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Clin Med I - ENT > Head & Neck Cancers > Flashcards

Head & Neck Cancers Flashcards

1
Q

What is the main etiology of cancer in western countries?

A
  • alcohol

- tobacco

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2
Q

What infection is the etiology of oral cancers and over 50% of oropharynx cancers?

A
  • HPV
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3
Q

What is the etiology of Mediterranean and Far East nasopharynx cancers?

A
  • EBV (Epstein Barr Virus)
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4
Q

What type of cancers are most head and neck cancers?

A
  • squamous cell
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5
Q

Are salivary gland tumors mostly benign or malignant?

A
  • benign
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6
Q

What are salivary gland tumors called?

A
  • adenomas or adenocarcinomas
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7
Q

What are white or red patches usually of the buccal mucosa?

A
  • leukoplakia or erythroplakia respectivly
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8
Q

What makes leukoplakia or erythroplakial lesions premalignant?

A
  • dysplasia
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9
Q

What does the carcinogenesis of head and neck cancers frequently involve?

A
  • inactivation of tumor suppressor genes

- activation of oncogenes

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10
Q

What are the 10 phenotypic and genotypic characteristics of all cancers?

A
  • increased cell proliferation
  • failure of cells to differentiate
  • loss of normal cell death ( apoptosis) or senescence ( growth arrest)
  • genetic instability
  • insensitivity to antigrowth signals
  • self sustaining growth signals
  • increased angiogenesis
  • invasion
  • metastasis
  • immune evasion
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11
Q

Where do most tongue cancers arise?

A
  • lateral tongue
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12
Q

What are signs/symptoms of oral cancers?

A
  • nonhealing, painful mouth ulcers
  • change in fit of dentures
  • dysarthria (speech alterations
  • dysphagia (difficulting swallowing)
  • palpable cervical LN
  • fistulae of mouth
  • jaw pain
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13
Q

What are the diagnostic tests for oral cancers?

A
  • fine needle aspiration/biopsy
  • CT/PET CT
  • MRI
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14
Q

What does T, N and M mean in staging of cancers?

A
  • T = size
  • N = LN involvement
  • M = metastasis
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15
Q

What is Stage I oral cancer?

A
  • T1 = ≤ 2cm
  • N0
  • M0
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16
Q

What is Stage II oral cancer?

A
  • T2 = 2-4cm
  • N0
  • M0
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17
Q

What is Stage III oral cancer?

A
  • T = any
  • N1
  • M0
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18
Q

What is Stage IV oral cancer?

A
  • T = any
  • N = any
  • M = any
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19
Q

How should the treatment team be comprised?

A
  • multi-specialty
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20
Q

What is the treatment of Stage I oral cancer?

A
  • surgical excision
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21
Q

What is the treatment of Stage II oral cancer?

A
  • surgery

- unilateral neck dissection

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22
Q

What is the treatment for Stage III and IVa oral cancer?

A
  • combo chemo and radiation
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23
Q

What is the treatment for Stage IVb & c oral cancer?

A
  • palliative
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24
Q

What complications can combo treatment of head and neck cancers frequently lead to?

A
  • mucositis
  • lowering of blood counts
  • xerostomia (dry mouth)
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25
Q

What can xerostomia lead to?

A
  • lack of taste for food
  • inability to chew and digest food normally
  • poor dental health and osteoradionecrosis
  • bad breath
  • social and emotional problems
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26
Q

What should a patient be educated to look for after treatment of head and neck cancers?

A

new or worsening:

  • dysphagia
  • odynophagia
  • anorexia
  • head/neck pain
  • cranial neuropathies
  • enlarging LN
  • epistaxis or hemoptysis
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27
Q

Who should undergo intensive counseling after head/neck cancer treatment?

A
  • patients who continue to use ETOH or tobacco
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28
Q

Which cancers are relatively rare?

A
  • nasal cavity

- paranasal sinuses

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29
Q

What are the symptoms of nasal cavity and paranasal sinus cancers?

A
  • unexplained face pain
  • proptosis
  • epistaxis
  • nasal discharge or congestion
  • visual changes/diplopia
  • high cervical lymphadenopathy
30
Q

How are nasal cavity and paranasal sinus cancers diagnosed?

A
  • biopsy
  • MRI
  • PET/CT
31
Q

How are early stage nasal cavity and paranasal sinus cancers lesions treated?

A
  • radiation s/p excision
32
Q

How are more advanced nasal cavity and paranasal sinus cancers lesions treated?

A
  • combo chemo/radiation
33
Q

What other treatments might stage III or IV nasal cavity and paranasal sinus cancers require?

A
  • ipsilateral neck dissection
34
Q

What is common s/p nasal cavity and paranasal sinus cancers treatment?

A
  • loco-regional recurrence
35
Q

What does the f/u of nasal cavity and paranasal sinus cancers include?

A
  • periodic endoscopic exam

- surveillance MRI/CT

36
Q

What do patients need to be monitored for while receiving radiation treatment for nasal cavity and paranasal sinus cancers?

A
  • impaired vision
  • corneal ulcerations
  • diplopia
37
Q

What are the symptoms of nasopharynx cancers?

A
  • unresolving otitis media
  • unexplained headache
  • nasal obstruction
  • epistaxis
  • necrotic nasal discharge
38
Q

What is often associated with nasopharyngeal cancers?

A
  • cervical adenopathy
39
Q

What is the target population of nasopharyngeal cancers?

A
  • 50 to 59 y/o M
40
Q

How do nasopharyngeal cancers differ from other head and neck cancers?

A
  • endemic nasopharyngeal: poorly differentiated, nonkeratinized squamous cell
  • lymphoepitheliomas hightly associated with EBV
  • Western sporadic cases are keratinized squamous cell
41
Q

How is nasopharyngeal cancer diagnosed?

A
  • biopsy
42
Q

What is the treatment for stage I nasopharyngeal cancer?

A
  • image modulated radiation therapy (IMRT)

- ipsilateral neck disection

43
Q

What is the treatment for stage II nasopharyngeal cancer?

A
  • combo chemo and radiation
44
Q

What is the treatment for stage III & IV nasopharyngeal cancers?

A
  • combo chemo and radiation
45
Q

What is the treatment for metastatic nasopharyngeal cancer?

A
  • palliative
46
Q

What does the follow up treatment consist of after nasopharyngeal cancer?

A
  • documentation of remission via MRI & total body PET CT

- EBV titter

47
Q

What are complications of nasopharyngeal cancer treatment?

A
  • xerostomia
  • cranial neuropathies
  • Lhermitte’s Syndrome
  • hyperthyroidism
48
Q

What is Lhermitte’s Syndrome?

A
  • meningitis s/p radiation

- initiated when lowering the head giving to syncope and LE pain

49
Q

What are symptoms of oropharynx cancer?

A
  • nonresolving sore throat
  • otalgia
  • dysphagia
  • odonphagia
  • new onset sleep apnea/snoring
50
Q

What are risk factors for oropharyngeal cancer?

A
  • smoking
  • ETOH
  • HPV
51
Q

What are the treatments for oropharyngeal cancer?

A
  • radiation
  • combo chemo and radiation
  • tonsillectomy
  • ipsilateral neck disection
52
Q

What is a symptom of glottic cancer and when is it diagnosed?

A
  • hoarsness

- early stage

53
Q

What are the symptoms of subglottic cancers?

A
  • hoarsness
  • throat pain
  • difficulty swallowing or aspiration
54
Q

Stages of laryngeal cancers (T)

A
  • T1 = confined to one subarea
  • T2 = involving two adjacent subareas
  • T3 = invade areas adjacent to but outside of the larynx
  • T4 = locally advanced involving deep structures
55
Q

Staging of laryngeal cancers (N)

A
  • N1 = 1 ipsilateral LN < 3cm
  • N2a = 1 ipsilateral LN 3-6cm
  • N2b = 2+ ipsilateral LNs 3-6cm
  • N2c = bilateral LNs 3-6cm
  • N3 = LNs > 6cm
56
Q

General considerations for cervical adenopathy of unclear etiology

A
  • benign and reactive
  • therapeutic and diagnostic trial of abx with re-eval s/p 2w
  • enlarged occipital LNs are NEVER malignant unless obvious scalp involvement
  • supraclavicular LN are ALWAYS malignant until proven otherwise
57
Q

What is the treatment for squamous cell cancer of cervical LNs and unknown primary?

A
  • radical neck dissection
  • radiation therapy
  • combo chemo and radiation
58
Q

What is consideration for follow up s/p treatment of squamous cell cancer of cervical LN and unknown primary?

A
  • local recurrences are not rare

- primary may declare itself at a later time

59
Q

What are most salivary gland tumors?

A
  • benign adenomas (pleomorphic adenomas)
60
Q

Where are pleomorphic adenomas invasive?

A
  • locally
61
Q

What is the treatment for pleomorphic adenomas?

A
  • surgical
62
Q

What must be preserved if a pleomorphic adenoma is in the parotid gland?

A
  • facial n.
63
Q

Are lymphomas of the salivary gland rare or not?

A
  • not rare
64
Q

Are adenocarcinomas of the salivary gland rare or not?

A
  • rare
65
Q

Cancers are mostly associated with _______.

A
  • exposure to tobacco and alcohol
66
Q

A significant number of _______ cancers are caused by _______.

A
  • oropharyngeal

- HPV

67
Q

_______ cancers in Asia or individuals who have emigrated to the West from Asia are _______ termed _______.

A
  • nasopharyngeal
  • frequently poorly differentiated non-keratinizing squamous cell cancers
  • lymphoepitheliomas
68
Q

Lymphoepitheliomas are caused by _______ but are treated like _______.

A
  • EBV

- other head and neck cancers

69
Q

Small well confined cancers of the head and neck (Stage _______) are usually treated with _______.

A
  • I

- surgical excision

70
Q

If the cancers are larger or involve _______, _______ with or without _______ is given.

A
  • LNs
  • radiation
  • chemo
71
Q

What are the most common chemotherapeutic agents used in treatement of head and neck cancers?

A
  • platinum compounds
  • 5-fluorouracil (5FU)
  • cetuximab
72
Q

What is the goal of curative therapy for head and neck cancers?

A
  • elimination of all local regional disease with minimum morbidity

Clin Med I - ENT (13 decks)

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