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Ph RadOnc Residency PBRROE2-3 Review 2021 > Neck, Including Uknown Primary (under construction) > Flashcards

Neck, Including Uknown Primary (under construction) Flashcards

1
Q

Neck

Identify the group/level/chain of lymph nodes described:

lie adjacent to the internal
jugular vein and extend from the skull base to the clavicle

A

IJ chain

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2
Q

Neck

Identify the group/level/chain of lymph nodes described:

most superior portion of the IJC chain, lie near the base of the skull in the posterior
aspect of the lateral pharyngeal space

A

parapharyngeal or junctional lymph nodes

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3
Q

Neck

Identify the group/level/chain of lymph nodes described:

lymph nodes are distributed along the
course of cranial nerve XI

A

Spinal accessory chain

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4
Q

Neck

The superior nodes of the SAC blend with the upper IJC nodes.

What lymph nodes merge laterally and medially with the SAC inferiorly?

A 
supraclavicular (l)
lower IJC (m)
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5
Q

Neck

How many lymph nodes are typically found in the submandibular area?

A

3-6

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6
Q

Neck

How many lymph nodes are typically found in the submental area?

A

1-3

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7
Q

Neck

There are no lymph nodes in the substance
of the submandibular gland.

TRUE or FALSE?

A

True.

They are either pre or post glandular

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8
Q

Neck

Identify the group/level/chain of lymph nodes described:

lie next to the facial artery and vein around the marginal mandibular nerve

A

perifacial lymph nodes.

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9
Q

Neck

Identify the group/level/chain of lymph nodes described:

lie between the anterior bellies of the digastric muscle and anterior and superior to the hyoid bone, and superficial to the mylohyoid muscle.

A

submental nodes.

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10
Q

Neck

Identify the group/level/chain of lymph nodes described:

bounded anteriorly by the pharyngeal constrictors, superiorly by the skull base, and posteriorly by the prevertebral fascia.

usually at the level of C1-2 (or 3)

A

lateral RPN.
***

The medial retropharyngeal nodes are small, inconstant
intercalated nodes that are located near midline and empty into the lateral
retropharyngeal lymph nodes

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11
Q

Neck

Identify the group/level/chain of lymph nodes described:

from the skull base to the level of the hyoid bone divided by the spinal accessory nerve into
a (anterior to the nerve) and b (posterior to the nerve)

A

level II (upper IJ nodes)

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12
Q

Neck

Identify the group/level/chain of lymph nodes described:

bounded by the hyoid bone, the sternum, and the common carotid arteries

A

level VI (central neck nodes)

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13
Q

Neck

Identify the group/level/chain of lymph nodes described:

from the level of the omohyoid muscle to the clavicle

A

level IV (inferior IJ nodes)

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14
Q

Neck

What nodes are included in level VI?

A

paralaryngeal
pretracheal
precricoid (delphian)
tracheoesophageal groove nodes

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15
Q

Neck

In general, what influence the risk of lymph node metastases?

A

location of T

size of T

histologic differentiation

availability of capillary lymphatics

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16
Q

Neck

What sites are automatically considered high-risk of harboring subclinical neck disease (>30%) based on site, regardless of T-stage?

A

nasopharynx, pyriform sinus, base of tongue

17
Q

Neck

What sites are considered low risk of harboring subclinical neck disease (<20%) if T1, 
intermediate risk (20–30%) if T2, and high-risk if T3–4(>30%)?
A 
floor of mouth
retromolar gingiva
trigone
buccal mucosa
hard palate
18
Q

Neck

In general, what is the most common involved group of lymph nodes?

A

ipsilateral level II

19
Q

Neck

In general, aside from midline lesions, what sites with well-lateralized tumors have a propensity to spread bilaterally?

A

nasopharynx

base of tongue

20
Q

Neck

In general, patients who have clinically + ipsilateral nodes have a risk of contralateral spread due to obstruction of lymphatic trunks.

What extrinsic factor may also contribute to shunting of lymph across the submental region to the opposite side of the neck?

A

previous neck surgery.

21
Q

Neck

In general, what is the most common involved group of lymph nodes on the contralateral side?

A

II

22
Q

Neck

Which of the statements regarding PE is/are FALSE?

I. The patient is examined in the sitting position, the examiner behind the patient with one hand on the occiput to flex the patient’s head FORWARD and the other hand on the side of the neck to be examined.

II. To examine the IJC lymph nodes, which lie deep to the sternocleidomastoid muscle along the internal jugular vein, place the thumb and index finger around the sternocleidomastoid muscle in the form of a “C,” and then, gently proceed FROM the sternal notch TO the angle of the mandible.

III. Both sides of the neck should NOT be examined simultaneously.

IV. The level Ib and level Ia nodes may be evaluated by direct palpation of these areas as well as by a bimanual examination with the index finger placed in the floor of the mouth.

A

None.

ALL statements are lifted directly from the book.

p.3456

23
Q

Neck

Extension to neurovascular
bundles causes this PE finding.

A

fixed to palpation

24
Q

Neck

Tumor size is related the likelihood of capsular penetration.

TRUE or FALSE?

A

True

25
Q

Neck

Review of the 2017 AJCC staging for neck nodes:

a. ENE+
b. ipsilateral <3
c. ipsilateral >3 <6
d. bilateral
e. contralateral
f. multiple ipsilateral <6

A

a. n3b
b. n1
c. n2a
d. n2c
e. n2c
f. n2b

26
Q

Neck

What structures are removed in a “radical” neck dissection?

A

lymph nodes levels I to V
IJV
SCM
spinal accessory nerve

27
Q

Neck

What structures are removed in a “modified radical” neck dissection?

A

lymph nodes levels I to V

with preservation of at least one of the non lymphatic structures removed in a radical procedure
(IJV
SCM
spinal accessory nerve)

28
Q

Neck

Patients with lesions arising in these sites ______ have a low risk of subclinical neck
disease, and the neck is not treated electively unless the lesion is recurrent,
advanced, or poorly differentiated.

A

lip,
nasal vestibule,
nasal cavity, or paranasal sinuses
T1-2 glottic

29
Q

Neck

Total RT dose for clinically positive nodes when a post RT neck dissection is “not” planned?

A

at least 70 Gy

30
Q

Neck

Biopsy of the neck nodes prior to definitive treatment “may” “potentially” cause neck control failure that may not be removed by an RND.

TRUE or FALSE?

A

True

31
Q

Neck

When using conventional lateral opposed fields, how can you minimize the risk of fibrosis and lymphedema at the submentum?

A

sparing an anterior strip of skin

32
Q

Neck

Prognostic factors (in order of importance) for predicting the time to occurrence.

Neck recurrence

A
  1. Increasing N-stage
  2. Treatment of the neck with RT alone
  3. Fixed nodes
  4. T-stage
33
Q

Neck

Prognostic factors (in order of importance) for predicting the time to occurrence.

Death with disease present

A
  1. Recurrence above clavicles
  2. Increasing N stage
  3. Fixed nodes
  4. Treatment of neck with RT alone
34
Q

Neck

Prognostic factors (in order of importance) for predicting the time to occurrence.

Distant metastasis

A
  1. Recurrence above clavicles.
  2. Increasing N stage
  3. Fixed nodes
  4. Nodes below the thyroid notch
35
Q

Unknown Primary (Neck)

Patients with enlarged lymph nodes in the upper neck have a good prognosis when treated aggressively, compared with those with enlarged lymph nodes in the low internal jugular chain or supraclavicular fossa.

TRUE or FALSE?

A

True

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

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