Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Skin Radiation therapy > oral cavity > Flashcards

oral cavity Flashcards

1
Q

most common subset of oral cavity cancer

A

lip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

oral cavity cancer is more common in men or women

A

men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

age group most common in oral cavity cancer

A

55-65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what causes oral cavity cancer

A 
alcohol
smoking pipes/ tobacco
Plummer Vinison syndrome
poor oral hygiene 
betel nut chewing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

subsides or oral cavity cancer

A 
upper and lower lips 
buccal mucosa
hard palate
upper and lower gingiva
floor of mouth
ant 2/3 of the tongue
retromolar trigone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

lymphatics of the upper lip

A

rain to the submandibular LN, Periaucular and parotid LN are sometimes involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lymphatics of the Lower lip, lower gingiva, oral tongue and buccal mucosa

A

submandibular and subdigastric LN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What LN do metastatic disease occur in for the oral cavity (excluding LN that are from the tip of the tongue or that cross the mid line

A

usually occurs in the ipsilateral cervical LN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which subsides of the oral cavity are most likely to have +LN at presentation

A

oral tongue and floor of the mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

nodal involvement incidence and hat LN are involved

A

LN are rarely involved but nodes involved are most likely submandibular and jugulodigastric LN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

distant mets site of the oral cavity

A

lung is most common

other sites include: maxillary sinus, bone, brain or skin of the face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

typical presentation of oral cavity cancers

A

most commonly a mass, ulcer or patch of thickened white or red patch that persists for 2 or more weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

white and red patches in oral cancers

A

presentation of oral cancer
white patches are leukoplakia-are more common than erythroplasia and are less likely to be malignant than erethroplasia they are more likely in lower lip, floor of mouth, buccal mucosa, lateral tongue border and retromolar region.
red patches in the mouth are erethryoplasia- occurs mostly on the floor of the mouth, lateral tongue border and soft palate. The majority of erythroplasia are invasive carcinoma, carcinoma in situ, or severe epithelial dysplasia and must always be regarded as serious. It becomes malignant 50% of the time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

oral cavity cancers present )______

A

early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

diagnosis of oral cavity cancer

A

commonly diagnosed by the careful diagnosis by the dentist or doctor
inspection or palpation
biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

TNM of oral cavity cancer

A 
T1-<2cm
T2-2-4cm
T3 >4cm
T4 invading other tissues 
N1-mets in a single LN <3cm
N2-mets in ipsilateral LN 3-6cm
N3 mets >6cm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

stages or oral cavity cancer

A 
same for all H&amp;N cancers except Nasopharynx 
stage 1- T1 N0
stage 2 T2 n0
stage 3- T1-T3 N1
stage T3 N0
stage 4 any T, any N M1
T4, any N M0
any T N2,N3 M0
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

prognostic indicators in oral cavity cancer

A

stage
location- the further into the oral cavity the worse prognosis therefore lip has the best diagnosis
LN involvement
distant mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what must be done before XRT in oral cavity cancer

A

dental visit must be done first and dental surgery and tooth extractions must be done before XRT this helps its to avoid getting osteoradionecrosis, Also careful oral hygiene throughout treatment is important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

chemo in oral cavity cancer

A

chemo is sometimes given concurrently with XRT but is rarely used in oral cavity cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

primary treatment for T1-T2 oral cavity cancer

A

primary treatment is surgery for T1-T2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

treatment for T3-T4 oral cavity cancer

A

primary is surgery followed by XRT dose of 60-66Gy(+/-) concurrent chemo if there is +margins or + LN
Older patients get 66/33 and if the tumour is not operable the treatment is 70/30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

oral tongue surgery

A

excision biopsy is not adequate
wide local excision is treatment of choice for lesions that can be excised trans orally for lesions with a 1cm margin
this is hard to achieve for the posterior part of the mobile tongue and can result in difficulty swallowing and speaking
larger tumours are treated with semi or total hemiglossectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

XRT for oral tongue

A

Post op XRT is used for larger lesions close or + margins or perineurial invasion also used for + margins initially that are -after excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

T1-T2 treatment of the oral tongue

A

lesions can be cured by resection especially in older patients
-55-60Gy for microscopic disease (not common)
-60-65 for small posteriorly situated tumours ill defined lesions inaccessible by Surgery
-65-70Gy for exophytic superficial lesions with muscle involvement are amenable to successful treatment of XRT
-70-75Gyfor medium sized moderately advanced tumours T2 tumours of the floor of the mouth
surgical treatment includes partial glossectomy partial mandibulectomy and neck dissection surgery is used for salvage and recurrent disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

T3-T4 treatment of the oral tongue

A

unlikely to be cured by XRT alone
managed by XRT 50-60Gy (5-6weeks) +surgery
larger T3-T4 tumours get higher doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

XRT techniques for oral tongue

A

lateral POP Tongue depressed away from palate with bite block
Portal includes submandibular, subdigastric and submental nodes
Submental nodes are especially important to be covered when the lesion is located at the tip of the tongue, ant floor of the mouth or the lower lip
Upper border shaped to give at least 2 cm margin above the dorsum of the tongue and to spare the hard palate and the parotid glands
Post border is designed to be approximately 2 cm behind the sternocleidomastoid muscle
The inf part of the field usually lies at the thyroid notch
With cervical node mets, treatment of level IV or V nodal stations may be indicated, depending on the degree of nodal involvement
If the post chain requires radiation, portals are reduced at 45 Gy to spare the spinal cord
For lower neck (level IV), these nodes are treated through an ant portal with a larynx shield

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

dose for oral tongue

A

post op dose is 60/30GyFor close of +ve margins or extracapsular extension in any of the cervical nodal stations, an additional 6 Gy is delivered with reduced fields and concurrent chemo is often administered
Smaller, more anteriorly situated primary lesions in an edentulous (lacking teeth) jaw are most suitable for interstitial implant or intraoral cone radiation therapy as a boost procedure
For an anteriorly situated carcinoma that does not involve the adjacent floor of the mouth or gingival ridge, a boost dose of 25-40 Gy in 10 fx, 5 fx a week by intraoral cone, can be given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

floor of mouth surgery

A

resection of the inner table for tumours that re tethered or fixed to the mandible
advanced lesions of the floor of the mouth due to bone invasion are treated by wide local excision and segmental resection of the mandible followed by reconstruction of the floor and mandible
Very advanced disease involving the floor of the mouth, tongue and mandible and for massive neck disease, the chance of cure with any aggressive treatment is low and is often associated with formidable complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what timing is XRT given for floor of mouth

A

XRT is given adjuvantly after surgery due to the negative prognostic factors of floor of mouth cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

XRT procedure and dose for floor of mouth cancer T3-T4

A

t3-t4 INVOLVEMENT OF THE TONGUE AND MANDIBLE ARE TREATED PRIMARILY BY radical surgery followed by plastic closure and then adjuvant XRT
lat POP 45Gy for 4-5weeks followed by reduced fields with a total dose of 75-77Gy hypo fractionation 1.2Gy/fx b.i.d.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

treatment for very small superficial lesions of the floor of mouth

A

can be treated with interstitial implant 60-65Gy or intramural cone 45Gy/3 weeks alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

treatment for T1-T2 floor of mouth cancer

A

treatment is 45Gy EBRT +boost
+interstitial implant of 25Gy
or+ intraoral cone of 20Gy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

treatment for small lesions of the lip

A

small lesions of the lip <2cm
treated with surgery OR radiation in 90% of patients
post op XRT is used for +surgical margins or perineurial invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

treatment of larger lesions of the lip

A

larger lesions of the lip are >4cm are treated with radiation with surgery used for salvage treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

margin for tumours of the lip

A

margin is 1,5cm if the lesion is well differentiated and there is no indication for nodal XRT

37
Q

ENERGY AND BOLUS USED FOR LIP

A

ENERGY is typically 6-9mev because the lip is so external it can be treated with electrons bolus is typically 1-1.5cm bolus

38
Q

doses for small vs larger lip lesions

A

small lip lesions are treated with 50Gy/4-4.5 weeks

large lip lesions are treated with 60Gy/5-6 weeks smaller lesions are more often treated with interstitial brachy

39
Q

treatment for buccal mucosa T1 -T2

A

SURGERY IS EFFECTIVE for involvement of the commissure
T1&T2 lesions without nodal involvement can be treated with EBRT +intraora conel or interstitial implant boost
dose is 55-60Gy +20-25Gy boost
T2 lesions of the commissure XRT is preferred

40
Q

treatment for T3-T4 buccal mucosa

A

radical surgery reconstruction followed by adjuvant XRT

41
Q

TREATMENT OF THE GINGIVA

A

T1 exophytic lesions of the gingiva can be treated by EBRT alone
radical surgery is used to treat larger lesions that involve the mandible
neck is radiated if the LN are + and the mandible from the mental symphysis to the TMJ is included

42
Q

what is introral cone treatment

A

treatment used for the anterior tongue or anterior floor of the mouth
uses 250KEV or 6-12MEV electrons
cone is equipped with device to visualize the target volume and ensure proper coverage

43
Q

interstitial implants in oral cavity

A

cover the volume with a .5-1cm margin most common technique is after loading with angiocatheters with IR-192
most implants are done with LDR which delivers 45-50cGy/hr to target volume
Can be used as a sole treatment for T1-T2 tumours or is used with EBRT

44
Q

DIRECT SPREAD FOR FLOOR OF MOUTH

A

1.Soft tissue, tonsils, salivary glands
2.root of tongue
3, base of tongue
4.geniod-myehoid muscles

45
Q

direct spread of the tongue

A
  1. ant 2/3 of tongue
  2. lateral borders
  3. base abd underside of tongue
  4. floor of mouth
46
Q

direct spread of the lips

A
  1. skin
  2. commisure
  3. mucosa
  4. muscle
47
Q

direct spread of the gingiva

A

1.soft tissue of buccal mucosa
2.periosteum
3,bone and maxillary antrum
4.dental nerves

48
Q

direct spread of the buccal mucosa

A
  1. side walls of the oral cavity
  2. lips
  3. retromolar trigone
  4. muscles
49
Q

lymphatic drainage off the lips

A

submandibular, periauricular and facial LN

50
Q

LYMPHATIC DRAINAGE OF THE BUCCAL MUCOSA

A

SUBMAXILLARY AND SUBMENTAL LN

51
Q

Lymphatic drainage of the gingiva

A

submaxillary and juguodigastric LN

52
Q

Lymphatic drainage of the retromolar trigone

A

submaxillary and jugulodigastric LN

53
Q

Lymphatic drainage of the hard palate

A

submaxillary and upper jugular LN

54
Q

LYMPHATIC DRAINAGE OF THE FLOOR OF MOUTH

A

SUBMAXILLARY AND JUGULAR LN

55
Q

LN drainage of the ant 2/3 of the tongue

A

submaxillary and upper jugular LN

56
Q

WHAT LN are commonly + in oral cavity cancers

A

submandibular triangle nodes are commonly + in oral cavity cancer

57
Q

what is a sign that shows an in situ cancer

A

erythroplakia or leukoplakia

58
Q

sunlight causes what H&N cancer

A

oral cavity- lip

59
Q

poor oral hygeine can cause what H&N cancer

A

tongue- oral cavity

60
Q

what causes Buccal mucosa, gingiva. lip and FOM cancer

A

snuff, betel nut chewing and slaked lime

61
Q

what causes hard palate cancer

A

smoking cigars in inverted position

62
Q

what causes tongue cancer

A

poor oral hygeine

63
Q

what causes cancer of the lip

A

HPV or sunlight exposure

64
Q

which occurs more often leukoplakia or erythroplasia

A

leukoplakia

65
Q

which is more severe: leukoplakia or erythroplasia

A

erythroplasia is considered cis and becomes malignant 50% of the time

66
Q

late s&s

A

loose teeth, dysarthria, dysphagia, trismus

67
Q

the main pathology is SCC except for what?

A

the hard palates primary histology is salivary in origin

68
Q

oral cavity is _____ differentiated

A

moderately to well differentiated

69
Q

oral cavity cancer is diagnosed_____

A

early

70
Q

what area has the best prognosis?

A

lip- the more post the worse prognosis

71
Q

why are teeth removed before XRT

A

Prevents osteoradionecrosis

72
Q

brachy and electrons may be used for which subsite?

A

the lip

73
Q

which subsite has the biggest margin

A

the ant 2-3 of the tongue ha margins of 1.5-2cm while other subsites are 1-1.5cm

74
Q

FOM and tongue have similar treatments, which has a better result

A

FOM

75
Q

LIP CONSIDERATIONS -

A

BOLUS covered peice of lead inserted behind the guns

76
Q

FOM considerations

A

bite block

77
Q

brachy for FOM

A

Interstitial implant can be sole tx for very small lesions 60-65Gy or intraoral cone 45/15
T1-2: can be used as boost after 45Gy EBRT
boost dose of 20-25Gy

78
Q

where are tumours of the tongue most common

A

lat borders near mid and post 1/3 section

79
Q

tumours in what portion of the tongue present early? late? which most commonly has +LN?

A

in the ant part of the tongue lesions are early stage while the mid and post sections are most commonly LN+ and present at later stage

80
Q

what is required before performing brachy in a tongue cancer treatment

A

a tracheotomy d/t tongue swelling with brachy

81
Q

which oral cavity cancers is bilateral neck fields most important in and why?

A

in the tongue because it has a rick lymphatic network and is part of the oral cavity at greatest risk for lN involvement

82
Q

surgery for tongue

A

wide excision or hemiglossectomy (remove half of tongue)

83
Q

what lN are tx for tongue lesions

A

SMN,, SD, SMD

84
Q

what is the buccal mucosa

A

its the mucous membrane that lines the inside of the lips

85
Q

S&S for the buccal mucosa

A

a bump is noticed with the tip of the tongue - pain is nOT associated

86
Q

what can cause hsrd palate cancer?

A

ill fitting dentures

87
Q

in genral oral cavity cancer tx T1-2 vs T3-4

A

T1-2 are generally tx with Sx alone
T3-4 sx with adjuvat XRT
cX MAY BE ADDED CONCURRENTLY WITH xrt for high risk pts (ex: LN+ or + margins)

88
Q

doses in general

A

60-66Gy for lower risk adj tx
for elderly pts -66Gy
for advanced staged, inoperable 70Gy

89
Q

what agent is used for H&N brachy

A

IR-192

Skin Radiation therapy (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions