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Ph RadOnc Residency PBRROE2-3 Review 2021 > Hypopharynx > Flashcards

Hypopharynx Flashcards

1
Q

The hypopharynx, sometimes referred to as the laryngopharynx, is contiguous
superiorly with the oropharynx and inferiorly with the cervical esophagus.

TRUE or FALSE?

A

TRUE

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2
Q

What marks the superior border of the hypopharynx?

A

Hyoid bone

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3
Q

What marks the inferior border of the hypopharynx?

A

Cricoid cartilage

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4
Q

What are the three anatomic subsites of the hypopharynx?

A

the 3 Ps.

bilateral pyriform sinuses
postcricoid region
posterior pharyngeal wall

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5
Q

The pyriform sinuses are suorrounded by the thyrohyoid membrane through which nerve passes?

(Tumor involvement of the sensory branches of this nerve can result in referred otalgia).

A

Internal branch of the superior laryngeal nerve.

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6
Q

What separates the posterior pharyngeal wall from the prevertebral fascia?

A

retropharyngeal space.

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7
Q

What are the superior and inferior borders of the postcricoid region?

A

Sup: arytenoid
Inf: Esophageal mucosa

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8
Q

Sensory innervation of the hypopharynx

A

Internal branch of the superior laryngeal nerve

as well as fibers deriving from CN IX.

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9
Q

Motor supply of the hypopharynx

A

Recurrent laryngeal nerve and pharyngeal plexus

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10
Q

Arterial supply of the hypopharynx

A

branches of the external carotid artery: superior thyroid arteries, ascending pharyngeal arteries, and lingual arteries.

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11
Q

Approximately 3/4 of cases hypopharyngeal cancer cases occur in women.

TRUE or FALSE?

A

FALSE

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12
Q

Main etiologic factor for the development of hypopharyngeal cancer.

A

Over 90% of patients with hypopharynx
cancer report past cigarette use. Alcohol appears to potentiate the carcinogenic
effects of tobacco. Additionally, alcohol consumption at medium to high levels
for a long period of time can increase the likelihood of hypopharynx cancer in
nonsmoking patients.

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13
Q

Alcohol consumption alone at medium to high levels for a long period of time can increase the likelihood of hypopharynx cancer.

TRUE or FALSE?

A

TRUE.

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14
Q

What is this syndrome characterized by hypopharyngeal webs, iron deficiency anemia, weight loss, and dysphagia that is a recognized as having increased risk for developing cancers of the postcricoid region?

A

Plummer-Vinson Syndrome.

Favorable changes in the epidemiology of hypopharynx cancer have resulted
from changes in nutrition. The addition of iron to flour has made Plummer-
Vinson syndrome quite rare in the upper Midwestern United States and
Scandinavian countries where it was formerly more common. An associated
decrease in hypopharynx cancer involving the postcricoid region has followed.

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15
Q

Tumor location has an impact on outcome. Tumors on this anatomic subsite of the hypopharynx carry a better outcome than the other sites?

A

Pyriform sinus.

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16
Q

AJCC 8th edition T staging:

Define T1

A

Limited to 1 subsite of the hypopharynx and ≤2 cm in greatest dimension

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17
Q

AJCC 8th edition T staging:

Define T2

A

Tumor invades more than 1 subsite of the hypopharynx or an adjacent site, or
measures >2 cm but ≤4 cm in greatest diameter without fixation of hemilarynx

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18
Q

AJCC 8th edition T staging:

Define T3

A

Tumor measures >4 cm in greatest dimension or with fixation of hemilarynx or with
extension to the esophagus

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19
Q

AJCC 8th edition T staging:

Define T4a

A

Invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, or central compartment soft
tissue, which includes prelaryngeal strap muscles and subcutaneous fat

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20
Q

AJCC 8th edition T staging:

Define T4b

A

Tumor invades prevertebral fascia, encases carotid artery, or involves mediastinal
structures

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21
Q

Where is the most common location of hypopharyngeal cancer?

A

Pyriform sinus 83%

9% - PPW
4% - PCR

(NCI’s SEER database 2000-2008)

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22
Q

Identify the most-common subsite involved:

Cancers from this location may spread superiorly to involve the aryepiglottic folds and arytenoids and invade the paraglottic and preepiglottic
space

A

Pyriform sinus

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23
Q

Identify the most-common subsite involved:

Cancers arising within this location region can extend circumferentially to
involve the cricoid cartilage or anteriorly to involve the larynx with resultant
vocal cord fixation.

A

Postcricoid region

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24
Q

Identify the most-common subsite involved:

Primary tumors in this area are often quite
extensive and can involve the pyriform sinus, trachea, or esophagus. As a result,
these tumors generally carry a worse prognosis in comparison to tumors from
other subsites of the hypopharynx

A

Postcricoid region

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25
Q

Identify the most-common subsite involved:

Tumors arising from the medial wall, the most common site of involvement for this location, there is a likelihood of tumor involvement of intrinsic muscles of
the larynx resulting in vocal cord fixation.

A

Pyriform sinus

26
Q

Identify the most-common subsite involved:

Tumors arising from the this location can extend to involve the oropharynx superiorly, the cervical
esophagus inferiorly, and the prevertebral fascia and retropharyngeal space
posteriorly

A

Posterior pharyngeal wal

27
Q

Identify the most-common subsite involved:

Lateral tumor extension can involve portions of the thyroid cartilage,
allowing entry into the lateral compartment of the neck

A

Pyriform sinus

28
Q

Identify the most-common subsite involved:

Inferior tumor extension beyond the
apex can involve the thyroid gland

A

Pyriform sinus

29
Q

Careful study through serial sectioning of surgical specimens has identified that 60% of hypopharynx cancers demonstrate subclinical spread with a range of __mm superiorly, __mm medially, __mm laterally, and __, inferiorly.

A

10 superiorly
25 medially
20 laterally
20 inferiorly

30
Q

Hypopharyngeal cancer has a poor lymphatic drainage hence low risk of cervical lymphadenopathy at presentation.

TRUE or FALSE?

A

False

31
Q

The risk of bilateral cervical node metastasis is negligible.

TRUE or FALSE?

A

False

32
Q

Most common site for distant metastasis in patients with hypopharyngeal cancers?

A

Lung

33
Q

Most patients present with locoregionally advanced disease.

TRUE or FALSE?

A

True

34
Q

Enumerate (3):

Contemporary indications for primary surgical management of patients with early hypopharyngeal cancers.

A

-history of previous H&N
radiation,
-those in whom organ conservation approaches are deemed possible,
-those who refuse radiation

35
Q

What is/are the role/s of the H&N surgeon in patients who will not be treated primarily with surgical approaches?

A
  • endoscopic biopsy with detailed assessment of tumor extent
  • secure the airway (tracheotomy or laser debulking)
  • ensure adequate nutrition (gastrostomy)
  • multidisciplinary oncologic follow-up after nonoperative treatment
36
Q

What is/are the advantage/s of transoral robotic surgery (TORS) over transoral laser microsurgery (TLM)?

A
  • better visualization with a three-dimensional magnified camera
  • option to utilize angled endoscopes
  • manipulation using “wristed” instruments, which provide the means to resect tumor en bloc
37
Q

For locoregionally advanced hypopharyngeal cancers,

when is esophagectomy usually added to laryngopharyngectomy aside from the involvement of the esophagus itself?

A

Involvement of the cricopharyngeus to ensure adequate inferior margin.

38
Q

What are the classical indications for PORT in hypopharyngeal cancer?

A
  • primary T4
  • more than one metastatic lymph node
  • close or positive microscopic margins,
  • cartilage or bony invasion,
  • or presence of ECE.
39
Q

General Treatment Recommendation/s:

Stage I

A

Radiation alone or voice preservation surgery if

feasible

40
Q

General Treatment Recommendation/s:

Stage II

A

Radiation alone

41
Q

General Treatment Recommendation/s:

Stage III and IV with functional laryngopahrynx

A

Concurrent chemoradiation followed by selective

neck dissection

42
Q

General Treatment Recommendation/s:

Stage III and IV with dysfunctional laryngopahrynx

A

Laryngopharyngectomy with adjuvant RT or CRT

43
Q

Anatomic Landmarks for Conventional RT (Lateral fields’ borders):

Superior

A

Include base of skull

44
Q

Anatomic Landmarks for Conventional RT (Lateral fields’ borders):

Posterior

A

Behind vertebral spinous processes (or further if required to cover metastatic cervical lymph nodes)

45
Q

Anatomic Landmarks for Conventional RT (Lateral fields’ borders):

Inferior

A

Lower aspect of cricoid cartilage unless extensive caudal tumor extension

46
Q

Anatomic Landmarks for Conventional RT (Lateral fields’ borders):

Anterior

A

Flash skin at level of thyroid cartilage

47
Q

Conventional RT doses:

T3 and T4:
Definitive RT
Primary tumor and gross nodes

A

70 Gy/2/35

If patients are scheduled to undergo post RT neck dissection, then gross nodal disease can be limited to 60 to 63 Gy.

48
Q

Conventional RT doses:

T3 and T4:
Definitive RT
Areas of microscopic disease

A

50 to 60 Gy

49
Q

Conventional RT doses:

PORT:
areas of ECE or positive margins

A

60 to 66 Gy

50
Q

Conventional RT doses:

PORT:
all areas at risk

A

54 to 63 Gy

51
Q

In T3-T4 tumors, there is a decreasing benefit of CRT with conventional fractionation over RT alone in patients with increasing age over 70.

TRUE or FALSE?

A

True

52
Q

In T3-T4 tumors, there is less benefit in using CRT if RT given is altered fractionation.

TRUE or FALSE?

A

True

53
Q

An international phase III trial comparing high-dose
radiation alone versus radiation plus cetuximab in advanced hypopharyngeal cancer
patients confirmed a locoregional control improvement (10% at 5 years) and
overall survival advantage (10% at 5 years) with the addition of cetuximab.

TRUE or FALSE?

A

False.

This study was for H&N cancer in general.

A relatively small subset of patients with hypopharynx cancer was enrolled in
this study of 424 patients, and this subset did not demonstrate a clear advantage
with use of the EGFR inhibitor treatment.

54
Q

In the EORTC trial involving pyriform sinus cancers and induction chemo, compare the results of induction chemo using cisplatin+5FU followed definitive RT, vs. primary surgical resection followed by PORT.

A

No significant difference in the 5- or 10- year OS or PFS.

55
Q

What are the usual RT fractionation used for palliative intent RT?

A

4-5 Gy x 5x over 1 to 2 weeks

3.7 Gy BID x 2 consecutive days (for 3 cycles every 2 to 3 weeks) [RTOG 85-02]

50 Gy/3.125/16fx

30Gy/6/5fx - 2fx/week

56
Q

Follow-up schedule: year 1

A

every 1-3 months

57
Q

Follow-up schedule: year 2

A

every 2-4 months

58
Q

Follow-up schedule: years 3 to 5

A

every 4-6 months

59
Q

Follow-up schedule: after 5 years

A

every 6-12 months

60
Q

What hormone should be measured during follow-up (ideally every 6 months) for patients who underwent H&N RT?

A

TSH

Ph RadOnc Residency PBRROE2-3 Review 2021 (57 decks)

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