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BDS4 Head and Neck Cancer symposium > Role of Radiation > Flashcards

Role of Radiation Flashcards

1
Q

What aspects of care of head and neck cancer patients is radiology required for?

A

Diagnosis

Staging

Pre-radiotherapy

Checking treatment response/recurrence

Checking for post-op complications

Dental rehabilitation

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2
Q

What imaging is used in diagnosis of cancer?

A

Oral cavity- exophytic soft tissue mass or non-healing socket
-> Take OPT to look for bone involvement

If neck lump- ultrasound

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3
Q

What are the radiological signs that may indicate a cancer diagnosis?

A

Moth eaten bone- areas of ill-defined radiolucency and sclerosis

Pathological fractures

Non-healing sockets

Floating teeth

Unusual perio bone loss- marked around one tooth

Spiculated periosteal reaction

Widening of PDL- with no occlusal trauma

Loss of bony outline for anatomical structures- IDC, walls of antrum

Thinning of cortico-endosteal margin

Atypical aggressive root resorption

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4
Q

What are the other causes of moth-eaten bone?

A

MRONJ

ORN

Osteomyelitis

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5
Q

What are the common metastases of Adenoid Cystic Carcinoma?

A

Ribs

Spine

Lungs

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6
Q

What are the signs on ultrasound of cancer in neck lumps?

A
  • LNs- appearing round (should be kidney shaped/rugby ball shaped)
  • Enlargement in short axis (if over 10mm- concerning)
  • Conglomerate nodes- LNs fuse together
  • Necrosis of nodes
  • Increased vascularity- normally through hilum, if increased/avascular it is concerning or hilum is lost
  • Internal calcification- only present in metastatic SSC/papillary carcinoma of thyroid
  • Extracapsular spread- outline of node disappears and extends to involve other tissues like BVs
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7
Q

What else must we consider when looking at neck lumps?

A

Are they unilateral/bilateral

Are they single or mutliple

What level of neck are they on

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8
Q

What are the levels of the neck?

A
  • Level 1- submental/mandibular region
  • Level 2-4- cervical chain
  • Level 5 posterior triangle
  • Level 6 midline
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9
Q

How does a normal node appear on ultrasound?

A
  • Kidney bean shaped
  • Hilum appears white
  • Black capsule
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10
Q

What is the difference between FNA and Core biopsy?

A

FNA- cells for cytopathology

Core biopsy- histopathological sample

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11
Q

What staging is used for tumours?

A

TNM8
-> different between oropharyngeal, oral cavity, maxillary sinus
-> We consider HPV status and depth of invasion

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12
Q

What is required in order to come to a TNM staging?

A

Requires imaging in 3D of brain, pelvis, chest and abdomen with large field of view to look for metastases
-> CT
-> MRI

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13
Q

TNM brief description:

A

T 1-4 (smallest to advanced)

N 0-3
- No nodes up to bilateral
- Size
- Extracapsular spread

Metastases- distant metastases from original site

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14
Q

CT vs MRI:

A

CT
-> quick
-> good for soft tissue and bone
-> iodinated contrast must be given (enhances tumour)

MRI
-> no radiation
-> Good for soft tissue, marrow involvement, perineurial spread

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15
Q

What must be tested before iodinated contrast can be given for CT?

A

Blood test- eGFR, creatinine
-> check kidney function

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16
Q

What his used if we cannot find primary tumour?

A

PET/CT scan (positron emission tomography)
- Nuclear medicine- inject patient with 18-FDG
- Gives little anatomical detail but shows metabolically active tissues (superimposed over CT)

17
Q

What can cause false positive results in CT scans?

A

Active muscles

Infection

18
Q

What occurs after staging scan and biopsy?

A

MDT meeting
 Discuss treatment options
 Typically run by radiologists and surgeons

19
Q

Who are the members of the MDT for head and neck cancer patients?

A

Surgeons
Radiologist
Oncologist
SLT
Dieticians
Restorative dentist
Clinical support nurse

20
Q

What is done as part of the dental pre-assessment before radiotherapy?

A

Treatment and extraction of teeth with obvious disease and dubious prognosis

OPT/PAs

21
Q

What is imaging to ascertain treatment response used for?

A

Patient who undergo chemotherapy to check for shrinkage prior to surgery

22
Q

What conditions may imaging to ascertain treatment response be used for?

A

Lymphomas

Some sarcomas

Some oro-pharyngeal carcinomas

23
Q

What is used to check for recurrence in oral cancer?

A

CT
-> dark areas may be free flap reconstruction as opposed to recurrence

PET/CT- for distant metastases

24
Q

Why is MRI not used as often for recurrence?

A

False positves- inflammation in other tissues

25
Q

What are the post treatment complication of radiotherapy?

A

ORN- may require bone graft

Infection

26
Q

What is involved in dental rehab following cancer treatment?

A

Implant planning following resection and reconstruction
-> may be traditional or zygomatic depending on surgical location

27
Q

What imaging is used for dental rehab?

A

CBCT

BDS4 Head and Neck Cancer symposium (5 decks)

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