcinolone 0.1% paste x 4 times daily
* Topical antiseptic
* Oropharyngeal chlorhexidine 0.12%, 15 ml swish and spit
* Topical antimicrobials
* Doxycycline capsule (100 mg) in 10 mL of water administered as a mouth rinse for 3 minutes
29
Oropharyngeal SCC is the ___ most common cancer
8th
30
Oropharyngeal SCC presentation
*Red, white, or red & white lesion
*Any lesion persisting for ≥ 3
weeks is suspicious
*Indurated lump or ulcer
*Lesion that will not heal or recurs
in the same location
*Early carcinomas may not be
painful
*Diagnosis is often delayed by 6
months
31
Oropharyngeal SCC exam
*Most common sites include the
lower lip, the lateral margin of
the tongue, and the floor of the
mouth
*Ulcers, lumps, fissures
*Red or white areas
*Lesions must be palpated after
inspection to detect induration
and fixation to deeper tissues
32
Oropharyngeal SCC Diagnosis/treatment
*Biopsy
*CT scan head & neck with contrast
*Refer to ENT
*Oncology referral
* Surgery
* Radical neck dissection
* Radiation
*Patient education
33
Salivary Gland Neoplasms make up ___% of head/neck tumors
7
34
Risk Factors for Salivary Gland Neoplasms
Nutritional deficiency,
exposure to ionizing radiation, UV
exposure, genetic predisposition, EBV
35
Salivary Gland Neoplasms presentation
Parotid
* Slow growing, asymptomatic mass
* Inability to move one side of face, one shoulder, one side of tongue
Submandibular
* Asymptomatic mass
* Painful mass as enlarges
* Decreased sensation in ipsilateral lower teeth, lip and gums
* Inability to move ipsilateral tongue or to move part of face
Sublingual
* Asymptomatic swelling in floor of mouth
* Ipsilateral loss of sensation of one side of tongue
36
Salivary Gland Neoplasms Exam
* Hard, fixed mass
* Cranial nerve deficits
* Trismus
37
Salivary Gland Neoplasms Imaging
* CT scan of the neck with contrast
* MRI
38
Salivary Gland Neoplasms treatment
* Refer to ENT specializing in head and neck
dissection for surgery
* Frey’s syndrome, facial nerve injury, motor
and sensory disturbance of the tongue
* Oncology referral
* Radiation
39
Lipoma
*Benign tumor
*Very common
*Composed of adipose tissue
enclosed by a fibrous capsule
40
Lipoma presentation
*Painless mass
*May occur at the site of a
previous minor injury
* Controversial
*Tend to run in families
41
Lipoma Exam
*Soft to the touch, “doughy”
*Situated just under the skin
*Usually mobile, not fixed
*Often non-tender
42
Carotid Body Tumor
*Paraganglioma
* Neuroendocrine neoplasm
* 1-2 per 100,000 population
*Develop within the medial aspect of the
carotid bifurcation
*Typically middle-aged adults,
occasionally children
*Inherited in 10-50% of cases
*5% are bilateral
*5-10% are malignant
43
Carotid Body Tumor presentation
*Often an asymptomatic neck mass
*Slow-growing
* Doubling time > 7 years
*Pulsatile tinnitus
*Approximately 10% of the cases present
with cranial nerve palsy
44
Carotid Body Tumor diagnosis/imaging
* Ultrasonography with color Doppler
* CT
* MRA/MRI
* Biopsy is not recommended and may be
harmful
45
Carotid Body Tumor treatment
* Refer to vascular surgeon for surgical
management
* Radiotherapy
46
Thyroid Nodule
*Most are benign hyperplastic
lesions
*Solitary nodules more likely to be
cancerous
47
Types of thyroid nodules
*Thyroid adenomas (Benign) - Follicular
*Thyroid cysts
*Hyperplastic thyroid nodules
48
Thyroid carcinoma risk factors
* Preexisting benign thyroid disease
* Irregular menstruation
* Bilateral oophorectomy
* Family history
49
Thyroid Nodule Presentation
*Fixed mass
*Neck pain, stridor, dysphonia,
dysphagia
50
Thyroid Nodule exam
*↑ size correlates with ↑ risk of
malignancy
*Size is used in tumor staging and
is highly predictive of outcome
51
Diagnostic test of choice for Thyroid nodules
FNA (fine needle aspiration)
52
Thyroid Nodule treatment if benign
* Observation
* Refer to endocrinology for
levothyroxine suppression therapy
* Administered for 6-12 months,
observe for decrease in size
* Growth of a nodule during therapy
is a strong indication for surgery
53
Thyroid Nodule treatment if malignant
* Refer to ENT for thyroidectomy
* Oncology
* Radiation
54
NHL risk factors
* EBV
* Chemicals and herbicides
* Radiation
* Autoimmune diseases
55
NHL presentation
* Painless, swollen lymph nodes in your neck, armpits or groin
* Abdominal pain or swelling
* Chest pain, coughing or trouble breathing
* Fatigue
* Fever
* Night sweats
* Weight loss
56
HL Risk factors
* EBV infection
* Age between 15-30 years or ≥ 55 years
* Family history of lymphoma
* Male
* Immunocompromised
57
HL presentation
* Painless, swollen lymph nodes in your neck, armpits or groin
* (70%) of HL patients have a swollen lymph node in the neck
* Fatigue
* Loss of appetite
* Fever and chills
* Night sweats
* Weight loss
* Itching
* Increased sensitivity to the effects of alcohol or pain in the
lymph nodes after drinking alcohol
58
Lymphoma exam
*Painless lymphadenopathy that
is often hard, matted, immobile
*Neck
*Axillary
*Groin
*In children, often greater than 3
cm in diameter
*Swollen spleen or liver
59
Lymphoma labs
*CBC c diff
*CMP - calcium, phosphate, uric
acid
*Liver function
*LDH
*ESR
60
if lymphoma of the tonsils is suspected, what treatment can be done?
Diagnostic tonsillectomy
61
Most _____ originate in the glottis
Laryngeal Cancers
62
Laryngeal Cancer presentation
* Dysphonia
* Dysphagia
* Dyspnea
* Cough
* Stridor
* Aspiration
* Blood-tinged sputum
* Fatigue
* Weight loss
* Pain
* Halitosis
* Neck mass
* Otalgia
63
Laryngeal Cancer Imaging
*Refer to ENT if symptoms persist for
longer than 3 weeks for FFL
*CT scan of the head and neck with
contrast
64
Laryngeal Cancer treatment
*Referrals – ENT, oncology
*Complex due to crucial functions of this
anatomic area
*The goal is to remove the tumor and prevent
recurrence while maintaining laryngeal function*
Chemo
*Laryngectomy: Breathe through a stoma
65
_____ accounts for more
than 90% of head and neck cancers
Squamous cell carcinoma
