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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
Q

___ is an option for those who are medically unfit for another surgery or refuses surgery

A

prosthesis

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26
Q

warning signs for skin lesions

A 
Asymmetry
Border irregularity
Color variation
Diameter greater than 6 mm
Evolving changes
27
Q

most common malignancy in humans around the world

A

basal cell carcinoma

28
Q

what is basal cell carcinoma

A
  • slow growing epithelial malignancy
  • most frequent in sun exposed skin
  • rarely metastasizes
  • aberrant activation of hedgehog signaling pathway
29
Q

presentation and tx for basal cell carcinoma

A
  • raised, rolled border with central ulceration and may be pruritic
  • tx: dermabrasion, cryosurgery, mohs surgery, wide excision with/without reconstruction
  • vismodegib: hedgehog inhibitor
30
Q

t/f intermittent recreational sun exposure is at higher risk than cumulative uv radiation

A

true

31
Q

malignant epidermal tumor from keratinocytes with a locally destructive and metastatic potential, 2nd most common skin cancer

A

squamous cell ca

32
Q

high risk for multiple skin cancers

A

immunocompromised and xenoderma pigmentosum

33
Q

management for squaca

A
  • wide excision with or without reconstruction and neck dissection
  • more aggressive: adjuvant radiation and/or systemic therapy (cetuximab, pd1, pdl1 inihibitors)
34
Q

most lethal form of skin cancer

A

cutaneous melanoma

35
Q

risk factors for cutaneous melanoma

A

sun exposure, light skin, atypical nevi

36
Q

manifestation of cutaneous melanoma

A
  • potentially metastatic when it reaches vertical growth phase
  • satellite lesions: discrete nests of melanoma cells that are clearly separated from body of tumor
37
Q

management of cutaneous melanoma

A
  • 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
Q

type of biopsy to be done in salivary gland neoplasms

A

fnab

39
Q

most common salivary gland tumor, least malignant: ___

least common salivary gland tumor, most malignant: ___

A

most common salivary gland tumor, least malignant: parotid

least common salivary gland tumor, most malignant: sublingual

40
Q

incidence of histology of malignant salivary gland neoplasms

A

most common: mucoepidermoid

adenoid cystic, adenocarcinoma

41
Q

benign vs malignant salivary gland tumors

A

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
Q

mgt for salivary gland tumor

A
  • mri, ct to rule out bone involvement
  • surgical resection
  • adjuvant radiationi
43
Q

risk factors for nasopharyngeal cancer

A
  • chinese descent (guangdong province)
  • fish, ebv, smoking
  • highest indicence: southern china, hk, guangzhou province
44
Q

histology of nasopharyngeal ca

A
  • most common: nonkeratinizing undifferentiated ca
45
Q

histologies of npca

A

most common: nonkeratiniing
undifferentiated

keratinizing squamous cell ca, basaloid squamous cell ca

46
Q

diagnostics for npca

A
  • biopsy: histology

- imaging: extent (cct for base of skull, mri for intracranial)

47
Q

mgt for npca

A
  • stage 1 and 2: radiation only
  • stage 3 and 4: concurrent chemo
  • local and regional recurrency: surgical
48
Q

most common site for paranasal sinus ca

most common histology for paranasal sinus ca

A

maxillary sinus

adult: squaca
pedia: rhabdomyosarcoma

49
Q

diagnostics for paranasal sinus ca

A
  • 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
Q

mgt of paranasal sinus ca

A

surgical only

- endoscopic or open

51
Q

contraindications for endoscopic mgt of paranasal sinus ca

A
  • dura involvement beyond mid pupillary line
  • anterior/lateral frontal sinus involvement
  • facial/orbital soft tissue extension
  • palatal involvement
  • gross brain parenchyma involvement
52
Q

contraindication for open surgery for paranasal ca

A
  • gross invasion of the brain
  • invasion of orbits
  • carotid encasement
  • invasion of cavernous sinus
  • significant comorbidities
  • extension to nasopharynx or pterygoid fossa
53
Q

presentation for laryngeal and hypopharyngeal cancers

A
  • hypopharyngeal and supraglottic ca: dysphagia
  • glottic cancer: hoarseness
  • subglottic cancer: dyspnea
  • squaca: MOST COMMON HISTOLOGY
54
Q

important subset of laryngeal tumors with aggressive behavior and high risk of lymphatic metastasis

A

transglottic tumors

55
Q

diagnostics for laryngeal and hypopharyngeal cancers

A
  • laryngeal exam
  • ct scan of the neck with contrast!!!
  • imaging before operative endoscopy and biopsy
56
Q

mgt of laryngeal and hypopharyngeal ca

A

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
Q

presentation of oral cavity ca

A
  • ulcerative exophytic lesions
  • involvement of adjacent structures
  • dysarthria (tongue involvement)
  • teeth mobility
  • neck nodes are usual
58
Q

diagnostics for oral cavity ca

A
  • ct: cortical bone erosion and ln metastases
  • mri: extent
  • punch biopsy or periphery and/or fna of regional metastases
59
Q

mgt of oral cavity ca

A
  • surgery!!

- advanced stage: combined modality (surgery and radio)

60
Q

most common histology of oropharyngeal ca

A

scc

61
Q

signs of hpv-associated opscc

A
  • 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
Q

mgt of oropharyngeal ca

A
  • early: single modality

- advanced: multimodal (with surgery)

63
Q

synchronous vs metachronous lesion

A

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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