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oral cavity Flashcards

1
Q

most common subset of oral cavity cancer

A

lip

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2
Q

oral cavity cancer is more common in men or women

A

men

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3
Q

age group most common in oral cavity cancer

A

55-65

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4
Q

what causes oral cavity cancer

A 
alcohol
smoking pipes/ tobacco
Plummer Vinison syndrome
poor oral hygiene 
betel nut chewing
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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
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6
Q

lymphatics of the upper lip

A

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

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7
Q

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

A

submandibular and subdigastric LN

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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

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9
Q

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

A

oral tongue and floor of the mouth

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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

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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

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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

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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

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14
Q

oral cavity cancers present )______

A

early

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15
Q

diagnosis of oral cavity cancer

A

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

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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
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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
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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

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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

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20
Q

chemo in oral cavity cancer

A

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

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21
Q

primary treatment for T1-T2 oral cavity cancer

A

primary treatment is surgery for T1-T2

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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

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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

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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

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25
T1-T2 treatment of the oral tongue
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
26
T3-T4 treatment of the oral tongue
unlikely to be cured by XRT alone managed by XRT 50-60Gy (5-6weeks) +surgery larger T3-T4 tumours get higher doses
27
XRT techniques for oral tongue
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
28
dose for oral tongue
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
29
floor of mouth surgery
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
30
what timing is XRT given for floor of mouth
XRT is given adjuvantly after surgery due to the negative prognostic factors of floor of mouth cancer
31
XRT procedure and dose for floor of mouth cancer T3-T4
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.
32
treatment for very small superficial lesions of the floor of mouth
can be treated with interstitial implant 60-65Gy or intramural cone 45Gy/3 weeks alone
33
treatment for T1-T2 floor of mouth cancer
treatment is 45Gy EBRT +boost +interstitial implant of 25Gy or+ intraoral cone of 20Gy
34
treatment for small lesions of the lip
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
35
treatment of larger lesions of the lip
larger lesions of the lip are >4cm are treated with radiation with surgery used for salvage treatment
36
margin for tumours of the lip
margin is 1,5cm if the lesion is well differentiated and there is no indication for nodal XRT
37
ENERGY AND BOLUS USED FOR LIP
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
doses for small vs larger lip lesions
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
treatment for buccal mucosa T1 -T2
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
treatment for T3-T4 buccal mucosa
radical surgery reconstruction followed by adjuvant XRT
41
TREATMENT OF THE GINGIVA
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
what is introral cone treatment
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
interstitial implants in oral cavity
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
DIRECT SPREAD FOR FLOOR OF MOUTH
1.Soft tissue, tonsils, salivary glands 2.root of tongue 3, base of tongue 4.geniod-myehoid muscles
45
direct spread of the tongue
1. ant 2/3 of tongue 2. lateral borders 3. base abd underside of tongue 4. floor of mouth
46
direct spread of the lips
1. skin 2. commisure 3. mucosa 4. muscle
47
direct spread of the gingiva
1.soft tissue of buccal mucosa 2.periosteum 3,bone and maxillary antrum 4.dental nerves
48
direct spread of the buccal mucosa
1. side walls of the oral cavity 2. lips 3. retromolar trigone 4. muscles
49
lymphatic drainage off the lips
submandibular, periauricular and facial LN
50
LYMPHATIC DRAINAGE OF THE BUCCAL MUCOSA
SUBMAXILLARY AND SUBMENTAL LN
51
Lymphatic drainage of the gingiva
submaxillary and juguodigastric LN
52
Lymphatic drainage of the retromolar trigone
submaxillary and jugulodigastric LN
53
Lymphatic drainage of the hard palate
submaxillary and upper jugular LN
54
LYMPHATIC DRAINAGE OF THE FLOOR OF MOUTH
SUBMAXILLARY AND JUGULAR LN
55
LN drainage of the ant 2/3 of the tongue
submaxillary and upper jugular LN
56
WHAT LN are commonly + in oral cavity cancers
submandibular triangle nodes are commonly + in oral cavity cancer
57
what is a sign that shows an in situ cancer
erythroplakia or leukoplakia
58
sunlight causes what H&N cancer
oral cavity- lip
59
poor oral hygeine can cause what H&N cancer
tongue- oral cavity
60
what causes Buccal mucosa, gingiva. lip and FOM cancer
snuff, betel nut chewing and slaked lime
61
what causes hard palate cancer
smoking cigars in inverted position
62
what causes tongue cancer
poor oral hygeine
63
what causes cancer of the lip
HPV or sunlight exposure
64
which occurs more often leukoplakia or erythroplasia
leukoplakia
65
which is more severe: leukoplakia or erythroplasia
erythroplasia is considered cis and becomes malignant 50% of the time
66
late s&s
loose teeth, dysarthria, dysphagia, trismus
67
the main pathology is SCC except for what?
the hard palates primary histology is salivary in origin
68
oral cavity is _____ differentiated
moderately to well differentiated
69
oral cavity cancer is diagnosed_____
early
70
what area has the best prognosis?
lip- the more post the worse prognosis
71
why are teeth removed before XRT
Prevents osteoradionecrosis
72
brachy and electrons may be used for which subsite?
the lip
73
which subsite has the biggest margin
the ant 2-3 of the tongue ha margins of 1.5-2cm while other subsites are 1-1.5cm
74
FOM and tongue have similar treatments, which has a better result
FOM
75
LIP CONSIDERATIONS -
BOLUS covered peice of lead inserted behind the guns
76
FOM considerations
bite block
77
brachy for FOM
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
where are tumours of the tongue most common
lat borders near mid and post 1/3 section
79
tumours in what portion of the tongue present early? late? which most commonly has +LN?
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
what is required before performing brachy in a tongue cancer treatment
a tracheotomy d/t tongue swelling with brachy
81
which oral cavity cancers is bilateral neck fields most important in and why?
in the tongue because it has a rick lymphatic network and is part of the oral cavity at greatest risk for lN involvement
82
surgery for tongue
wide excision or hemiglossectomy (remove half of tongue)
83
what lN are tx for tongue lesions
SMN,, SD, SMD
84
what is the buccal mucosa
its the mucous membrane that lines the inside of the lips
85
S&S for the buccal mucosa
a bump is noticed with the tip of the tongue - pain is nOT associated
86
what can cause hsrd palate cancer?
ill fitting dentures
87
in genral oral cavity cancer tx T1-2 vs T3-4
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
doses in general
60-66Gy for lower risk adj tx for elderly pts -66Gy for advanced staged, inoperable 70Gy
89
what agent is used for H&N brachy
IR-192

Skin Radiation therapy (40 decks)

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