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Skin Radiation therapy > salivary glands > Flashcards

salivary glands Flashcards

1
Q

what % of H&N cancers are pf the salivary glands

A

they are very RARE 2% of all H&N cancer

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2
Q

where do most salivary gland cancers arise

A

70% arise in the parotid gland

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3
Q

malignant vs bening men and women

A

benign salivary gland tumours occur more frequently in women and malignant occur equally in men and women

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4
Q

age groups benign vs malignant

A

benign 45yo and malignant 55 yo

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5
Q

causes of salivary gland cancer

A

previous radiation
dental radiographs
this cancer is NOT associated with smoking and drinking
family history

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6
Q

salivary gland cancer can cause which other cancers after treatment

A

oral cavity, lung, thyroid and kidney

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7
Q

what 3 gland comprise salivary glands

A
  1. parotid glands
  2. submandibular glands
  3. sublingual glands
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8
Q

which is the largest gland that are part of the salivary glands

A

the parotid glands

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9
Q

where are the parotid glands

A

they are located superficially and slightly behind the rams of the mandible

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10
Q

saliva secretion from the parotid glands

A

secretes saliva through stensen’s ducts to the oral cavity to help with mastication and swallowing

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11
Q

location of the submandibular glands

A

located beneath the lower jaws superior to the digastric muscles

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12
Q

saliva secretion from the submandibular glands

A

enters the oral cavity by the whartons ducts and they produce a mixture of serous fluid and mucus

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13
Q

which salivary gland produces the most saliva that is within the oral cavity

A

70% of the saliva in the oral cavity comes from the submandibular glands even though these glands are much smaller than the parotid glands

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14
Q

LN drainage of the submandibular glands

A

drains to the submandibular and subdigastric Ln

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15
Q

location of the sublingual glands

A

located beneath the tongue anterior to the submandibular glands

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16
Q

secretion of the sublingual glands

A

sublingual glands is mainly mucus secretion but it is considered as a mixed gland accounts for 5% of the saliva in the oral cavity

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17
Q

saliva secretion from the sublingual glands

A

unlike the submandibular and parotid glands the sublingual glands do not have striated ducts and exit from 8-20 excretory ducts

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18
Q

LN drainage of the sublingual glands

A

drains to the submandibular or deep internal jugular chain

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19
Q

which glands are most commonly cancerous ?

A

the parotid glands

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20
Q

Minor salivary glands

A

there are about 600 minor salivary glands
usually only about 1-2mm in diameter
surrounded by connective tissue
secretion is mostly mucous in nature and functions to coat the oral cavity with saliva

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21
Q

initial route of spread for malignant salivary gland tumours

A

initial route of spread is through local extension

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22
Q

are most salivary gland tumours benign or malignant

A

most are benign

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23
Q

which salivary gland tumours commonly have LN invasion at presentation

A

submandibular tumours are most common to have LN + at presentation

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24
Q

which salivary gland tumours have this spread: spread beyond the gland early and enter surrounding tissue such as the lower jaw or skin

A

submandibular and subinguinal

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25
Q

distant mets of salivary gland tumours

A

bone, lung and liver

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26
Q

diagnostic methods in salivary gland tumours

A

History and physical
FNA biopsy
CT, MRI

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27
Q

s&s of salivary gland cancer

A
  • facial nerve palsy in 25% of patients with parotid gland but only 10% complain of pain
  • adenopathy
  • swelling
  • painless rapidly growing mass (mass is often present for years before a change in growth patterns)
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28
Q

most common malignant subtype of parotid gland cancer

A

mucoepidermoid carcinoma is most common malignant parotid gland cancer

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29
Q

most common histology of minor, major malignant salivary gland cancers except parotid

A

adenoid cystic carcinoma

30
Q

malignant subtypes of salivary gland cancers

A 
Mucoepidermoid carcinoma *most common in parotid 
Adenoid cystic carcinoma *most common minor salivary gland 
Polymorphous low grade adenocarcinoma
Acinic cell carcinomas
Malignant mixed tumours 
Epithelial- myoepithelial tumours 
Salivary duct carcinoma
Squamous cell carcinoma
Undifferentiated carcinoma 
Basal cell carcinoma
31
Q

TNM staging salivary gland cancer

A 
T1 <2cm
T2 2-4 cm
T3->4cm or extraparenchymal extension 
T4-invades, skin, mandible base of skull or facial nerves
N1-<3cm
N2 3-6 cm
N3->6cm
32
Q

grades for salivary gland cancer

A 
(same for all H&amp;N cancer except nasopharynx)
stage1- T1 n0
stage 2-T2 N0
stage 3 T1-T3 N1
T3 N0
Stage4 any T N2,N3
T4, N0
any T any N M1
33
Q

prognostic indicators in salivary gland cancers

A 
LN involvement 
stage
grade
over expression Her2neu and P53 = bad
histopathology adenoid cystic tend to have perineurial involvement = poor prognosis
34
Q

general management for salivary gland cancer

A

most patients with high risk prognostic factors get surgery followed by XRT
Adjuvant chemo is not typically used except for in the palliative setting

35
Q

surgery for low grade salivary gland tumours

A

low grade parotid tumours are treated with a superficial parotidectomy unless they begin in the deep lobe of the parotid
neck dissection is NOT done

36
Q

surgery for high grade salivary gland tumours with and without facial nerve involvement

A

NECK DISSECTION IS used in patients with high grade high stage tumours with + LN
if the facial nerves are NOT involved nerve sparing surgery is performed
if the facial nerves ARE involved reconstruction of the facial nerve with a cable nerve graft with the rural nerve or the auricular nerve - the incidence of facial nerve palsy

37
Q

bulls eye technique

A

there is a direct high energy beam anteriorly (18025Mv)that is heavily weighted 80%
and a POP for the lats with a lower energy (6Mv) the lats typically have wedges 10% each for weighting

38
Q

advantage of bulls eye technique

A

to treat superficially between the eyes while still getting a high dose to the paranasal sinuses

39
Q

3 different techniques to treating the salivary glands

A
  1. homolatersl wedge pair
  2. Bulls eye technique
  3. iMRT
    * **IMRT id mostly used today not so much the other techniques
40
Q

homolateral wedge pairs in treating the salivary glands

A
  • thick ends of the wedges are together
  • one of the 2 beams avoids the spinal cord all together
  • includes a 2cm margin for ipsilateral ln
  • 4-10MV photons and 12-16MEV electrons are used for 80% of the dose
41
Q

IMRT

A

5-7 beams allows optimal coverage while sparing structures such as the mandible, cochlea, spinal cord, brain and oropharynx

42
Q

XRT for the parotid gland
(dose)
margins
coverage

A

55-60Gy at 5cm with 2Gy/fx
the surgical bed with a 2cm margin is used
tumours with a high propensity for perineurial invasion (ex: adenoid cystic) will include the cranial nerves in the volume from the parotids the base of the skull

43
Q

XRT doses and coverage for submandibular gland

A

dose if there is no perineurial invasion and - margins after surgery is 50/25
if there is perineurial invasion the dose should be increased to 60-66Gy and the nerves should be covered to the base of the skull
entire submandibular and ipsilateral neck should be irradiated

44
Q

XRT for minor salivary glands

A

similar to SCC of the H&N with 2 exceptions
1.For patients receiving post-op radiation after surgical resection, 60 Gy is given for negative margins and 66 Gy for microscopically +ve margins
2,For gross residual disease after surgery or for lesions treated with radiation alone, a total of 70 Gy is given in 2 Gy fractions

45
Q

acidic cell carcinoma occurs in which salivary gland cancer

A

only in the parotid gland

46
Q

most common histopathology in minor salivary glands and submaxillary gland

A

adenoid cystic tumours

47
Q

what is pleomorphic adenoma

A

it is a benign tumour that accounts for 65-75% OF ALL PAROTID TUMOURS

48
Q

Standard therapy for pleomorphic adenoma

A

standard treatment is conservative parotidectomy however the following are indications for adjuvant XRT
1.Involvement of the deep lobe of the parotid
2.recurrences
3.large lesions >5cm which would make the lesion in-excisable
4.microscopically + margins after resection
5.malignant transformations in a benign tumour
dose of 50-60 Gy in 5-6 weeks 50/25,60/30 at 4-5cm depth

49
Q

side effects of treatment in parotid gland cancer

A

facial nerve paralysis is most common a===nd is usually due to surgery
partial xerostomia can occur due to XRT and can be permanent

50
Q

most common site of disease of minor salivary gland cancers

A

palate is the most common followed by: paranasal sinus, tongue, and nasal cavity

51
Q

what tumour type are most minor salivary gland tumours ?

A

adenoid cystic

52
Q

adenoid cystic tumours of the minor salivary glands are less likely to have mets in which LN?

A

Cervical LN

53
Q

What should the dose to the parotids be limited to avoid xerostomia

A

n.b. the TD5/5 for the parotid gland is 3200

therefore one pa3rotid should be spared to 20Gy and both glands should be spared to a mean dose of 25Gy

54
Q

most and second most common type of salivary gland cancer

A

parotid followed by SMD

55
Q

what salivary gland is paired

A

parotid gland, and sublingual glands

56
Q

what are the major salivary glands

A

parotid, submandibular and sublingual glands

57
Q

how much saliva is excreted daily

A

IL/day

58
Q

are salivary glands radioresistant or radiosensitive

A

sensitive (n.b. the td5/5 of parotid gland is v. low)

59
Q

most salivary gland tumours are dx at what stage

A

benign is most common

60
Q

how often are parotid tumours benign vs malignant

A

2/3 benign 1/3 malignant

61
Q

a karger parotid gland is an indication of what

A

+ risk of benign tumour

62
Q

what shape is the parotid gland

A

pyramidal

63
Q

what location of tumour most commonly is dx with LN mets

A

SMD

64
Q

Salivary glands are made of what 2 types of cells

A

mucinous and serous cells

65
Q

what cell type makes salivary gland tumours radioSENSITIVE

A

serous cells

66
Q

after how long of tx can xerostomia begin

A

after 10 GY (1 week of tx)

67
Q

Most parotid tumours occur in what lobe?

A

the superficial lobe 80%

68
Q

what pathology has the worst prognosis?

A

Adenoid cystic has worst prognosis

69
Q

3 main radiation treatment modalities are used for salivary gland cancer

A

Homolateral wedge pair, bulls eye technique and IMRT

70
Q

indications for ADJ XRT

A 
Gross residual disease or margins <5mm	
T3-4
LN+ 
Perineural disease 
SCC subtype
71
Q

what LN are included in parotid tx plan

A

subdigastric ln

72
Q

what are the margins for a parotid TX plan

A

2 cm

Skin Radiation therapy (40 decks)

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