OMFS- Head and Neck Oncology Flashcards
What is the most common type of oral cancer?
Squamous cell carcinoma
What are the main risk factors for head and neck cancer?
Alcohol
Tobacco
Betel/Pan use
HPV
EBV
HIV
Poor OH
What cancers are HIV/EBV/HPV associated with?
HIV- caposi sarcoma
EBV- naso-pharyngeal carcinoma (prevalent in Chinese males)
HPV- Oral pharyngeal and laryngeal carcinoma
What are the sites for cancer in the oropharynx?
Base of Tongue
Tonsil
Soft Palate
What are the sites for cancer in the oral cavity? (in order of prevalence)
Lateral/ anterior of tongue
Floor of mouth
Retromolar trigone
Buccal mucosa
Hard palate/alveolus- rarer
What are the red flags for malignancy? (7)
1) Ulcer perists (t > 2 weeks) despite removal of any obvious causation
2) Rolled margins, central necrosis
3) Speckled erythroleukoplakia- red and white patches
4) Cervical lymphadenopathy (enlarged (size > 1cm), firm, fixed, tethered, non-tender, unilateral)
5) Worsening pain (neuropathic, dysaethesia, paraesthesia)
6) Referred pain (ear, throat, mandible)
7) Weight loss (local / systemic effects)- cachexia
What is meant by rolled margins?
Raised peripheral areas that are firm and hard
What cancerous sites tend to be associated with pain?
Primary- neuropathic, sharp, radiating pain
Metastatic sites- painless
Why do patients suffer from rapid weight loss when they have cancer?
Increased metabolic demands of systemic processes
Who should we refer to if we are suspicious of oral cancer?
MFS
What are the descriptors when trying to diagnose Oral cancer?
Shallow/deep
Size- width/length
Borders
Consistency- Soft/hard
Shape
Painful
Homegenous/uniform
What are the features of a traumatic ulcer?
shallow, soft, white, small
Why do raised white and red patches on the attached gingival raise suspicion?
Could be PLV
-> high malignant transfer rate
What is a crusting lesion on the lip most likely to be caused by?
Herpes simplex- resolves on tx
If it fails to resolve - refer
What is chronic hyper plastic candidiasis? What should be done if this is detected?
Premalignant condition
Refer for biopsy to exclude underlying dysplasia
What are the different levels of the regional lymph node basin in the anterior triangle of neck?
Ia- Submental nodes
Ib- submandibular nodes
II- upper jugular chain(divided into a/b in relation to spinal accessory nerves- also divides level V)
III- mid jugular chain
IV- lower jugular chain
What is level 5?
Posterior triangle
What is the most common cause of enlarged LNs?
Infection
What should be done if lymphadenopathy persists?
Refer even in young adults
What is used for initial investigation into enlarged LNs?
Ultrasound
-> If suspicious- ultrasound guided fine needle aspirate taken to be analysed by cytology
What are the main investigations for head and neck cancer?
CT scan of primary site- neck/thorax
OPT- assess dentition (dentally fit for treatment- to prevent complications)
Ultrasound and FNA
Punch biopsy- delayed until required (after radiology- to prevent biopsy artefacts skewing radiographs)
In theatre- iodine staining (highlights dysplastic tissue- potential malignant)
What suggests tumour in one side of the maxilla?
Obliteration of maxillary buttress and sinus (unilateral)
What investigations are required to produce a TMN staging?
Tissue (Histology)
Imaging (CT or MRI for primary site and CT Chest)
How does TMN staging work? (TMN8- most recent)
Tumour- size and depth of invasion (deeper means increased risk of metastases)
Nodes- number, laterality, has it breached peripheral capsule of nodes (extra capsular spread)
Metastases- most common for H/N cancer is thorax
What are the treatment options in oral cancer?
Nil
Surgery alone
Radiotherapy alone
Chemo radiotherapy
Dual or Triple Modality- combination
What are the different ends of the WHO performance level spectrum for patients receiving cancer treatment?
Go to work- level 0
Bed bound 24 hours- level 4
What are the surgical options for primary sites?
Resection and packing
Resection and Primary closure
Resection and reconstruction
What types of flaps can be used in cancer surgical reconstruction?
Local- utilising flaps from other areas in mouth (FAM flap- buccal mucosa with facial artery to floor of mouth)
Pedicled- attached to origin blood supply- pectoralis major
Free- skin, fascia, bone is detached with blood vessels from blood supply and anastomosed to local blood supply
Which flaps are better for tongue/manidble?
Tongue- thin pliable flaps
Mandible- bony
What aids are used for reconstruction?
Planning with 3-D CT
+/- Model/mirror image if asymmetric tissue loss
Cutting guides & templates
What are the most common donor sites for reconstruction?
Radial Forearm
Rectus Abdominus
Latissimus Dorsi
Anterolateral Thigh
DCIA
Fibula
Composite Scapula
What is a composite flap?
Bone and soft tissue
-> fibula is most common, scapula is second
What is a pedicle?
Loop of vessels created in reconstruction
-> Vein and artery from a free flap (donor site) are anastomosed to new site
