pharynx, larynx Flashcards
What are the three subdivisions of the pharynx
nasopharynx, oropharynx, laryngopharynx/hypopharynx
______ is
-Cuboidal in shape
- Positioned posterior to the nose and extends inferiorly to the Uvula
- Located at Level of C1
Nasopharynx
Cancers in the _____have symptoms, such as consistent sore throat, pain while swallowing, pain in the ear, and cervical node enlargement
pharynx
Adenoids are located within the
nasopharynx
Nasopharynx is located close to the base of the
brain
_____usually occur in the lateral walls of the nasopharynx
carcinomas
There is a strong connection between nasopharyngeal cancers and the
Epstein. Barr virus (EBV)
Oropharynx is Positioned posterior to the oral cavity and extends from the
soft palate (Superiorly) to the hyoid bone (inferiorly)
________ is
located at level C2 to C3
Contains lymphoid tissue called palatine tonsils
Oropharynx
Most cancers in the oropharynx occur in the
tonsils
Oropharynx is Associated with
alcohol consumption, smoking, and HPV
The Laryngopharynx extends from the
hyoid bone to esophagus
_____ is
- located C3 to C6
- Posterior to larynx
- Made up of the pyriform sinuses, postcricoid and lower posterior pharyngeal walls
Laryngopharynx
The _____ is the superior border of the laryngopharynx at the level of C3
epiglottis
_______ is the most common location for cancer within the hypopharynx
Pyriform sinus
Majority of pharynx cancers have what histology
squamous cell carcinoma (SCC)
_______drains to subdigastric, upper cervical, submaxillary and parapharyngeal nodes
Oropharynx
_____drains to cervical nodes, retropharyngeal node (node of Rouviöre), and jugulodigastric nodes
Nasopharynx
______drains to midcervical nodes, superior deep, middle and low jugular nodes; and retropharyngeal node (node of Rouviöre)
Hypopharynx
Oropharynx tumors spread to lymph nodes and invade structures located
close to the tumor
The hypopharynx commonly spreads to lymph nodes and invades
nerves and muscles nearby
The _____ extend from the epiglottis to the cricoid cartilage
Larynx
Cancer in the larynx is strongly associated with
cigarette smoking
The larynx is located at the level of
C3 to C6
Common symptoms of larynx cancer is
constant soreness of the throat and hoarseness
The larynx includes the
supraglottis, glottis, and subglottis
_____ = epiglottis, false vocal cords, ventricles, aryepiglottic folds, arytenoids
Supraglottis
____ = true Vocal cords and anterior/posterior commissures
glottis
_____ = 1 cm below true Vocal cords
subglottis
Supraglottic cancers spread first to what nodes?
jugulodigastric and midjugular nodes
What is most common histology of larynx cancer
squamous cell carcinoma
Glottic cancers rarely spread to
lymph nodes
Subglottic cancers spread first to what nodes?
pretracheal, paratracheal, and inferior jugular nodes
what is the clinical presentation for nasopharynx
- blood discharge
- auditory dysfunction
- respiratory dysfunction
-cranial nerve involvement
-squamous cell carcinoma most common
detection and diagnosis for nasopharynx
- history and physical
- inspection - indirect mirror examination
- palpation
- biopsy
- fiber optic endoscopy
- CT/MRI
- EBV - specific serologic test
- liver function test/ bone scans with advanced disease
what is treatment for nasopharynx?
- opposing lateral fields to cover tumor and possible pathways of spread
- supraclavicualr area treated
- IMRT replacing most treatemtns
typical dose scheme for nasopharynx
50-70 Gy with electron boost and special consideration to
- spinal cord, optic nerve and pituitary and brainstem
radiation treatment border for nasopharynx
Superior - 2 cm beyond tumor (seen on Ct) to include base of skull and sphenoid sinuses
Posterior - 2 cm margin beyond mastoid process or posterior margin may extend further to allow 1.5 cm margin on enlarged nodes
anterior - to include the posterior third of the maxillary sinus and nasal cavity, careful attention adequate margin (2cm) for more anterior tumors
inferior - thyroid notch to allow sparing of larynx
lower neck - anterior supraclavicular field with larynx block
clinical presentation for oropharynx
- sore throat
- pain or swallowing
- upper spinal nodal swelling
- referred otalgia
- squamous cell carcinoma most common
detection and diagonosis
oropharynx (tonsils)
direct inspection
palpation
biopsy
treatment for oropharynx
T1-T2 soft palate, tonsil , pharyngeal walls , tongue: 66-70 Gy
T3-T4 - oropharygeal and T2 base of tongue 70-81.6 Gy
hyper fractionation - 70 Gy
radiation treatment border oropharynx (tonsils)
anterior - 2 cm from known tumor
superior - 1.5 - 2.0 cm superior to the soft palate
posterior - posterior spinous process
inferior - level of hyoid
clinical presentation for hypohphraynx
- sore throat
- odynophagia
- neck mass
- dysphagia
- weight loss
- squamous cell carcinoma most common
detection and diagnosis for hypopharynx
- inspection
- palpation
- biopsy
- fiber optic endoscopy
- CT/MRI
treatment for hypopharynx
large fields treated to 45 Gy reduced of cord then continued to 70 Gy
treatment borders hypopharynx
superior - inferior border of mandible and mastoid process, to the base of skull
inferior - lower border of the cricoid cartilage 1.5 to 2.0 cm margin
anterior - in front of the thyroid cartialge “shine off” (fall off) if larynx involved
posterior - behind the spinous process
larynx is made up off :
glottis supraglottis and subglottis
larynx clinical presentation:
- persistent sore throat
- hoarseness and stridor
- cervial lymph node - supreglottic lesions
- squamous cell carcinoma most common
detection and diagnosis for larynx
- palpation
- direct inspection
- biopsy
treatment for larynx
surgery chemo radiation therapy
radiation treatment borders for glottis
superior - upper thyroid notch
inferior - cricoid cartilage (lower border of C6)
anterior - 1-1.5 cm shine over (flash) over the skin surface at the level of the vocal cords
posterior - just anterior to the vertebral body including the anterior portion of the posteiror pharyngeal walls
radiation treatment borders for supraglottis and subglottis
often much larger fields
