Head and Neck Oncology Flashcards
How much more likely are you to develop SCC if you drink alcohol & smoke cigarettes?
16x more likely to get SCC
What are some causes of SCC cancers?
- smoking
- alcohol
- HPV
- EBV
- HIV
- Betel/paan chewing
- previous SCC
How can SCC present in the oral cavity?
- ulcerated
- uneven surface
- indurated
- rolled edges
- well defined margins
- exophytic
How is performance status graded when evaluating head and neck cancer patients?
ECOG performance status
Why might you take a CT scan on a potential head & neck cancer pt?
- assess primary tumour
- assess for any synchronous head and neck tumours
- assess for regional spread
- assess for distant metastasis or unrelated second cancers
Why might you take an MRI instead of a CT scan when checking for H&N cancer?
- no radiation
- improved soft tissue definition
- not affected by dental amalgam
- extent of bone involvement
- extent of nerve involvement
- surgical planning
When might you perform an ultrasound on a head and neck cancer pt?
Pt presents with a salivary or neck mass
What is a positron emission scan?
Radioactive tracer injected into pt and tracked
What radioactive tracer is used in a positron emission scan?
Fluorodeoxyglucose
Who might be involved in a head and neck cancer MDT?
- OMFS surgeon
- ENT surgeon
- pathologists
- clinical oncologists
- radiologists
- speech and language therapist
- dietician
What does the T, N & M stand for in the TNM classification?
T = primary tumour size/depth
N = nodal status
M = disease distant to primary tumour
Why do we stage cancer patients?
- treatment planning
- prognostic
- research purposes
What treatment options are available for head and neck cancer patients?
Curative vs Palliative
- surgery alone
- radiotherapy alone
- chemoradiotherapy
- dual or triple modality
- immunotherapy
What surgical options are available for the primary cancer site?
- resection & packing
- resection and primary closure
- resection & reconstruction
- local flap, pedicled flap, free flap
When performing resection surgery of oral cancer, how big should the margin be?
at least 1cm of healthy tissue surrounding cancer site
What is involved in reconstruction of pts that have had oral cancer resection?
- seal oral cavity from neck
- fill dead space
- maintain oral competence
- maintain function
- facilitate restorative options
- avoid trismus
- aesthetics
What is a free flap?
tissue is completely detached from its blood supply at the original location & then transferred to another location
When is radiology input required for cancer care?
- diagnosis
- staging
- pre-radiotherapy
- treatment response
- recurrence
- post op complications
- dental rehabilitation
When would you take a radiograph for cancer diagnosis vs soft tissue imaging?
If suspicious lesion in:
- retromolar trigone
- non-healing socket
- coming out of hard palate
What might you see on a radiograph that indicates bony cancers of head & neck?
- moth eaten bone
- pathological fractures
- non-healing sockets
- floating teeth
- spiking root resorption [suggests agressive]
- unusual periodontal bone loss
- spiculated periosteal reaction
- generalised widening of PDL space and loss of lamina dura
- loss of bony outlines for anatomical features
What are some signs on an ultrasound that may suggest cancer
- rounded lymph nodes
- enlarged lymph nodes
- conglomerate nodes [lymph nodes matted together - warning sign for aggressive malignancy]
- necrosis of nodes
- increased vascularity or avascular
- loss of hilum
- internal calcification
- extrascapular spread [prognosis drops by another 50%]
How does your survival prognosis drop after lymph node involvement of cancer?
30-50% drop
What methods exist for ultrasound guided biopsies?
- fine needle aspirate
- core biopsy [more invasive & requires small incision in skin]
