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RTT H/N
Head and Neck
| Question | Answer |
|---|---|
| What is the percentage of head and neck cancers? | 4% |
| What virus is associated with cancer of the nasopharynx? | Epstein Barr Virus |
| What virus is associated with the tongue, floor of the mouth, and tonsils? | HPV |
| What are the subdivisions of the upper aerodigestive tract? | Oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx. |
| What does the oral cavity consist of? | Anterior 2/3 of the tongue, lip, buccal mucosa, retromolar trigone, floor of the mouth, and the hard palate. |
| What does the nasopharynx consist of? | Posterosuperior pharyngeal wall and lateral pharyngeal wall, eustachian tube orifice, and the adenoids. |
| What does the oropharynx consist of? | Base of tongue, tonsils (fossa and pillars), soft palate, and oropharyngeal walls. |
| What does the hypopharynx consist of? | Pyriform sinuses, postcricoid, and lower posterior pharyngeal walls below the base of tongue. |
| What does the larynx consist of? | Glottis, supraglottis, subglottis. |
| What are the borders for the oral cavity? | Extends from the skin-vermilion junction of the lip to the posterior border of the hard palate superiorly and to the circumvallate papillae inferiorly. |
| What is the clinical presentation for oral cavity cancer? | Poor oral and dental hygeine, Plummer-Vinson syndrome (iron deficiency in females), leukoplakia/erythroplasia, nonhealing ulcers, scc is common |
| What is used for detection and diagnosis of oral cavity cancer? | Oral inspection and palpation, biopsy, CT/MRI |
| What is the lymphatic drainage of the lips? | Submandibular, preauricular, and facial nodes. |
| What is the lymphatic drainage of the buccal mucosa? | submaxillary and submental nodes |
| What is the lymphatic drainage of the gingiva? | submaxillary and jugular nodes. |
| What is the lymphatic drainage of the retromolar trigone? | Submaxillary and jugulodigastric nodes. |
| What is the lymphatic drainage of the hard palate? | submaxillary and upper jugular nodes |
| What is the lymphatic drainage of the floor of the mouth? | submaxillary and jugular (middle and upper) nodes |
| What is the lymphatic drainage of the anterior 2/3 of the tongue? | submaxillary and upper jugular nodes |
| When the tumor in the oral cavity is less than 1 to 1.5cm what is the treatment of choice? | surgical removal |
| What is the radiation treatment for oral cavity tumors? | 5000-7000cGy with parallel opposed laterals and boost fields |
| What are the treatment borders for the oral cavity? | Anterior; anterior portion of mandible (excluding lower lip), Posterior: behind the vertebral bodies or spinous processes, Superior; 1.5cm above the tongue Inferior; thyroid notch |
| This structure lies in a line from the zygomatic arch to the EAM, extending inferiorly to the mastoid tip. It is located behind the nose and extends from the posterior nares to the level of the soft palate. | Nasopharynx |
| What is the clinical presentation of cancer of the nasopharynx? | Bloody discharge, auditory dysfunction, respiratory dysfunction, cranial nerve involvement 3, 5, 6, 9, 12, SCC is common |
| What is the most common form of nasopharynx cancer? | SCC |
| What is used to detect and diagnose nasopharynx cancer? | H&P, inspection-indirect mirror examination, palpation, biopsy, fiber optic endoscopy, CT/MRI, chest x-ray, EBV-specific serologic tests, and liver function test/bone scans with advanced disease. |
| What is the lymphatic drainage for the nasopharynx? | Retropharyngeal nodes into the superior jugular and posterior cervical nodes, lateral retropharyngeal node (node of Rouviere) |
| What is the treatment for cancer of the nasopharynx? | Opposing lateral fields to cover tumor and possible spread. Supraclavicular area treated. IMRT replacing most conventional treatment. 50 to 70 Gy with electron boost and special considertion to spinal cord, optic nerve, pituitary, and brainstem. |
| What is the anterior treatment border for the nasopharynx? | Posterior 2cm of nasal cavity (or 2cm beyond tumor extension). Posterior 1/3 of the maxillary sinus, posterior ethmoid sinuses, and posterior 1/4 of the orbit. |
| What is the superior treatment border for the nasopharynx? | Entire sphenoid sinus, cavernous sinus, base of skull (with at least a 0.5 cm margin). |
| What is the posterior treatment border for the nasopharynx? | Behind spinous processes to include retropharyngeal nodes, posterior pharyngeal walls, deep cervical nodes, or posterior cervical nodes. |
| What is the inferior treatment border for the nasopharynx? | thyroid notch to allow sparing of larynx |
| What is the lower neck treatment border for the nasopharynx? | anterior supraclavicular field with larynx block. |
| What is the number one cancer of the oropharynx? | Tonsil |
| What is the clinical presentation for cancer of the oropharynx? | sore throat, pain on swallowing, upper spinal nodal swelling, referred otalgia, SCC is common |
| What is the most common histologic type for oropharynx cancer? | SCC |
| What is used for detection and diagnosis of cancer of the oropharynx? | direct inspection, palpation, biopsy |
| What is the lymphatic drainage of the base of the tongue? | jugulodigastric, low cervical, and retropharyngeal nodes |
| What is the lymphatic drainage of the tonsillar fossa? | jugulodigastric and submaxillary nodes |
| What is the lymphatic drainage of the soft palate? | jugulodigastric, submaxillary, and spinal accessory nodes |
| What is the lymphatic drainage of the pharyngeal walls? | retropharyngeal nodes, pharyngeal nodes, and jugulodigastric nodes |
| What are the routs of lymphatic drainage for the oropharynx? | Jugulodigastric, midjugular, cervical nodes |
| What is the treatment dose for T1-T2 soft palate, tonsil, pharyngeal wall, tongue; cancer of the oropharynx? | Conventional 66-70Gy |
| What is the treatment dose for T3-T4 oropharyngeal and T2 base of tongue? | 70-81.6 Gy |
| What is the hyperfractionation dose for treatment of the oropharynx? | 70 Gy |
| What is the treatment dose for oropharynx with clinically negative nodes? | 50-54 Gy |
| What is the treatment dose for oropharynx with node dissection | 60 Gy |
| What is the treatment technique used for cancer of the oropharynx? | IMRT |
| What are the radiation treatment borders for oropharynx? | Anterior: 2cm from tumor. Superior: Entire jugular chain and above C1 (to include the retropharyngeal lymph nodes). Inferior: Thyroid notch, or to include the sclav area. Posterior: behind the spinous process to include posterior cervical lymph nodes. |
| Clinical presentation of the hypopharynx (pyriform sinuses) | Sore throat, odynophagia, neck mass, dysphagia, weight loss, SCC is common |
| The most common histologic type of cancer for hypopharynx | SCC |
| Detection and diagnosis of cancer of hypopharynx | Inspection, palpation, biopsy, fiber optic endoscopy, CT/MRI |
| Lymphatic drainage of the hypopharynx | superior deep, middle, and low jugular nodes; Rouviere (lateral retropharyngeal lymph nodes at base of skull) |
| What is the treatment for T1-T2 cancer of the hypopharynx | Radiation therapy or surgery |
| What is the treatment of T2-T4 cancer of the hypopharynx? | Surgery and large radiation fields |
| What is the radiation dose for treatment of cancer of the hypopharynx? | large fields treated to 45Gy then back off spinal cord to 70 Gy |
| What is the most common area for cancer in the hypopharynx? | Pyriform sinus (swallowing) |
| What is the superior treatment border for the hypopharynx? | inferior border of mandible and mastoid process, to the base of the skull |
| What is the inferior treatment border for the hypopharynx? | lower border of the cricoid cartilage, 1.5 cm to 2.0 cm margin |
| What is the anterior treatment border for the hypopharynx? | in front of the thyroid cartilage (fall off) if larynx is involved |
| What is the posterior treatment border for the hypopharynx? | behind the spinous processes |
| What does the larynx consist of? | Glottis, supraglottis, subglottis |
| What is the clinical presentation for larynx cancer? | persistent sore throat, hoarseness and stridor, cervical lymph node-supraglottic lesions, SCC is the most common |
| What is the most common histologic type for larynx cancer? | SCC |
| What is the detection and diagnosis for larynx? | palpation, direct inspection, biopsy |
| What is the lymphatic drainage for glottis? | extremely rare for nodal involvement |
| What is the lymphatic drainage for subglottis? | into the peritracheal and low cervical nodes |
| What is the lymphatic drainage for supraglottis? | into the peritracheal, cervical, submental, and submaxillary nodes. |
| What is the treatment for early lesions of the larynx? | surgery or radiation |
| What is the treatment for advanced lesions of the larynx? | surgery and postoperative radiation |
| What is the treatment for helophytic lesions? | more responsive to radiation than infiltrative lesions |
| What is the treatment for poorly differentiated carcinoma of the larynx? | radiation alone or concurrent chemo |
| What are the radiation treatment borders for the glottis? | Sup: upper thyroid notch, Inf: cricoid cartilage (lower border of C6), Ant: 1 to 1.5 cm (flash) over the skin surface at the level of the vocal cords. Post: just anterior to the vertebral body, including the anterior portion of the posterior pharyngeal wa |
| What are the radiation treatment borders for the supraglottic and subglottis? | often much larger fields, fields should include jugulodigastric, anterior and posterior cervical and supraclavicular lymph nodes. |
| These tumors are common in southern China but are relatively rare in the US. | Nasopharynx |
| Treatment dose for parotid gland (salivary gland) | Postop 60-63 Gy, 70-75 Gy if gross residual disease |
| Treatment dose for maxillary sinus | postop 60-63 Gy. 70 Gy recommended for unresectable tumors |
| Dry mouth occurs | 2000 cGy |
| Erythema occurs | 2000 cGy |
| Brachial plexus occurs | 5500 cGy |
| Spinal cord | 4500 Cgy |
| Lhermitte sign | 2000-3000 cGy |
| Mandible teeth and gums | 5000-6000 cGy |
| Mucositis occurs | 3000 cGy |
| Ears | 4000 cGy |
| Cataracts occur | 500-1000 cGy |
| Dry eye occurs | 4000 cGy |
| Optic nerve | 5000 cGy |
| Retina | 5000 cGy |
| Trismus occurs | 6000 cGy |
| Laryngitis occurs | 5000 cGy |
| Taste changes occur at | 1000 cGy |
| Severe dry eye from lacrimal gland damage occurs in 100% of patients at | 5700 cGy |
| Xerostomia may be seen at what cGy and may be permanent at what cGy? | 1000-2000 cGy and 4000 cGy |
| What is cranial nerve VI? | Abducens, eye movement outward |
| What is cranial nerve III? | Oculomotor, raises the eyelid and nerves innervate the eye |
| What cranial nerves are involved with the nasopharynx? | III, IV, V, VI |
| Commonly, cranial nerves 9-12 can be involved due to enlarged retropharyngeal nodes. | Nasopharynx |
| Includes posterior superior pharyngeal wall and lateral wall, eustacian tube orifice, and adenoids | nasopharynx |
| I lie behind the nasal cavities and above the level of the soft palate | nasopharynx |
| Uncommon in Japan | nasopharynx |
| Presents 75-85% of the time with clinically positive cervical nodes bilaterally or contralateral disease | nasopharynx |
| 90% of my lesions are SCC | nasopharynx |
| I have extensive nodal disease, 40-70% with cervical disease and I can spread to adjacent subsites rather quickly | nasopharynx |
| I am not common in white populations, consist of 2% of all cases of head and neck in the US | nasopharynx |
| I have a small peak in adolescence and young adulthood, and a large peak between 50-70 years of age. | nasopharynx |
| Disease in my area can cause considerable respiratory or auditory dysfunction. | nasopharynx |
| I am mostly poorly differentiated and have unusual growth patterns. | nasopharynx |
| My dose for 3 field and a minimum of 5000 cGy or IMRT 7440 cGy bid | nasopharynx |
| I am common in China and middle eastern countries | Oropharynx |
| My 5 year survival rates are above 70% with early lesions and less than 25% for advanced disease | Oropharynx |
| I can distantly metastasize to bone, lung, and liver | oropharynx |
| I consist of base of tongue, tonsils, soft palate, and oropharyngeal walls | oropharynx |
| Soft palate and tonsil have the best prognosis. If I am a stage III or IV RTT and chemo are recommended | oropharynx |
| I am located between the axis and C3 | Oropharynx |
| Most common site of disease for the oropharynx? | Tonsil |
| I am located posterior to the oral cavity from the soft palate above the level of the hyoid bone below | oropharynx |
| T1 staging for oropharynx | 2cm or less |
| T2 staging for oropharynx | greater than 2cm but less than 4cm |
| T3 staging for oropharynx | greater than 4cm |
| T4 staging for oropharynx | Can invade other structures such as the larynx hard palate, mandible, pterygoid muscle. |
| What is the primary lymphatic drainage of the lip? | Submental nodes |
| What is the most at risk when treating the maxillary antrum? | eye |
| The most commonly involved group of nodes for the oropharyngeal region are the | Jugulodigastric nodes |
| A tumor confined to the larynx with cord fixation in glottic cancer is staged as a | T3 |
| Palpation of the cricoid cartilage indicates the inferior border of the | larynx |
| Postcricoid cancers predominately occur in | Women |
| Which cranial nerve may be involved in facial paralysis? | VII Facial |
| What is the most common site of distant mets for head and neck cancers? | Lungs |
| Incidence of distant mets is greatest with tumors of the | nasopharynx and hypopharynx |
| Exposure to radiation in childhood can cause cancer later in life where? | Thyroid and salivary gland |
Created by:
amy wiseman
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