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Head, neck CA

CMI - Fall 2011

90% of head and neck CA is? Squamous cell CA
NL mucosa cells are what type of cells? Squamous cells
Head and neck CAs that start in glandular cells are called? Adenocarcinomas
If an asymptomatic mass is found on the head or neck of someone over 40..what is the general rule? Is considered CA, until proven otherwise (must do MULTIPLE BXs)
What is the most common skin CA? BCC (least likely to develop metastases)
SCC usually follows a predictive pattern of metastases, what is it? To lymph>Lungs, liver, bones
What is the benign tumor that arises from the vestibular division of the 8th CN from the Schwann cells which produce myelin? Acoustic neuroma (Vestibular schwannoma)
What are some sxs of acoustic neuroma? -Gradual UNILATERAL SNHL w/tinnitus (HL can be sudden for ~10%) -May see vertigo, unsteadiness
What to do during PE to test for acoustic neuroma? Weber/RInne test, Audiogram
Dx acoustic neuroma? CT w/contrast, MRI of brain
TX for acoustic neuroma? Surgery (go in behind ear and in skull to remove) --Is not URGENT
A CT w/ contrast can help you see what things that may otherwise be missed? Smaller things...
What other nerve is important to consider when having problems with acoustic neuroma? Facial nerve (facial drooping, sxs)
Most malignant tumors of the ear will be where? 85% of the auricle
Types of cancer of auricle and external ear? 2/3 SCC; 1/3 BCC
TYpe of CA of middle ear? SCC
What are some possible causes for nasal/sinus CA? Expos to wood dust, nickel, Thorotrast -- usually not causes by tobacco *MC in males >50yo
Type of CA of nose/sinus? SCC
Risks for nasopharyngeal CA? Smoking, mono, EBV exposure
If an adult has an ear infex with no prior URI sxs, think...? Nasophar tumor
An adenocarcinoma of the nose/sinus is usually found where? Ethmoid sinus - in pts under 40 (slow-growing)
When would you think of adenocarcinoma of ethmoid sinus? Initially think is sinus infex..if not responding to abx -- do XR series, CT
What is the rare CA that can be found in the mid-20s and is in the roof of the nose, is slow-growing? Esthesioneuroblastoma
Sxs of esthesioneuroblastoma? Unilateral nasal obstrux, loss of smell, epistaxis
What kind of CA is benign and found solely in males age 7-19 and can invade the base of skull and be fatal...sxs of obstruction and epistaxis? Juvenile nasopharyngeal angiofibroma
Major RFs for laryngeal CA? Smoking and drinking
Lymph node involvement in laryngeal CA? Usually will not see....unless very late stge = BAD!
Most of laryngeal CA is of where? TRUE VCs (glottic)
To determine CA of larynx, must do 5 of which 6 things? 1. Palpate cervical soft tiss 2. Indir laryngoscopy w/mirror 3. Direct laryngoscopy w/ BX 4. XR of neck and chest 5. CT/MRI of larynx 6. Other contrast studies (Swallow study, upper GI) USually ENT will do 3,4,5,6
15% of those with laryngeal CA also have? Lung CA
Laryng CA at the Glottic area is where? True VCs
Sxs of glottic CA? Hoarseness, scratchy pain, dyspahgia, cough, stridor(late in dz)
To look for subglottic CA, what can you have to pt do, to see below the VCs? Have them pant through mouth and wipe mirror on tongue to warm to prevent fogging
Laryngeal CA of the marginal zone involves what structure? Aryepiglottic folds
Most to least common types of larygeal CA? Glottic, Subglottic, Marginal Zone
In the asian and Indian populations, what kind of CA accounts for 50% of all? Oral and pharyngeal CA (probably d/t chewing betel nut)
RFs for oral CA? Tobacco use = #1!! -Heavy alc, Chewing betel nut, nutritional fxs, genetics, sun exposure (lip CA)
Lip CA is mostly found in men age 50-70...who? Fair-skinned, exposre to sun and pipe smoking
SCC of the lip is usually foudn where? mets? Lower lip at Vermillion border; mets late
BCC of the lip is usually found where? mets? Upper lip; mets early
WHat does a CA of mouth/buccal mucosa look like? Non-healing, painless, red ulceration w/ rolled borders (irregular shape; canker sores are usually more rounded)
Where is tongue CA usually found? Ant 2/3 of tongue --most often assoc w/ mets and usually presents at advanced stage
What is the white plaque-like lesion that involves the tongue or floor of mouth and tends to be malig or pre-malig? Leukoplakia (painless and will not scrape off w/ tongue blade)
What is the condition called that is similar to leukoplakia, but pink and more often assoc with malignancy? Erythroplakia -- REFER TO ENT
Created by: ferrier.kath
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