Oropharyngeal Cancer Flashcards
Boundaries of the OP?
Anterior: junction of hard and soft palate & circumvallate papillae
Superior: the level of the hard palate
Inferior: Superior surface of the hyoid
What is the m/c site of OP cancer?
Tonsil and lateral pharyngeal wall
What are the subsites of OP cancer?
- Tonsil/Lateral pharyngeal wall
- Posterior pharyngeal wall
- Soft palate
- BOT
- Vallecula
What is T4a OP CA?
Moderately advanced local dz, invasion through:
- larynx
- extrinsic muscles of tongue
- medial pterygoid
- hard palate
- mandible
What is T4b OP CA?
Very advanced local dz, invasion through:
- lateral ptyergoid
- ptyergoid plates
- lateral NP
- skull base
- carotid encasement
What is lymphoepithelioma
A subgroup of poorly differentiated carcinoma
May present in the tonsil
Exophytic
Radiosensitive
Single modality MAN of OP CA
- Excision vs RT
- Indicated for T1 or T2 OP CA (except BOT)
Multimodality MAN of OP CA
- Chemo/RT vs excision and postop RT vs RT then salvage surgery
- T3 or T4 OP (or BOT)
How to treat N0 necks in OP CA
Elective b/l ND vs RT
How to treat N1-N3 necks in OP CA
Mod RND
Adjuvant Rx for OP CA
Postop RT for:
- Advanced or agressive dz (BOT)
- Close or positive margins
- Multiple positive neck nodes
- ECS/PNI/Intravascular invasion
- Invasion of bone, cartilage, or soft tissue
Chemo/RT
CAn be initial Tx followed by surgical salvage of neck
Failure of primary site is highly predictive of failure
Surgical approaches for OP CA
- Transoral (post pharyngeal, anterior pillar, uvula, soft palate) - eg TORS
- Transcervical/Visor Flap (large tumors of BOT or tonsil)
- Mandibulectomy (risk of malocclusion)
- Mandibulotomy
- Lateral pharyngotomy (enter pharynx b/w hypoglossal and SLN)
- Transhyoid pharyngotomy (enter pharynx above hyoid)
