Oro and hypopharynx Flashcards
1
Q
What are available investigations for these cancers?
A
- Endoscopy
- Biopsy
- HPV testing
- Nodal ultradosound +/- needle biopsy
- PET CT
2
Q
How are these cancers staged?
A
- T1 = <2cm
- T2 = 2-4cm
- T3 = > 4cm
- T4a = invades larynx or deep extrinsic muscle of tongue
- T4b =
3
Q
How are early stage tumours managed?
A
- RT or surgery (T1-T2, N0, M0)
- Surgery is TLM or TORS
- open surgery to be avoided
- No neck nodes would be rare
- Selective disection/prophylactic irradiation if primary is not over midline
- Neck disection can be done with TORS
4
Q
What is the typical RT schedule for oropharynx?
A
- 70Gy in 2Gy #s (would be 7 weeks)
- or 66Gy in 2.2Gy #’s ( 30#, 6 weeks)
5
Q
How are advanced oropharynx cancers managed?
A
- ChemoRT offered as part of organ preservation
- If transoral surgery is not appropriate chemoRT should be considered
- ChemoRT has similar results but salvage surgery worse than in larync
6
Q
What is the regime for concurrent chemoRT?
A
- 70Gy in 35# in 7 weeks
- Concurrent cisplatin
- RT alone in unfit patients (70+?)
7
Q
How is early stage hypopharynx managed?
A
- Surgery or RT
8
Q
How is late stage hypopharynx managed?
A
- no clear evidence for one modality over another
- RT can be given with chemo or cetuximab (low improvements on survival)
9
Q
What issues can neck irradiation cause?
A
- damage to major vessels, stroke?
- pain
- stiffness
- hypothyroidism
