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Skin Radiation therapy > nasal cavity and paranasal sinuses > Flashcards

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
Q

distant mets for nasal cavity and paranasal sinuses

A

to bone and brain

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26
Q

presentation of these tumours

A 
nasal obstruction
worsened sinusitis
pain 
facial swelling
epistaxis
diplopia
proptosis
duration of symptoms can be from 1 month-8 year before diagnosis
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27
Q

diagnostic methods

A

physical exam
fiberoptic nasal endoscopy
biopsy
examination for cranial nerve involvement

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28
Q

pathologies of these cancer

A

adenocarcinoma - wood dust related, common in the ethmoid sinuses
SCC( most common)- smoking related
undifferentiated sinonasal carcinoma) SNUC bad prognosis

29
Q

T1-4 of the maxillary sinuses

A

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
Q

T1-4 of the nasal cavity or ethmoid sinus

A

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
Q

stages in nasal cavity, paranasal sinus cancerq

A 
same as other h &amp;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
Q

what paranasal sinuses are the hardest to operate on

A

sphenoids and ethmoids are hardest to operate on

33
Q

prognostic indicators

A

T4 tumours survival decreases by 50%
SCC’s recur faster
nodal involvement
area- sphenoids and ethmoids cant get surgery therefore worse progosis

34
Q

treatment for nasal cavity

A

intranasal surgery followed by XRT

Dose is usually 60/30 or 66/33 for + margins

35
Q

treatment for ethmoid sinus

A

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
Q

treatment for maxillary sinus

A

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
Q

treatment of sphenoid sinus

A

XRT is the primary treatment and surgery is saved for salvage treatment

38
Q

treatment with chemo

A

used concurrently with XRT nd is usually cisplatinum

39
Q

surgery in general

A

surgery is used as a primary treatment for tumours that are resectable

40
Q

total maxillectomy

A

resection of the entire maxilla, the floor and medial wall of the orbit and the ethmoid sinuses

41
Q

orbital exenteration

A

removal of the entire eyeball, orbital soft tissues and some or all of the eyelids

42
Q

bulls eye technique usage

A
  • 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
Q

homolateral wedge pair

A

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
Q

DOSES FOR OPERABLE VS INOPERABLE TUMOURS

A 
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
Q

most tumours present in _____stages

A

advanced

46
Q

lymphatic drainage of the sinuses

A

retropharyngeal and superior cervical LN

47
Q

ages for these cancers

A

10-20 yo and 50-60 yo bimodal age distribution

48
Q

complications of ethmoid sinus surgery

A

include total blindness, loss of ocular motility, hemorrhage, meningitis, CSF leak, cellulitis, pain sinusitis, brain access, stroke and damage to frontal lobe

49
Q

complications of matxillectomy

A

failure of the graft to heal, trisimus, CSF leak and hemorrhage

50
Q

complications of XRT

A

Unilateral and bilateral vision loss, serous otitis media, chronic sinusitis

51
Q

what countries is this cancer more common in

A

more common in Japan and South Africa

52
Q

what type of salivary gland cancer is most common?

A

Maxillary is most common

53
Q

what causes adenocarcinoma?

what portion of the sinuses does it occur in?

A

caused by sawmill dust

this occurs in nasal cavity and the ethmoid sinus

54
Q

what causes SCC? what portion of the sinuses does it occur in?

A

causes by nickel exposure and occurs in the nasal cavity

55
Q

what causes cancer in the MAXILLARY sinus?

A

thorium dioxide ( a contrast agent)

56
Q

what are the 3 regions of the Nasal cavity

A

Nasal vestibule, Nasal Fossa, Olfactory Region

57
Q

what is the most common pathology of MAXILLARY SINUS tumours?

A

SCC

58
Q

differential diagnosis for nasal vestibule tumours

A

present with same s&s as nasal polyps

ex: nasal discharge, nasal ulcer, obstrucyion and epitaxis

59
Q

maxillary sinus tumours are dx ? Why?

A

dx late because they have an indolent course of tx, no s&s until they have spread

60
Q

s&s of maxillay sinus tumour

A

facial swelling, pain and parasthesia

61
Q

imaging of choice

A

MRI for soft tissue delineation

62
Q

what areas are resectable/ unresectable in nasal cavity

A

Post nasal septum -> easily treated with Surgery

Ant/ inf septal lesions -> can be treated with XRT

63
Q

what paranasal sinus is considered unresectable

A

sphenoid sinus

64
Q

primary XRT for nasal cavity and ethmoid sinus

A

tumour + 2-3cm margin to 50 gy

then margins are tightened to 1-2cm for an additional 16-20gy

65
Q

Adjuvant XRT margins and dose for nasal cavity and ethmoid sinus

A

tumour +1-2cm to 54Gy + a boost of 6-12Gy

66
Q

tx technique for ant nasal cavity tumours

A

oblique wedged photons

67
Q

tx technique for post nasal cavity tumours

A

opposed lats

68
Q

for upper nasal cavity and ethmoid tumours tx technique

A

3 field (bulls eye)

69
Q

what LN should be XRT with maxillary tumours, in what situation

A

iN SCC pathology (most are SCC) SMD AND SD LN should be xrt

Skin Radiation therapy (40 decks)

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