pharynx flashcards

The hypopharynx extends from

The high bone to the inferior aspect of the cricoid cartilage

What are the divisions of the hypopharynx

The pyriform sinuses, posterior lateral pharyngeal wall and post cricoid region

The most common histology in the pharynx is

Squamous cell carcinoma

What is the most common area in the hypopharynx to get a tumor?

The pyriform sinus

What is the second most common place in the hypopharynx to get a tumor?

The pharyngeal wall

Is it more likely for men or women to get pharyngeal cancer?

Men

What are the etiologic factors for hypopharyngeal cancer?

Alcohol smoking, occupational, exposures, like fumes and dust, nutritional deficiencies, vitamin A&E and genetics

What are the most common lymph nodes involved in hypopharyngeal cancer?

Jugular digastric and mid jugular level two and level three

Hypopharyngeal cancers have direct drainage to which nodes

The spinal accessory nodes

Distant mets for hypopharyngeal cancer is

The lung

Piriform sinus tumors often spread where

Across the mucosal surface to involve aryepiglottic folds, and false vocal cords

Post cricoid, tumors commonly invade

Cricoid cartilage, interarytenoid space and posterior cribthyroid muscle

Esophagus, trachea and pyriform sinuses are at risk of advanced local extension

What is the work up for hypopharyngeal cancer?

History and physical exam which includes a laryngeal scopic and endoscopic exam under topical anesthesia

CT and MRI with contrast of the head and neck area

Biopsy of the tumor notes

Swallowing evaluation, dental evaluation, nutrition, and speech

What are the treatment options for early stage hypopharyngeal cancer?

Surgery with postop RT but can do RT alone

What is the treatment options for locally advanced, hypopharyngeal cancer?

Concurrent chemo radiation

What are the presenting signs of hypopharyngeal cancer?

Sore throat, odynophagia, Neck, mass, dysphasia, weight loss

Postcricoid carcinoma often presents with

Dysphasia

Hypopharyngeal cancer Staging is based on

Tumor size and extent of invasion

What are the prognostic factors of hypopharyngeal Cancer

Increasing age, T stage, and stage, size of regional Mets, male, black race, lower socioeconomic status, tumor, location, female females do better

Which location in the hypopharynx does better

Piriform sinus

Pyriform sinus tumors are

Highly infiltrative and have a high rate of nodal Mets

The oralpharynx borders are

Oral cavity anteriorly, the hypopharynx and larynx inferiorly, and the nasal fairings superiorly

What are the four divisions of the oropharynx?

The base of tongue, Soft palette, lateral imp, posterior pharyngeal wall and tonsil region

The oral pharynx is situated between the

Axis and C3

Tumors in the base of tongue are

Poorly differentiated in more aggressive

Tumors in the facial arch are

Well, differentiated and less aggressive

Incident is on the rise for which pharyngeal cancer And why?

Oropharynx Possibly due to HPV

Tumors of the oral cavity and base of tongue are more common where and why?

In India, probably due to environmental factors and cultural influence, like chewing beetle, nuts, or pan or tobacco

Etiologic factors of oropharynx cancers

HPV, alcohol, tobacco, chewing tobacco

Tonsil tumors like to spread where

The retromolar trigon base of tongue and pharyngeal space

Base of tongue tumors are diagnosed later because

They are sneaky and don’t really have symptoms because they don’t have pain receptors

The most common lymph nodes for mets in oral pharynx cancer is

Level two lymph nodes, jugulodigastric, and mid jugular

The base of tongue spreads to which nodes

Jugulodigastric, low cervical and retropharyngeal notes

Tonsillar tumors spread to what nodes

Jugulodigastric, and submaxillary

Soft palette lymph spread

Jugulodigastric and submaxillary and spinal accessory nodes

Pharyngeal wall lymph spread

Retropharyngeal, pharyngeal, jugulodigastric

What is the work out for oropharynx cancer?

History and physical exam with an emphasis on alcohol and tobacco use

Detailed and endoscopy of the entire pharynx

Palpation of the oral cavity

CBC, TSH test, blood camp profile

CT or MRI of the neck with contrast

Biopsy

HPV or P 16 test testing

The treatment options for T1 to T2, oral pharyngeal cancer

Definitive radiation therapy or surgery

Treatment options for T3 T4, oropharynx cancer

Definitive chemo, radiation or surgery with adjuvant radiation

Treatment options for T4 and any noodle status or medically inoperable oropharynx cancer

Definitive chemo, radiation or induction chemotherapy followed by RT or definitive RT

What are the presenting signs of oropharynx cancer?

Sore throat and pain during swallowing

Pain of the inner ear or temporal mandibular joint, lymphedema in the neck, otalgia, symptoms of more advanced disease are dysarthria, odynophagia, trismus

Staging for oropharynx cancer is based on

Tumor size

Diagnostic factors of oral pharyngeal cancer

Tumor size and extent, HPV status has a better response to chemo, tumor. Outside of the neck notes is a poor outcome, number of nodes involved, base of tongue has the worst prognosis, location of tumor.

The nasopharynx is located

Behind the nose, extending from the posterior nares to the level of the soft pallet

What are the borders of the nasopharynx?

Anteriorly the posterior, nasal conch, the body of the sphenoid bone superiorly, the clivus and C1 C2 vertebrae posteriorly, and the superior surface of the soft pallet inferiorly

Nasopharyngeal cancer has a tendency for what growth patterns

Poor differentiation and unusual growth patterns

An aggressive, rare sub type of nasopharyngeal cancer is

Basaloid

Nasopharyngeal cancer is common where

In southern China

What is the peak age range for nasopharyngeal cancer?

Biometal peak at age 50 to 70 and a small peak in adolescence

What is one of the biggest etiologic Factors of nasopharyngeal cancer

Epstein bar virus

What are some etiologic factors of nasopharyngeal cancer

EBV, environmental factors like salt, cured food and smoking, genetics, alcohol, abuse, HPV, occupational exposure, is like dust and fumes

The most common nodes involves for nasopharyngeal cancer are

Retropharyngeal and level two neck nodes

What is the primary lymph spread for nasopharyngeal cancer?

Retropharyngeal, upper jugular, spinal accessory notes

Which pharyngeal cancer can obstruct the eutashian tube and the base of school

Nasopharyngeal

What is the work up for nasopharyngeal cancer?

History and physical exam with a detailed evaluation of the entire fairing, exam of cranial nerves, Laryngoscopy, neck note assessment, MRI or CT, biopsy, otiologic Assessment, EBV and HPV tests

What is the main treatment option for nasopharyngeal cancer?

RT since surgery is challenging due to its location

Advanced Nasopharyngeal tumors treatment is

Chemo radiation, which involves cisplatin and flurouracil

What are the presenting signs of nasopharyngeal cancer?

Maybe a symptomatic initially, nasal stuffiness, discharge, epistaxsis, ear pain, hearing loss, serous otitis media, Headache

Dipolopia means

Cranial nerve involvement Double vision

Nasopharyngeal cancer staging is based on

Tumor extension

Prognostic factors of nasal pharyngeal cancer

Survival decrease decreases as cervical lymph node involvement progresses from upper to middle to lower cervical notes

Extent of local infiltration, females have a better prognosis, tumor volume, lymphoepithelioma, and undifferentiated carcinoma’s are more radiosensitive, Survival is different depending if staged with CT or MRI