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Head and Neck > Hypopharyngeal Cancer > Flashcards

Hypopharyngeal Cancer Flashcards

1
Q

Boundaries of the hypopharynx

A

Hyoid bone to inferior border of the cricoid cartilage

Lies behind and around the larynx

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2
Q

What is the m/c site of hypopharyngeal CA?

A

Piriform sinus

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3
Q

Hypopharyngeal CA subsites

A
  • Piriform sinus (65-75%)
  • Posterior pharyngeal wall
  • Postcricoid region (rare, <5%)
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4
Q

What is T4a HP CA?

A

Moderately advanced local dz, invasion of

  • thyroid/cricoid cartilage
  • hyoid
  • thyroid gland
  • central compartment soft tissue
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5
Q

What is T4b HP CA?

A

Very advanced local dz, invasion of

  • prevertebral fascia
  • carotid encasement
  • mediastinal involvement
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6
Q

What are skip lesions?

A

Tumors of the HP may extend submucosally resulting in skip lesions

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7
Q

MAN of early HP CA (T1 or T2)

A
  • Single modality Rx:
  • -RT (incl both necks) w/ salvage surgery
  • -Excision w/ postop RT
  • Neck MAN:
  • -Elective RT to b/l necks w/ primary
  • -Elective IPSI ND w/ primary excision
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8
Q

MAN of advanced HP CA (T3 or T4)

A
  • Multimodality Rx:
  • -Chemo/RT w/ salvage surgery for poor response
  • Neck MAN:
  • -Elective RT to b/l necks
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9
Q

Options of surgery for HP CA

A
  • Partial laryngopharyngectomy
  • Combined suprahyoid and lateral pharyngectomy
  • TL w/ partial pharyngectomy
  • Esophagectomy
  • Wookey procedure (turned-in cervical skin flaps)
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10
Q

When do you consider a partial laryngopharyngectomy?

A

Early T1-T2 piriform CA if tumor involves primarily the medial wall and > 1.5 cm clear from apex

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11
Q

When to perform combined suprahyoid and lateral pharyngectomy?

A

For early T1-T2 posterior cricopharyngeal wall CA

Includes removal of lateral 1/3 of thyroid cartilage

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12
Q

When to perform TL with partial pharyngectomy?

A

Most postcricoid primaries
Advanced HP dz
Recurrence
Radiation failures

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13
Q

Complications of gastric pull-up recon

A
  • Anastamosis breakdown/leak (10-37%)
  • Abdominal complications
  • Cardiopulm complications
  • Hypocalcemia
  • Tracheobronchial injury
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14
Q

Imp epidemiology of HP CA

A
  • Rare (<5% of HNC)
  • 76% male
  • 90% smokers
  • 77% p/w stage III/IV dz
  • 64-90% p/w nodal dz, 40% w/ b/l nodes
  • 60% have systemic mets at presentation or f/u
  • 5 yr dz survival 33%
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15
Q

What would be an advantage of getting an MRI in a pt w/ HP CA?

A

-MRI is good to look for invasion of prevertebral fascia

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16
Q

T1 HP CA

A

Limited to 1 subsite AND <2cm

17
Q

T2 HP CA

A

More than 1 subsite or 2-4 cm

18
Q

T3 HP CA

A

Fixation of hemilarynx or > 4 cm

19
Q

What is the Tx for early stage dz (Stage I-II)?

A

-RT usu (Primary RT is comparable to surgery)

20
Q

What is the Tx for late stage dz (Stage III-IV)?

A
  • Primary RT is inferior to surg + adjuvant RT

- Chemo/RT is comparable to surg + adjuvant RT

21
Q

Salvage rates after chemo/RT

A

25%

  • Increases survival from 3.8 to 14 months
  • Inc morbidity (fistula rate 75%)
22
Q

Lymphatic drainage of HP?

A
  • Jugulodigastric nodes (II-IV), sometimes V
  • RP nodes (esp posterior pharyngeal wall)
  • Inferiorly - paratracheal/paraesophageal nodes
  • BILATERAL DRAINAGE COMMON
23
Q

How should you treat the necks?

A
  • In the 34% of pts who p/w N0 necks, 41% will have occult mets so treat both necks (maybe just IPSI neck for T1 lesions)
  • If there is nodal dz, treat both necks
  • N0 –> II-IV
  • N+ –> I-V
24
Q

What are the radical open surgeries available for T3-T4 lesions?

A
  • Total laryngopharyngectomy (lesions involving > 2/3 circum of pharynx)
  • TL, partial pharyngectomy

Recon

  • Pedicled myocutaneous flaps (DP, pec)
  • Gastric pullup transposition
  • Free flaps (RFFF, ALT, jejunal)
25
Q

What are the main problems with jejunal free flaps

A
  • Wet voice

- Hypocalcemia

26
Q

What are the partial open surgeries available for T1-T2 lesions?

A

Partial pharyngectomy

  • Lateral pharyngectomy (cut small part of thyroid lamina)
  • Trans-thyroid pharyngotomy
  • Trans-hyoid pharyngotomy
  • Median labiomandibular glossotomy

May need to combine w/ partial laryngectomy to get margin

Head and Neck (12 decks)

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