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Head, neck CA
CMI - Fall 2011
| Question | Answer |
|---|---|
| 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 slow-growing..so 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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