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Skin Radiation therapy > Hypo pharynx > Flashcards

Hypo pharynx Flashcards

1
Q

exception to hypo pharynx cancer being considered more common in men

A

posterior cricoid is more common in women than men

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2
Q

causes of hypo pharynx cancer

A

alcohol smoking and plummer vision syndrome can occur in people with long-term iron deficiency anemia; it causes difficulty swallowing due to small, thin growth called an esophageal web- blocks the esophagus

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3
Q

hypo pharynx is the —–and ____ part of the pharynx

A

lowest and inferior

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4
Q

hypo pharynx extends from —- to ——–

A

hyoid bone end epiglottis to post of the cricoid cartilage

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5
Q

t levels the hypo pharynx is located between

A

c3-c6

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6
Q

hypo pharynx connects ——to ———-

A

oropharynx to thoracic inlet

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7
Q

shape of hypopharynx

A

horseshoe due to the indent made by the larynx

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8
Q

divisions of the hypo pharynx
It is subdivided into 4 parts: the lateral sides of the ‘horseshoe’ are referred to as the ——–, the posterior border forms the ————and the———- which extends from the level of the hyoid bone to the inferior border of the cricopharyngeus muscle

A

pyriform sinuses
postcricoid region
posterolateral pharynx

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9
Q

which hypo pharynx tumours do NOT qualify for voice sparing surgery

A

pyriform fossa apex or postcricoid area

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10
Q

lymphatics involved in the piriform fossa

A

jugulodigastric, retropharyngeal, jugulo-omohyoid, paratracheal

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11
Q

lymphatics involved in the posterior cricoid

A

jugulodigastric LN

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12
Q

LYMPHATICS INVOLVEDD IN THE POSTERIOR PHARYNX

A

: jugluodigastric, retropharyngeal

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13
Q

MOST COMMON HISTOPATHOLOGY HYPOPHARYNX

A

SCC

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14
Q

TNM staging hypopharynx

A 
T1-limited to 1 subset or <2cm 
T2-1 subset or 2-4 cm 
T3->4cm or extension into  the esophagus
T4a- Invades thyroid/cricoid cartilage, hyoid bone, thyroid gland or central compartment of soft tissue
T4-bInvades prevertebral fascia, encases carotid artery or involves mediastinal structures
N1- mets in 1 single ipsilateral Ln <3CM
n2-METS IN IPSILATERAL lN 3-6CM 
N3-Mets >6cm
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15
Q

stages for hyoppharynx cancer

A 
stage1- T1N0
stage 2 T2,N0
stage3 T1,N1,M0
T2,N1,M0, T3N0M0, T3,N1,M0
stage 4 T4,N0,M0
Any T N2,N3,MO
Any T ANY n M1
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16
Q

most common subsides to least common sub sites of hypo pharynx cancer

A

pyriform fossa, postcricoid, hypopharyngeal wall

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17
Q

________ tumours spread to involve the aryepiglottic folds; they sometimes invade medially and deeply into the false vocal cords and larynx via the paraglottic space- this allows it to behave as a transglottic carcinoma

A

medial pyriform fossa

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18
Q

____________ commonly invade the thyroid cartilage and less commonly the cricoid cartilage

A

lateral wall and apex of the piriform fossa

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19
Q

_____________tumours invade the cricoid cartilage, interarytenoid space and posterior cricohyoid muscle to produce hoarseness

A

post cricoid cartilage

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20
Q

Areas of distant mets for hypo pharynx cancer

A

lungs is most common then bone and brain

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21
Q

hallmark of postcricoid cartilage tumours presentation wise?

A

dysphagia

22
Q

Late symptoms of hypo pharynx cancer

A

dysphagia and weight loss

23
Q

most common and less common symptoms of hypo pharynx cancers

A

most common: ore throat, odynophagia (painful swallowing), pain in the ipsilateral ear, and a neck mass which may be associated with salivary drooling, stiff neck and a ‘hot potato’ voice
Less common: hoarseness, blood-streaked saliva, airway obstruction, halitosis (bad breath) and nasal voice

24
Q

prognostic indictors hypo pharynx cancer

A

gender: better prognosis in women
age: survival better for younger patients
+ surgical margins = worse prognosis
location: decreasing in survival are: pyriform sinus, pharyngeal walls and postcricoid region **poorest results seen with pyriform apex, postcricoid and two or three wall tumours
neck mets= poor prognosis

25
Q

treatment of T1-T2 lesions of the pyriform sinus

A

Irradiation alone (70Gy) or partial laryngopharyngectomy, ipsilateral neck dissection (postoperative irradiation, depending on pathologic findings)

26
Q

Treatment of resectable T3-T4 pyriform sinus tumours

A

Total laryngectomy, ipsilateral neck dissection and postoperative irradiation (66 Gy in 6.5wk)

27
Q

treatment for unresectable lesions of the pyriform sinus and with fixed LN

A 
Irradiation alone (70-75 Gy) with altered fractionation and/or combined chemoradiation
FIXED LN
Preoperative irradiation (45-50 Gy in 4.5-5.0 weeks)
28
Q

treatment for T1 pharynx wall

A

XRT alone 70Gy

29
Q

treatment for T2,T3,T4 pharynx wall

A

Surgical resection followed by adjuvant irradiation (60-66 Gy)

30
Q

treatment for postcricoid region

A

Optimal treatment undefined; surgery and postoperative radiation if resectable; radiation alone if unresectable

31
Q

use of chemo in hypopharynx

A

used concurrently with chemo for stage 3 and 4 cancer

32
Q

chemo agents in hypopharynx

A

cisplatinum anf 5fu

33
Q

surgery for hypo pharynx

A

T1/T2 get surgery or XRT

T3/T4are not candidates for laryngeal preservation but they can use radical surgery

34
Q

which sub site of hypo pharynx is not considered resectable

A

posterior pharyngeal wall is not considered resectable

35
Q

contraindications to conservation surgery

A

transglottic extension, cartilage invasion, vocal fold paralysis, pyriform apex invasion, postcricoid invasion and extension beyond the laryngeal framework

36
Q

indications for XRT in hypo pharynx cancer

A

Used as primary treatment (for smaller or unresectable lesions) and adjuvant (for larger lesions and neck mets)
Can be used as a boost
Can be used alone; can control a large portion of small surface lesions in the pyriform sinus
Radiation with surgery; better to deliver radiation postoperatively because preoperative radiation slows healing of tissues– more complications than postoperative
Doses are higher post-op than pre-op

37
Q

when is angled down technique used?

A

Used when shoulders would be in the way of a lateral POP

38
Q

field borders for angled down technique

A

SUP: usually includes jugulodigastric l/n
INF: SSN
ANT: to clear skin by 1cm
POST: variable

39
Q

gantry angles and energy for angled down technique

A

90 and 270 at 6MV

40
Q

WHAT types of cancers use angled down technique

A

larynx and hypopharynx

41
Q

FS for angled down technique and what is the field centred on

A

14x14 AND field is entered on the laryngeal prominence

42
Q

couch kick for angled down technique

A

The couch is rotated inferiorly * 10-15 degrees away from the gantry

43
Q

is prep or post op art preferred for hypopharynx

A

post op is preferred as there is less complications

44
Q

what are the subsites of the hypopharynx

A

piriform sinus, postcricoid and post pharyngeal walls

45
Q

what is the Tlevel of th hypopharynx

A

C3-6

46
Q

What subsite is more common in women

A

post cricoid

47
Q

what areas do not qualify for voice sparing Sx

A

piriform fossa apex and post cricoid

48
Q

what LN are most commonly invovled

A

SD & midjugular

49
Q

what stage is hypopharynx usually DX at?

A

with LN mets

50
Q

how is piriform fossa bst visualized

A

upon phonation, speech

Skin Radiation therapy (40 decks)

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