Laryngeal Cancers Flashcards
What does the larynx consist of?
Supraglottis
Glottis
Subglottis
What are the presenting symptoms of glottis cancer?
Persistent sore throat
Hoarseness and stridor
What detection and diagnosis is used for glottis cancers?
Palpation
Direct inspection
Biopsy
What is the lymphatic drainage for the glottis?
Glottis is extremely rare for nodal involvement.
What is the lymphatic drainage for the subglottis?
Into the peritracheal and low cervical nodes.
What is the lymphatic drainage for the supraglottis?
Into the peritracheal, cervical, submental, and submaxillary nodes.
What is the treatment for early lesions of the glottis?
Surgery or radiation.
What is the treatment for advanced lesions of the glottis?
Surgery and postoperative radiation.
How do helophytic lesions respond to treatment compared to infiltrative lesions?
Helophytic lesions are more responsive to radiation than infiltrative lesions.
What is the treatment for poorly differentiated carcinoma?
Radiation alone or concurrent with chemotherapy.
What is the treatment for veracious carcinoma?
Conservative surgery.
What is the treatment for larynx cancer?
Radiation therapy
What energy level is used in radiation therapy for larynx treatment?
6MV
What is the purpose of wedges in radiation therapy?
To compensate for the slope of the skin surface
Wedges of 15 or 30 degrees are used.
What is the typical dose range for larynx radiation therapy?
65 to 70 Gy
Hyper-fractionation can be 7440 to 7680 cGy at 120 cGy per fraction BID.
How are treatment fields centered in larynx radiation therapy?
Fields are centered on the vocal cords with flash over the anterior skin surface to prevent underdosage to the anterior commissure.
What size fields are used in larynx radiation therapy?
Radiation therapy is delivered by 5x5 or 6x6 cm opposed lateral fields.
What is the superior border for Glottis Radiation Treatment?
Upper thyroid notch
What is the inferior border for Glottis Radiation Treatment?
Cricoid cartilage (lower border of C6)
What is the anterior border for Glottis Radiation Treatment?
1.0 to 1.5 cm flash over the skin surface at the level of the vocal cords
What is the posterior border for Glottis Radiation Treatment?
Just anterior to the vertebral body, including the anterior portion of the posterior pharyngeal wall
What are the lateral field borders for Glottis?
Anterior: 1.5-2 cm beyond thyroid cartilage
Superior: Top of thyroid cartilage
Posterior: Anterior margin of the vertebral bodies
Inferior: Below the cricoid cartilage
What are the two anatomical regions discussed?
Supraglottic and Subglottis
What is often much larger in the context of these regions?
Fields
What lymph nodes should the fields include?
Jugulodigastric, anterior and posterior cervical, and supraclavicular lymph nodes
