Head & Neck Cancers Flashcards
What is the main etiology of cancer in western countries?
- alcohol
- tobacco
What infection is the etiology of oral cancers and over 50% of oropharynx cancers?
- HPV
What is the etiology of Mediterranean and Far East nasopharynx cancers?
- EBV (Epstein Barr Virus)
What type of cancers are most head and neck cancers?
- squamous cell
Are salivary gland tumors mostly benign or malignant?
- benign
What are salivary gland tumors called?
- adenomas or adenocarcinomas
What are white or red patches usually of the buccal mucosa?
- leukoplakia or erythroplakia respectivly
What makes leukoplakia or erythroplakial lesions premalignant?
- dysplasia
What does the carcinogenesis of head and neck cancers frequently involve?
- inactivation of tumor suppressor genes
- activation of oncogenes
What are the 10 phenotypic and genotypic characteristics of all cancers?
- 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
Where do most tongue cancers arise?
- lateral tongue
What are signs/symptoms of oral cancers?
- nonhealing, painful mouth ulcers
- change in fit of dentures
- dysarthria (speech alterations
- dysphagia (difficulting swallowing)
- palpable cervical LN
- fistulae of mouth
- jaw pain
What are the diagnostic tests for oral cancers?
- fine needle aspiration/biopsy
- CT/PET CT
- MRI
What does T, N and M mean in staging of cancers?
- T = size
- N = LN involvement
- M = metastasis
What is Stage I oral cancer?
- T1 = ≤ 2cm
- N0
- M0
What is Stage II oral cancer?
- T2 = 2-4cm
- N0
- M0
What is Stage III oral cancer?
- T = any
- N1
- M0
What is Stage IV oral cancer?
- T = any
- N = any
- M = any
How should the treatment team be comprised?
- multi-specialty
What is the treatment of Stage I oral cancer?
- surgical excision
What is the treatment of Stage II oral cancer?
- surgery
- unilateral neck dissection
What is the treatment for Stage III and IVa oral cancer?
- combo chemo and radiation
What is the treatment for Stage IVb & c oral cancer?
- palliative
What complications can combo treatment of head and neck cancers frequently lead to?
- mucositis
- lowering of blood counts
- xerostomia (dry mouth)
What can xerostomia lead to?
- lack of taste for food
- inability to chew and digest food normally
- poor dental health and osteoradionecrosis
- bad breath
- social and emotional problems
What should a patient be educated to look for after treatment of head and neck cancers?
new or worsening:
- dysphagia
- odynophagia
- anorexia
- head/neck pain
- cranial neuropathies
- enlarging LN
- epistaxis or hemoptysis
Who should undergo intensive counseling after head/neck cancer treatment?
- patients who continue to use ETOH or tobacco
Which cancers are relatively rare?
- nasal cavity
- paranasal sinuses
What are the symptoms of nasal cavity and paranasal sinus cancers?
- unexplained face pain
- proptosis
- epistaxis
- nasal discharge or congestion
- visual changes/diplopia
- high cervical lymphadenopathy
How are nasal cavity and paranasal sinus cancers diagnosed?
- biopsy
- MRI
- PET/CT
How are early stage nasal cavity and paranasal sinus cancers lesions treated?
- radiation s/p excision
How are more advanced nasal cavity and paranasal sinus cancers lesions treated?
- combo chemo/radiation
What other treatments might stage III or IV nasal cavity and paranasal sinus cancers require?
- ipsilateral neck dissection
What is common s/p nasal cavity and paranasal sinus cancers treatment?
- loco-regional recurrence
What does the f/u of nasal cavity and paranasal sinus cancers include?
- periodic endoscopic exam
- surveillance MRI/CT
What do patients need to be monitored for while receiving radiation treatment for nasal cavity and paranasal sinus cancers?
- impaired vision
- corneal ulcerations
- diplopia
What are the symptoms of nasopharynx cancers?
- unresolving otitis media
- unexplained headache
- nasal obstruction
- epistaxis
- necrotic nasal discharge
What is often associated with nasopharyngeal cancers?
- cervical adenopathy
What is the target population of nasopharyngeal cancers?
- 50 to 59 y/o M
How do nasopharyngeal cancers differ from other head and neck cancers?
- endemic nasopharyngeal: poorly differentiated, nonkeratinized squamous cell
- lymphoepitheliomas hightly associated with EBV
- Western sporadic cases are keratinized squamous cell
How is nasopharyngeal cancer diagnosed?
- biopsy
What is the treatment for stage I nasopharyngeal cancer?
- image modulated radiation therapy (IMRT)
- ipsilateral neck disection
What is the treatment for stage II nasopharyngeal cancer?
- combo chemo and radiation
What is the treatment for stage III & IV nasopharyngeal cancers?
- combo chemo and radiation
What is the treatment for metastatic nasopharyngeal cancer?
- palliative
What does the follow up treatment consist of after nasopharyngeal cancer?
- documentation of remission via MRI & total body PET CT
- EBV titter
What are complications of nasopharyngeal cancer treatment?
- xerostomia
- cranial neuropathies
- Lhermitte’s Syndrome
- hyperthyroidism
What is Lhermitte’s Syndrome?
- meningitis s/p radiation
- initiated when lowering the head giving to syncope and LE pain
What are symptoms of oropharynx cancer?
- nonresolving sore throat
- otalgia
- dysphagia
- odonphagia
- new onset sleep apnea/snoring
What are risk factors for oropharyngeal cancer?
- smoking
- ETOH
- HPV
What are the treatments for oropharyngeal cancer?
- radiation
- combo chemo and radiation
- tonsillectomy
- ipsilateral neck disection
What is a symptom of glottic cancer and when is it diagnosed?
- hoarsness
- early stage
What are the symptoms of subglottic cancers?
- hoarsness
- throat pain
- difficulty swallowing or aspiration
Stages of laryngeal cancers (T)
- 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
Staging of laryngeal cancers (N)
- 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
General considerations for cervical adenopathy of unclear etiology
- 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
What is the treatment for squamous cell cancer of cervical LNs and unknown primary?
- radical neck dissection
- radiation therapy
- combo chemo and radiation
What is consideration for follow up s/p treatment of squamous cell cancer of cervical LN and unknown primary?
- local recurrences are not rare
- primary may declare itself at a later time
What are most salivary gland tumors?
- benign adenomas (pleomorphic adenomas)
Where are pleomorphic adenomas invasive?
- locally
What is the treatment for pleomorphic adenomas?
- surgical
What must be preserved if a pleomorphic adenoma is in the parotid gland?
- facial n.
Are lymphomas of the salivary gland rare or not?
- not rare
Are adenocarcinomas of the salivary gland rare or not?
- rare
Cancers are mostly associated with _______.
- exposure to tobacco and alcohol
A significant number of _______ cancers are caused by _______.
- oropharyngeal
- HPV
_______ cancers in Asia or individuals who have emigrated to the West from Asia are _______ termed _______.
- nasopharyngeal
- frequently poorly differentiated non-keratinizing squamous cell cancers
- lymphoepitheliomas
Lymphoepitheliomas are caused by _______ but are treated like _______.
- EBV
- other head and neck cancers
Small well confined cancers of the head and neck (Stage _______) are usually treated with _______.
- I
- surgical excision
If the cancers are larger or involve _______, _______ with or without _______ is given.
- LNs
- radiation
- chemo
What are the most common chemotherapeutic agents used in treatement of head and neck cancers?
- platinum compounds
- 5-fluorouracil (5FU)
- cetuximab
What is the goal of curative therapy for head and neck cancers?
- elimination of all local regional disease with minimum morbidity
