Oncology 2 Section 4 Final

H&N cancer with best prognosis

larynx

H&N cancer for which surgery is definitive modality

oral cavity

most common histologic cell type for malignancies of H&N

squamous cell carcinoma

most common primary site of cancer in the oropharynx

tonsil

most common primary site for lesion in the hypopharynx

pyriform sinus

when does salivary gland function generally begin to occur

after 2 weeks of radiation treatments

most common site of H&N cancer

larynx

H&N cancer not associated with tobacco use

nasopharynx

indications for pre-irradiation extractions

• advanced periodontal disease

• high caries index

• poor oral hygiene

site with best prognosis for cancer of the oropharynx

tonsil and soft palate

H&N cancer prognosis vs location of lesion

• decreases as it progresses backwards from lips to hypopharynx

• decreases as it crosses over midline

doses for nasopharyngeal tumors

65-70 Gy

H&N cancer with highest incidence of positive nodes and distant metastasis at presentation

hypopharynx

most common site for cancer of the sinus

maxillary sinus AKA maxillary antrum

site most likely to be treated with a single en face electron field or mixed-beam field

salivary gland

palatine tonsil is located in

oropharynx

amount of lymph nodes located in H&N area

1/3

external beam doses for H&N cancers in general

65-75 Gy

etiologic factors for carcinoma of salivary gland

radiation exposure

cancers of highest incidence in furniture workers

• nasal fossa

• nasopharynx

• maxillary sinus

H&N cancers tend to spread via

direct extension and lymphatic

major curative modality for most H&N cancers

RTT

location of pharyngeal tonsil

nasopharynx

contents of oral cavity

• anterior 2/3 of the tongue

• floor of the mouth

• buccal mucosa

• gingiva (upper and lower alveolar ridge)

• retromolar trigone

• hard palate

• lip (vermillion)

chemodectomas occur most often at what site

ear

lymphatic spread of the true vocal cords

glottis generally has no lymphatic spread

leukoplakia is more common in this site of the oral cavity than any other

buccal mucosa

cancer that involves invasion of the mandible

floor of mouth

site of oral cavity cancer with predominant female ratio

gingiva and hard palate

facial nerve paralysis is virtually diagnostic of what H&N cancer

parotid gland

prognosis/staging of a true glottic cancer is best determined by

cord mobility

nodes most likely involved in lymphatic drainage for oral tongue cancer

submaxillary and jugulodigastric (jugular) node

retropharyngeal node AKA

Rouvier’s node

area in which the majority of laryngeal cancers occur

glottic

most common area for cancer of the oral tongue

lateral borders

salivary gland in which the vast majority of tumors occur

parotid

cartilaginous structure in which the true vocal cords are located

larynx

most common site of lip cancers

lower lip

virus with strong relationship between nasopharyngeal cancer

Epstein Barr Virus (EBV)

Ohngren’s line

line drawn from inner canthus to gonion

thrush is a sign of what microbial organism

Candida Albicans

etiologic factors for nasal fossa cancer

• chronic sinusitis and/or nasal polyps

• higher incidence of adenocarcinoma in furniture workers

structure that is in two separate regions of the H&N

tongue (oral cavity and oropharynx)

conventional technique most likely to be used to shape the isodose curve to the tumor volume when treating maxillary antrum lesions

AP w/ lateral wedged pair or oblique wedged pair

areas that should be included when irradiating a tumor of the nasopharynx

• nasopharynx

• retropharyngeal AKA Rouvier’s nodes

• base of skull

• posterior 1/3 of the orbit

nasopharynx extends anatomically from

zygomatic arch to external auditory meatus (EAM)

symptoms of oropharyngeal cancer

• sore throat/painful swallowing

• referred otalgia

• enlargement of cervical nodes

type of therapy that has shown good potential for treatment of mixed malignant tumors of the parotid gland

neutron

locations in the H&N least susceptible to mucositis

larynx

dose that mucositis first appears in H&N patients

2000 cGy

etiologic factors for laryngeal cancer

• smoking/tobacco - very uncommon in non smokers

• mutation of gene 53

• alcohol, especially for supraglottic

• Nickel refining

most lethal region of H&N cancers

hypopharynx

symptoms of laryngeal caner

• persistent hoarseness

• sore throat

etiologic factors for cancer of the buccal mucosa

• chewing tobacco/snuff

• chronic biting of cheek

treatment for laryngeal lesions per stage

• small lesions (T1/T2): RTT only

• fixed cord or T3 lesions: RTT, larynfor salvage

• large lesions (T4): total laryngectomy and RTT

furniture and woodworkers are at higher risk for what H&N cancer

nasal fossa/sinuses

viruses associated with H&N cancers

• EBV

• HPV

• HSV-1

nodes involved with cancer of the floor of the mouth

submaxillary and jugular

most common single agent used for H&N cancer

methotrexate

borders of maxillary sinus

• superior: floor of orbit

• inferior: alveolar process + hard palate

• medial: nasal fossa

• posterior: pterygoid plate

Plummer-Vinson syndrome is associated with which H&N cancers

tongue, nasopharynx

histology of malignant parotid tumors

• adenoid cystic - most common

• mucoepidermoid

• adenocarcinoma

typical dose for glottic carcinoma

60-70 Gy

cartilages of larynx

total of 9 including thyroid cartilage and epiglottis

nodal group below the mastoid tip that receives nearly all of the lymph from the head and neck area and is often included in treatment

jugulodigastric nodes

jugulodigastric nodes AKA

subdigastric node

lymph node areas with very high risk for dissemination of disease, is inaccessible for surgery, and must be included as the minimum target volume in treating nasopharynx

Rouvier’s AKA lateral pharyngeal or retropharyngeal nodes

normal dose to supraclavicular area for H&N treatment

5000 cGy

why sharp field edge is necessary for treatment field including node of Rouviere

to avoid and protect the spinal cord

area of H&N cancer that is most common for involvement of cranial nerves

nasopharynx

most common site of distant metastatic disease from H&N area

lungs

“conventional” wedge-pair technique often used in treatment of parotid gland

superior/inferior oblique combination

trismus

lockjaw, difficulty in opening the mouth

tinnitus

ringing in the ear

leukoplakia

white patches

otitis

inflammation of the ear

odynophagia

painful swallowing of food

dysphagia

difficulty in swallowing

xerostomia

dry mouth

epistaxis

nosebleeds

erythroplasia

red patches

otalgia

ear ache

otorrhea

discharge from ear

ipsilateral

same side

regions of larynx

• supraglottic

• glottic

• subglottic

viral infection of the salivary gland

Mumps

borders of a typical conventional larynx field

• superior: top of hyoid bone

• inferior: cricoid cartilage

• anterior: 1 cm flash

• posterior: just anterior to vertebral body

most common site for cancers in the hypopharynx

pyriform sinus

larynx extends from where to where

thyroid cartilage to cricoid cartilage

what results in osteoradionecrosis

dental extractions after RTT

dewlap AKA

Rooster’s Crowell

amount of time to allow for healing after tooth extractions before starting radiation therapy treatments

10-14 days

main nodes of spread of nasopharyngeal cancer

• retropharyngeal

• superior jugular

• posterior cervical

staging for larynx (true vocal cord) cancer

• TNM staging

• T1: confined to the vocal cord, normal cord mobility

• T2: extension into supraglottis or subglottis, normal or impaired cord mobility

• stage III: disease still confined to the larynx but fixed vocal cord

• stage IV: extension beyond larynx and/or cartilage destruction