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nasal cavity and paranasal sinuses Flashcards

1
Q

how common is these cancer compared to H&N cancers in general

A

RARE <5% of all H&N cancer

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2
Q

what age is most common in these cancers

A

> 60 is most common

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3
Q

MORE COMMON GENDER IN THESE CANCERS

A

Males more commonly than females

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4
Q

what causes these cancers?

A

exposure to wood dust- (adenocarcinoma)
leather tanning, nickel working (SCC)
SMOKING
history of sinusitis

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5
Q

nasal cavity is located between _____ superiorly, and ______ inferiorly

A

base of the cranium superiorly

hard palate inferiorly

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6
Q

nasal cavity divisions and what is it divided by

A

divided into a left and right side and is divided by the septum

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7
Q

what is the post inferior part of the septum

A

the vomer

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8
Q

what are the 4 paranasal sinuses

A

ethmoid
sphenoid
maxillary
frontal

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9
Q

what shape is the maxillary sinuses

A

pyramid shaped

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10
Q

which is the largest paranasal sinus

A

the maxillary sinus

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11
Q

the roof of the maxillary sinus forms the floor of what structure?

A

the floor of theorbit

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12
Q

what separates the oral cavity from the maxillary sinus

A

alveolar process and the hard palate

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13
Q

shape of the ethmoid sinuses

A

ethmoid sinuses are paired and they are honeycomb shaped

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14
Q

the roof of the ethmoid sinus is what structure?

A

skull base

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15
Q

where is the frontal sinus located

A

lies in the frontal bone above the orbit they are not the same shape generally as they are deviated by the bony septum

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16
Q

what is the most posterior sinus?

A

the sphenoid sinus

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17
Q

the sphenoid sinus is post and sup to the _____enclosed in the ______ at the level of ______ and is superior to______

A

sup and post to the nasopharynx enclosed in the sphenoid bone at the level of the zygomatic arch and is superior to the sella turicica

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18
Q

LN of the paranasal sinuses

A

3they have very few lymphatics

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19
Q

most common subset of paranasal sinuses

A

maxillary sinus is the most common subsite

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20
Q

subsides that commonly have orbital invasion

A

maxillary and ethmoid sinus tumours

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21
Q

spread of lesions that involve the olfactory region

A

destroy the nasal bone and the septal region expands the nasal bridge and then progress to skin invasion

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22
Q

maxillary sinus spread sup inf ant post

A

sup=prbital floor
sup med-ethmoid sinus
pterygoid plate, hard palate, zygomatic arch and skull base post
cheek and skin ant

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23
Q

ethmoid sinus spread sup, lat, inf

A

sup-intracranial
lat-orbit
inf-nasal caivyt or maxillary sinus

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24
Q

sphenoid sinus ant spread

A

intracranial or nasopha2rynx

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25
distant mets for nasal cavity and paranasal sinuses
to bone and brain
26
presentation of these tumours
``` nasal obstruction worsened sinusitis pain facial swelling epistaxis diplopia proptosis duration of symptoms can be from 1 month-8 year before diagnosis ```
27
diagnostic methods
physical exam fiberoptic nasal endoscopy biopsy examination for cranial nerve involvement
28
pathologies of these cancer
adenocarcinoma - wood dust related, common in the ethmoid sinuses SCC( most common)- smoking related undifferentiated sinonasal carcinoma) SNUC bad prognosis
29
T1-4 of the maxillary sinuses
T1-limited to the maxillary sinus with no signs of erosion or destruction of the bone T2-causing bone erosion or extension into the hard palate T3-Invades any of the following: bone of the posterior waLL of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses T4a-invades frontal or sphenoid sinuses, orbit skin of the face, ptereygoid plates infra temporal fossa,cribriform plate T4b-invades orbital apex, brain, middle cranial fossa, nasopharynx, trigeminal nerve or clivus
30
T1-4 of the nasal cavity or ethmoid sinus
T1- restricted to 1 sub site T2- restricted to 2 subsides T3- invading the medial wall or floor of the orbit, the maxillary sinus, the palate or the cribriform plate T4a-invades skin of the nose or cheek, pterygoid sphenoid or frontal sinus T4b-onvades orbital apex, dural, brain, middle cranial fossa, cranial nerves other than V2, nasopharynx or clivus
31
stages in nasal cavity, paranasal sinus cancerq
``` same as other h &n cancers except nasopharynx Stage1 T1 N0 stage 2 T2 N0 stage 3 T3 N0 T1-T3 N1, stage 4 T4 any n any T any n M1 any t N2,n3 ```
32
what paranasal sinuses are the hardest to operate on
sphenoids and ethmoids are hardest to operate on
33
prognostic indicators
T4 tumours survival decreases by 50% SCC's recur faster nodal involvement area- sphenoids and ethmoids cant get surgery therefore worse progosis
34
treatment for nasal cavity
intranasal surgery followed by XRT | Dose is usually 60/30 or 66/33 for + margins
35
treatment for ethmoid sinus
surgical excision is done first if possible (however not likely possible) POST-OP XRT even if there is - margins for unresectable tumours XRT +chemotherapy is given 70/35+ cisplatinum but survival is poor
36
treatment for maxillary sinus
radical matxillectomy (removal of maxilla, nasal bone, ethmoid sinus and pterygoid plates) contraindications : tumour extension into the skull base, nasopharynx, cavernous sinus or carotid artery post op XRT is used borderline resectable tumour is treated with XRT FOLLOWED BY surgery 70/35
37
treatment of sphenoid sinus
XRT is the primary treatment and surgery is saved for salvage treatment
38
treatment with chemo
used concurrently with XRT nd is usually cisplatinum
39
surgery in general
surgery is used as a primary treatment for tumours that are resectable
40
total maxillectomy
resection of the entire maxilla, the floor and medial wall of the orbit and the ethmoid sinuses
41
orbital exenteration
removal of the entire eyeball, orbital soft tissues and some or all of the eyelids
42
bulls eye technique usage
* use of bolus with a hole in it to save the lens, hence “Bull’s eye” Borders: SUP: above frontal sinus INF: through odontoid process MED: at inner canthus of contralateral eye LAT: beyond skin ANT: posterior to bony orbital ridge to spare lens POST: at EAM 2 wedged lateral POP beams 1 direct any beam Low energy, low weight lateral beams boost dose to the paranasal sinuses Wedges: think end anterior High energy (18-25MV), high weighting on direct ant beam 3mm of cuprous oxide with silicon rubber sealant placed on the mask Buildup is placed around the eye with an aperture to permit the entire anterior globe to be visualized
43
homolateral wedge pair
2 beams; one ant and one lat Used when disease is in a lateral location, still limited to the ipsilateral side and not at risk of contralateral nodal spread Wedges; thick ends together May need to use a bite block to get the tongue out of the way and to use as bolus because of the air in the mouth
44
DOSES FOR OPERABLE VS INOPERABLE TUMOURS
``` OPERABLE: Primary: surgery Adjuvant: radiation (60-70 Gy/25-35) 6600 cGy/33 7000 cGy/ 35 INOPERABLE:Primary: radiation (70 Gy/35) Concurrent: chemotherapy ```
45
most tumours present in _____stages
advanced
46
lymphatic drainage of the sinuses
retropharyngeal and superior cervical LN
47
ages for these cancers
10-20 yo and 50-60 yo bimodal age distribution
48
complications of ethmoid sinus surgery
include total blindness, loss of ocular motility, hemorrhage, meningitis, CSF leak, cellulitis, pain sinusitis, brain access, stroke and damage to frontal lobe
49
complications of matxillectomy
failure of the graft to heal, trisimus, CSF leak and hemorrhage
50
complications of XRT
Unilateral and bilateral vision loss, serous otitis media, chronic sinusitis
51
what countries is this cancer more common in
more common in Japan and South Africa
52
what type of salivary gland cancer is most common?
Maxillary is most common
53
what causes adenocarcinoma? | what portion of the sinuses does it occur in?
caused by sawmill dust | this occurs in nasal cavity and the ethmoid sinus
54
what causes SCC? what portion of the sinuses does it occur in?
causes by nickel exposure and occurs in the nasal cavity
55
what causes cancer in the MAXILLARY sinus?
thorium dioxide ( a contrast agent)
56
what are the 3 regions of the Nasal cavity
Nasal vestibule, Nasal Fossa, Olfactory Region
57
what is the most common pathology of MAXILLARY SINUS tumours?
SCC
58
differential diagnosis for nasal vestibule tumours
present with same s&s as nasal polyps | ex: nasal discharge, nasal ulcer, obstrucyion and epitaxis
59
maxillary sinus tumours are dx ? Why?
dx late because they have an indolent course of tx, no s&s until they have spread
60
s&s of maxillay sinus tumour
facial swelling, pain and parasthesia
61
imaging of choice
MRI for soft tissue delineation
62
what areas are resectable/ unresectable in nasal cavity
Post nasal septum -> easily treated with Surgery | Ant/ inf septal lesions -> can be treated with XRT
63
what paranasal sinus is considered unresectable
sphenoid sinus
64
primary XRT for nasal cavity and ethmoid sinus
tumour + 2-3cm margin to 50 gy | then margins are tightened to 1-2cm for an additional 16-20gy
65
Adjuvant XRT margins and dose for nasal cavity and ethmoid sinus
tumour +1-2cm to 54Gy + a boost of 6-12Gy
66
tx technique for ant nasal cavity tumours
oblique wedged photons
67
tx technique for post nasal cavity tumours
opposed lats
68
for upper nasal cavity and ethmoid tumours tx technique
3 field (bulls eye)
69
what LN should be XRT with maxillary tumours, in what situation
iN SCC pathology (most are SCC) SMD AND SD LN should be xrt

Skin Radiation therapy (40 decks)

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