Term Test 1 Flashcards
What are the regions of the head and neck
Nasopharynx
Oropharynx
Hypopharynx
Larynx
Oral cavity
Salivary gland thyroid
At what vertebral level is the nasopharynx located at
C1
At what vertebral level is the oropharynx located at
C2-C3
At what vertebral level is the epiglottis located at
C3
At what vertebral level is the laryngopharynx located at
C4
At what vertebral level are the vocal cords located at
C4
What are the salivary glands of the head and neck region
parotid gland
Accessory parotid
Retromolar
Submandibular
Sublingual
Palatine
Describe where which each number of lymph nodes in the head and neck region are
- Submental / subma Ndebele
- Upper jugular
- Midjugular region
- Lower jugular region
- Posterior triangle
- Anterior compartment
What is the most common histology of head and neck cancer? Why is it the most common
Squamous cell carcinoma (90%)
Squamous cells line the moist surfaces of the head and neck
What are the other common head and neck cancer histologies
Nasopharyngeal carcinoma
Mucosal melanoma
Where are less common origins of head and neck cancers
Salivary glands
Sinuses
Muscles or nerves of the head and neck
What are risk factors of head and neck cancer
Tobacco use
Alcohol abuse
HPV and EPV
What are the signs and symptoms specific to a pharynx tumour
Difficult and pain with swallowing
What are the signs and symptoms specific to a larynx tumour
Hoarseness or voice change
What are the signs and symptoms specific to a nasopharynx tumour
Nasal obstructions or congestion
What is the diagnostic work up for head and neck cancers
Medical history and physical examination
Endoscopy
Biopsy (gold standard)
Imaging : CT , MRI , PET , X rays
Ultrasound
HPV (oro) and EPV (Naso) testing
When is surgical resection used in head and neck cancers
Localized tumours to achieve clear margins (varies on location and size)
When is radiation therapy used in head and neck cancers
Can be used as a primary treatment for difficult to reach tumours or adjuvantly to surgery
Can be palliative and curative
When is chemotherapy used in head and neck cancers
Often used with radiation therapy for locally advanced cancers or pre surgery to shrunk tumours
Also used for metastatic cases
What are some functional preservation techniques for head and neck cancer
Speech and swallowing
Reconstruction
Minimizing impact on quality of life
What is the neoadjuvant therapy used for head and neck cancer
- chemo or radiation to shrink tumours to make them more amendable to surgical removal
What is the adjuvant therapy used for head and neck cancer
Postoperative radiation therapy or chemoradiation to eliminate residual microscopic disease and reduce recurrence
What are some methods to treating palliatively for head and neck cancers
Chemo and radiation for advanced or recurrent disease or symptom management
What are special considerations for simulation for head and neck
Jewelry, glasses, and hearing aids are removed
Remove dentures if metal
Cut eyes out of mask , patient look straight up
Wire lips and surgical scars (scars can drain from sarcoma)
Where are the marks on the mask for head and neck cancers for nasopharyngeal and paranasal sinus (anterior mark)
Anterior: midline on chin
Where are the marks on the mask for head and neck cancers for oropharynx / hypopharynx (anterior mark)
Anterior midline above larynx
Where are the marks on the mask for head and neck cancers for cervical esophagus (anterior mark)
Anterior low on neck
Where are the marks on the mask for head and neck cancers for thyroid (anterior mark)
Anterior below larynx
Where are the marks on the mask for head and neck cancers for lateral
Mid neck, approximately EAM
What is the scanning parameter for standard head and neck
Above frontal sinus to carina
What is the scanning parameter for nasopharynx and paranasal sinus
Apex of head to carina
What is the scanning parameter for hypopharyngeal cases
Above frontal sinus to 2-3cm below diaphragm
What is the scanning parameter for cervical esophageal cases
Above frontal sinus to 2-3cm below diaphragm
What is the scanning parameters for thyroid cases
Lower orbital ridge to apex of lung
For scanning considerations of the head and neck: ask patient not to _______ during the scan . Assess scan before ______
Swallow
Sending patient home
For scanning considerations of the head and neck: ensure the ______ is down and flat if _____ block was used
If previous _________ include all of ________ in the scan
Tongue
Bite
Chest irradiation
Lungs
What is the tolerance for head and neck cancer set ups
5 mm
What do we match to in CBCT images for head and neck cancers
Bony anatomy match
What images are used for planning for head and neck cancers
CT MRI fusion or PET CT
What are the beam arrangements for head and neck cancers
VMAT or IMRT
7-9 beams
What is the dose and fractionation of head and neck cancers for : primary tumour and high risk areas
66-70 GY in fractions of. 2 Gy per fx over 6-7 weeks
What is the dose and fractionation of head and neck cancers for post operative high risk areas
60-66Gy (positive surgical margins or extracapsular nodal spread)
What is the dose and fractionation of head and neck cancers for elective lymphnode irradiation
50-54 Gy in 1.8-3 Gy per fraction
What is the dose and fractionation of head and neck cancers for palliative intent
3-50 Gy with hypo fractionated regimens (30/10)
What is mucositis? When does it occur? What are the symptoms? And how do you manage it
Inflammation and ulceration of the mucosal lining in the oral cavity, pharynx, and esophagus
- 1-2 weeks into treatment
- difficultly swallowing, pain, risk of secondary infections
- saline or baking soda rinses, topical anesthetics, pain control with systemic analgesics
What is xerostomia? When does it occur? What are the symptoms? And how do you manage it
- dry mouth: reduced saliva production due to radiation damage to parotid salivary glands
- can start early in treatment and persist long term
- difficult swallowing, speaking, and increased risk of dental decay
- saliva substitutes or stimulants (pilocarpine)
- encourage hydration and oral hygiene
What is dysphasia? When does it occur? What are the symptoms? And how do you manage it
- difficulty swallowing , swelling and inflammation of the pharynx and esophagus
- worsens as treatment progresses
- pain during swallowing, risk of aspiration
- modified diet, nutritional support, swallowing therapy exercises
What is skin reaction? When does it occur? What are the symptoms? And how do you manage it
- can range from mild to moist desquamation
- appears 2-3 weeks into treatment
- symptoms: redness, itching, peeling, or open sores in the treatment
- topical treatment, gentle skin care
What is dysgeusia? When does it occur? What are the symptoms? And how do you manage it
Altered or reduced sense of taste due to damage to taste buds salivary glands
Within first few weeks of treatment
Symptoms: metallic, bitter, or complete loss of taste
Management
- advise foods to find tolerable flavours
What is hoarseness? When does it occur? What are the symptoms? And how do you manage it
Description: Inflammation of the vocal cords if the larynx is in the radiation field.
Onset: Occurs progressively with treatment.
Management:
• Voice rest and hydration.
• Humidification of air.
What is fibrosis? When does it occur? What are the symptoms? And how do you manage it
Cause: Radiation-induced scarring in soft tissues, muscles, and skin. Symptoms:
• Stiffness or reduced mobility in the neck and jaw (trismus).
• Pain or discomfort in the treated area. Management:
• Physical therapy and jaw-stretching exercises.
• Pain management as needed.
What is osteoradiocreosis ORN ? When does it occur? What are the symptoms? And how do you manage it
Cause: Damage to the jawbone (typically the mandible) due to reduced vascularity and tissue healing capacity. Symptoms:
• Jaw pain, exposed bone, risk of infection. Management:
• Preventive dental care before radiation.
• Hyperbaric oxygen therapy in severe cases.
• Surgery for advanced ORN.
