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13 ENT > Head and Neck Tumors > Flashcards

Head and Neck Tumors Flashcards

1
Q

t/f head and neck cancer is more common in females, except for thyroid malignancy

A

false, more common in males

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2
Q

signs for benign mass

A
  • younger age
  • shorter duration
  • symptoms of inflammation
  • exposure to farm animals, tb, fungus
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3
Q

signs for malignant mass

A
  • older age group
  • chronic duration
  • fast growth
  • compressive or obstructive symptoms
  • family hx
  • exposure to ionizing radiation
  • smoker, betel nut chewer
  • alcoholic beverage drinker
  • hpv infection (oropharyngeal cancer)
  • ebv (nasopharyngeal cancer)
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4
Q

differentiating between benign and malignant masses on pe

A

benign: smooth, non-ulcerating, movable, well-defined borders
malignant: firm to hard, rough or irregular, ulcerative, friable or fragile, erythroplakia

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5
Q

types of biopsy

A

needle aspiration: deep tumors with intact skin (fnab)
punch biopsy: exophytic tumors
incision biopsy: for intact skin
excision biopsy: removal of entire tumor

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6
Q

most common histology for h&n malignancies is __

A

squaca

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7
Q

distant metastases work-up

A
  • chest xray or lung ct
  • hbt uts or whole abdomen uts
  • alkaline phosphatase or bone scan
  • pet/ct is superior for identifying distant metastases and posttreatment recurrence
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8
Q

tenets of reconstruction

A
  • complete removal of tumor
  • function > form
  • goal: match size, skin color, texture, and thickness of donor site tissue
  • put incisions on relaxed skin tension lines
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9
Q

what is primary closure

A
  • for small defects
  • you can close primarily but it depends on the laxity of the skin
  • pediatric and elderly are amenable
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10
Q

what is wound healing by secondary intention

A
  • defects will not be closed
  • used in superficial defects
  • causes unwanted contracture of wound edges
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11
Q

skin grafts vs flaps

A

graft: no direct blood supply, less contracture than secondary
flaps: has its own blood supply

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12
Q

what is split thickness skin grafts

A
  • epidermis + dermis
  • better perfusion and viability
  • poor color match, more contractures
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13
Q

what are full thickness skin grafts

A
  • epidermis + dermis + subcutaneous tissues
  • good color match, less contractures, better form
  • high probability of nonviability
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14
Q

factors that affect graft viability

A
  • blood supply to recipient bed
  • vascularity of the donor graft tissue
  • contact between graft and recipient bed
  • patient’s overall health
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15
Q

what are not good beds for skin graft

A

bare bone, irradiated tissue, infected tissue

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16
Q

sutures to give good contact between graft and bed

A
  • pie crust slits prevent blood accumulation between the graft and bed
  • basting sutures
  • bolster or pressure dressing to improve non movement
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17
Q

flaps according to location

A

local: tissue immediately adjacent to the defect
regional: flap from a site not immediately adjacent to the defect
distant: far from the area/defect

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18
Q

flaps according to blood supply

A

axial pattern: there is a named artery that supplies the flap

random: based on the rich perforating vascular plexus of the skin

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19
Q

t/f all regional and pedicle flaps are random flaps, all local flaps are axial pattern flaps

A

false!!!

all regional and pedicle flaps are axial patter

all local flaps are random flaps

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20
Q

flap used for extensive defects

A

pectoralis major myocutaneous flap: skin and muscle flap

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21
Q

examples of regional flaps

A
  • paramedian forehead flap (supratrochlear artery)

- deltopectoral flap (perforating branches of the internal mammary artery)

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22
Q

what is an anterolateral thigh free flap

A
  • thicker with more subcutaneous fat

- blood: lateral circumflex artery

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23
Q

signs of a healthy flap

A
  • pink, warm, slightly edematous
  • capillary refill within 3 seconds
  • pinprick will produce bright red blood
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24
Q

signs of bad flap

A
  • arterial thrombosis: no blood supply, pale and cold to touch, doesn’t bleed on pinprick
  • venous thrombosis: leads to congestion, violaceous, bleeds on pinprick but blood is dark
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25
___ is an option for those who are medically unfit for another surgery or refuses surgery
prosthesis
26
warning signs for skin lesions
``` Asymmetry Border irregularity Color variation Diameter greater than 6 mm Evolving changes ```
27
most common malignancy in humans around the world
basal cell carcinoma
28
what is basal cell carcinoma
- slow growing epithelial malignancy - most frequent in sun exposed skin - rarely metastasizes - aberrant activation of hedgehog signaling pathway
29
presentation and tx for basal cell carcinoma
- raised, rolled border with central ulceration and may be pruritic - tx: dermabrasion, cryosurgery, mohs surgery, wide excision with/without reconstruction - vismodegib: hedgehog inhibitor
30
t/f intermittent recreational sun exposure is at higher risk than cumulative uv radiation
true
31
malignant epidermal tumor from keratinocytes with a locally destructive and metastatic potential, 2nd most common skin cancer
squamous cell ca
32
high risk for multiple skin cancers
immunocompromised and xenoderma pigmentosum
33
management for squaca
- wide excision with or without reconstruction and neck dissection - more aggressive: adjuvant radiation and/or systemic therapy (cetuximab, pd1, pdl1 inihibitors)
34
most lethal form of skin cancer
cutaneous melanoma
35
risk factors for cutaneous melanoma
sun exposure, light skin, atypical nevi
36
manifestation of cutaneous melanoma
- potentially metastatic when it reaches vertical growth phase - satellite lesions: discrete nests of melanoma cells that are clearly separated from body of tumor
37
management of cutaneous melanoma
- wide excision with neck dissection if with regional metastases - radiation may be given post-surgery for pts with extra-capsular spread or multiple node involvement - immunotherapy (stage 4): dacarbazine, il2, ipilimumab, vemurafenib, pd1-i
38
type of biopsy to be done in salivary gland neoplasms
fnab
39
most common salivary gland tumor, least malignant: ___ least common salivary gland tumor, most malignant: ___
most common salivary gland tumor, least malignant: parotid least common salivary gland tumor, most malignant: sublingual
40
incidence of histology of malignant salivary gland neoplasms
most common: mucoepidermoid adenoid cystic, adenocarcinoma
41
benign vs malignant salivary gland tumors
benign: slow, mobile, no facial nerve paralysis, no overlying ulceration of skin malignant: fast, fixed to underlying tissue, facial nerve paralysis (parotid), constant pain, tongue numbness (submandibular), cervical lymphadenopathy
42
mgt for salivary gland tumor
- mri, ct to rule out bone involvement - surgical resection - adjuvant radiationi
43
risk factors for nasopharyngeal cancer
- chinese descent (guangdong province) - fish, ebv, smoking - highest indicence: southern china, hk, guangzhou province
44
histology of nasopharyngeal ca
- most common: nonkeratinizing undifferentiated ca
45
histologies of npca
most common: nonkeratiniing undifferentiated keratinizing squamous cell ca, basaloid squamous cell ca
46
diagnostics for npca
- biopsy: histology | - imaging: extent (cct for base of skull, mri for intracranial)
47
mgt for npca
- stage 1 and 2: radiation only - stage 3 and 4: concurrent chemo - local and regional recurrency: surgical
48
most common site for paranasal sinus ca most common histology for paranasal sinus ca
maxillary sinus adult: squaca pedia: rhabdomyosarcoma
49
diagnostics for paranasal sinus ca
- ct for skull base involvement - mri for intracranial involvement - biopsy: intranasal or into sinus - ohngren's line: above has poorer prognosis, blow has better prognosis
50
mgt of paranasal sinus ca
surgical only | - endoscopic or open
51
contraindications for endoscopic mgt of paranasal sinus ca
- dura involvement beyond mid pupillary line - anterior/lateral frontal sinus involvement - facial/orbital soft tissue extension - palatal involvement - gross brain parenchyma involvement
52
contraindication for open surgery for paranasal ca
- gross invasion of the brain - invasion of orbits - carotid encasement - invasion of cavernous sinus - significant comorbidities - extension to nasopharynx or pterygoid fossa
53
presentation for laryngeal and hypopharyngeal cancers
- hypopharyngeal and supraglottic ca: dysphagia - glottic cancer: hoarseness - subglottic cancer: dyspnea - squaca: MOST COMMON HISTOLOGY
54
important subset of laryngeal tumors with aggressive behavior and high risk of lymphatic metastasis
transglottic tumors
55
diagnostics for laryngeal and hypopharyngeal cancers
- laryngeal exam - ct scan of the neck with contrast!!! - imaging before operative endoscopy and biopsy
56
mgt of laryngeal and hypopharyngeal ca
goals: cure the pt, preserve larynx, minimize tx morbidity early (stage 1 and 2): surgery, radio (single modality) advanced (3 and 4): surgery and radio with/wo chemo post op, concurrent chemo-radio without surgery surgery = wide excision w/wo neck dissection, w/wo radio or chemo-radio
57
presentation of oral cavity ca
- ulcerative exophytic lesions - involvement of adjacent structures - dysarthria (tongue involvement) - teeth mobility - neck nodes are usual
58
diagnostics for oral cavity ca
- ct: cortical bone erosion and ln metastases - mri: extent - punch biopsy or periphery and/or fna of regional metastases
59
mgt of oral cavity ca
- surgery!! | - advanced stage: combined modality (surgery and radio)
60
most common histology of oropharyngeal ca
scc
61
signs of hpv-associated opscc
- younger (40-60), male > female - minimal/ no addication habit - nonkeratiinizing scc, poorly differentiated - small/unknown primary with bulky, cystic, or multiple odes - good 5 year survival
62
mgt of oropharyngeal ca
- early: single modality | - advanced: multimodal (with surgery)
63
synchronous vs metachronous lesion
synchronous: tumor detected simultaneously or within 6 mos of initial primary tumor metachronous: second primary lesion >6 mos after index tumor

13 ENT (18 decks)

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