HEENT head and neck cancer Flashcards
60 % of OP cancer is found at the
palatine
lingual tonsils
pts with HPV + will be
young patients
less likely to smoke or drink
tumors: basaloid and poorly diff
better prognosis
S/S of OP cancer
most common: swelling and sore that doesn’t heal
red/white patch in mouth = dont heal
persist sore throat
hoarseness or change in voice
difficult breathing
lump bump or mass with/without pain
pain/ hard to chew
loosening teeth
dentures don’t fit
unexplained weight loss
fatigue
blood in saliva
neck masses are found…
age?
type:
region:
80% adults > 40 y/o
80% SSC primary type
neck and head region
pt presents to your office with lump on neck. whats your next step?
step 1: CT of neck
step 2: Find needle aspiration
step 3: flexible laryngoscopy: to see the area
step 3: PET scan
What is used in PET scan
nuclear med. imaging to see metabolic processes in the body
it uses FDG (fludeoxyglucose) to indicate which tissue is increasing its uptake and metabolic
after you find out that the pt has SCC of the neck of unknown primary, what do you do?
determine HPV status with needle biopsy of neck mass
*HPV + …. > 95% most likely be primary Tonsil or Base of Tongue (BOT)
History
PE exam
Imaging - PET scan
biopsies/tonsillectomy
TNM staging system has 3 parts
primary tumor (T) - size
*(T1,2,3,4,)
regional lymph nodes (N)
*N0, 1, 2, 3
Distant Metastasis (M)
*M0, M1
nonsurgical tx options for H/N cancer?
radiation- radiation mask
chemotherapy
what is the first line treatment for oral cancer?
surgical resection
*ex: floor of mouth resection + neck dissection
*partial glossectomy
what is neck dissection and what factors play a role in it
removal of lymph nodes and tissues from neck
factors: type and extent of cancer - stage
T/F the higher the TNM stage, the worse? -
*TNM stage is a prognostic indictor
T
what is one of the strongest predictors of a 50% reduction in survival rate for head and neck cancer
cervical nodal involvement: 2/3 of SSCHN pts has
10% = metastasis
extracapsular spread (ECS) further reduces survival
other predictors for head and neck cancer
nodal burden
perineural invasion
histologic grade
extent of necrosis
+ tumor margin
1st line Tx for oropharyngeal cancer
radiation therapy +/- chemo
*most likely tonsils or BOT
if it reoccurs –> surgery
first line Tx for laryngeal and hypopharyngeal cancer in …
early stage
advanced stage
recurrent cancer
early stage: radiation +/- chemo
advanced stage : surgery (laryngectomy/ pharyngectomy)
recurrent cancer - treated with surgery
Total laryngectomy involves the removal of? and side affects?
removal of :
hyoid bone
thyroid and cricoid cartilage,
Vocal folds
epiglottis
upper 2 or 3 rings of the trachea
all intrinsic mm of larynx
selected extrinsic laryngeal mms
side affects
respiration
swallow
speak (no phonation)
when someone gets a total laryngectomy, what device do they put in the hole?
tracheostomy tube that goes into the trachea
Most people will eventually be able to eat normally with a tracheostomy, although swallowing can be difficult at first. While in hospital, you may start by taking small sips of water before gradually moving on to soft foods, followed by regular food.
what are 3 goals of reconstruction for neck and head cancer
cosmetic apperance
close surgical defect
return function like breathing and swallowing
what is the reconstructive ladder from bottom (simple) to highest (complex)
healing by secondary intent –> primary closure–> skin graft –> local flap –> regional flap –> free flaps
functional impairment of Oropharyngectomy
swallowing
speech
dry mouth
taste, chewing
fatigue
cervical and oral pain
weakness
neck and should dysfunction
ADL restrictions
lymphedema
anxiety/ depression
what is lymphedema, cause, and affects?
tissue swelling due to accumulation of protein rich fluid
removing lymph nodes or from radiation
affects: restricted ROM, infections, fibrosis of the skin
ways to treat lymphedema? techniques
kinesio tapping: lifts tissue = helps with circulation and lymphatic fluid flow with lymphedema
compression garment for neck
manual lymph drainage
graston technique: soft tissue therapy to break up scar tissue : alternative to message
what things can you use dry needling for?
radiation fibrosis
trismus (can also do PT and always measure progress)
tracheoesophageal puncture (TEP) surgery
indicated for:
process:
total laryngectomy: larynx is removed –>connection between mouth and trachea gone –> trachea is rotated forward and connects to the skin –> hole in neck (stoma)
TEP surgery –> puts pencil size hole between trachea and esophagus –> hole is a one way valve called TE voice prosthesis -> when pt covers the stome, air from lungs goes through the trachae and into the esopagus –> vibrates it –> creates voice
what are two things that can help a pt talk about a total laryngectomy ?
electrolarynx and TEP
what therapy should pts with larygectomy do?
swallowing and speech
what type of cancer makes 95% of head and neck cancers?
age:
sex:
affects mostly?
SSC
age: 65 y/o —> > 45 .. BOT and tonillar SSC
sex: men > female develop and die
high incidence in AA and poorer, 20 % lower, 5 year survival rate
Squamous cell carcinoma over …….. of malignancies of upper aerodigestive tract
a) Over 90% of malignancies in oropharynx
b) 3-6% are …..
c) 1-3% are …..
95%
a) oropharynx
b) nasopharyngeal carcinomas (NPC)
c) salivary cancer
OP demographic
RF:
Age:
two year survival rate
race
HPV (70%)
40s-50s
95%
white males
HPV should clear within
6-12 months
1-3 % women, 10 % of men = active oral HPV
HPV oral oncogenic types
16, 18, 39, 59
15 = 90 % of OP SSC cancer
congenital neck mass …
lymphangiomas
dermoid
thyroglossal
developmental neck mass …
brachial cysts…
laryngoceles
pharyngeal
skin and subq tissue neck mass ….
sabaceous cyst
lipoma
thyroid swellings neck mass…
multinodular goitre
solitary thyroid nodule
salivary gland tumors neck mass
pleomorphic adenoma
warthins
tumors of the parapharyngeal space neck mass
deep lobe parotid
chemodectoma
reactive neck lymphadenopathy neck mass
tonsilitis,
glandular fever
HIV
malignant neck node
carcinoma metastases (unknown primary)
lymphoma
