Term
| most common head and neck cancer |
|
Definition
|
|
Term
| causes of laryngeal cancer |
|
Definition
tobacco and alcohol (multiplicative)
chewing tobacco, HPV, EBV, Plummer Vinson, malnutrition, occupational exposure to carcinogens |
|
|
Term
| 6 divisions of the aerodigestive tract for staging |
|
Definition
lip and oral cavity
pharynx
larynx
nasal cavity
paranasal sinuses
major salivary glands
thyroid (discussed in endo surgery)
(I know there is 7 but this is what she had in the ppt) |
|
|
Term
| staging system of head and neck cancer |
|
Definition
|
|
Term
| what is most beneficial to the dx of laryngeal cancer? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what do you use to rule out mets in head and neck cancer? |
|
Definition
|
|
Term
| treatment for HNSCC (head/neck squamous cell carcinoma) |
|
Definition
surgery
RT
chemo
combo regimens |
|
|
Term
| common surgical practice in HNSCC |
|
Definition
| radical neck dissection (RND) |
|
|
Term
| alternative surgery option in HNSCC |
|
Definition
| modified radical neck dissection - attempts to preserve the SCM, IJ, or CN XI in any combo |
|
|
Term
| complication of modified radical neck dissection |
|
Definition
| loss of CN XI, denervation of the trapezius --> chronic, painful frozen shoulder |
|
|
Term
| MC location for lip cancer? type? |
|
Definition
lower lip
squamous cell carcinoma |
|
|
Term
| if skin cancer occurs on the upper lip what most likely caused it? what kind of cancer is it? |
|
Definition
sun exposure
basal cell carcinoma |
|
|
Term
| what should you be sure to do when assessing a pt for lip cancer? |
|
Definition
| assess for nerve involvement of the chin |
|
|
Term
| what are poor prognostic indicators for lip cancer? |
|
Definition
| nerve involvement, fixation of the maxilla or mandible, cancer arising on the upper lip or commissure, positive nodal disease, age < 40 years when diagnosed |
|
|
Term
| lip cancer treatment options: early, late |
|
Definition
early: surgery or radiation
late: neck dissection with postop RT |
|
|
Term
|
Definition
|
|
Term
| what is closely associated with oral cancer? |
|
Definition
|
|
Term
| most common oropharynx cancer |
|
Definition
|
|
Term
| tx of oropharyngeal cancer |
|
Definition
|
|
Term
| when is surgery necessary with oropharyngeal cancer? |
|
Definition
| primary disease that involve the mandible, resectable recurrent disease, very early, superficial tumors that don't justify a full course of radiation |
|
|
Term
| complications fo oropharyngeal cancer |
|
Definition
| altering capablity to swallow, velopharyngeal insufficiency (VPI) or nasal regurgitation of liquids/solids, possible obstructive sleep apnea |
|
|
Term
| who is hypopharyngeal cancer most common in? what is the exception? |
|
Definition
men age 55-70 with a h/o alcohol abuse and smoking
middle aged women with Plummer-Vinson syndrome |
|
|
Term
| what is Plummer-Vinson syndrome? |
|
Definition
| combination of dysphagia, hypopharygeal and esophageal webs, weight loss, and iron deficiency anemia (middle aged women) |
|
|
Term
| chronic sore throat, dysphagia, referred otalgia (from 8th cranial nerve) and foreign body sensation in the throat |
|
Definition
|
|
Term
| what is classified as the hypopharynx? |
|
Definition
| begins at the level of the tip of the epiglottis and ends at the level of hte lower border of the cricoid cartilage |
|
|
Term
| how do you diagnose hypopharyngeal cnacer? |
|
Definition
fiberoptic endoscopy
barium swallow
CT
biopsy usually requires direct laryngoscopy under general anesthesia |
|
|
Term
| larynx is divided into 3 regions, what are they? |
|
Definition
supraglottis (epiglottis)
glottis
subglottis |
|
|
Term
| hoarseness, ear pain or sore throat, signs of airway compromise (later in disease), dysphagia that may cause wt loss and malnutrition |
|
Definition
|
|
Term
| what test is standard for laryngeal lesions and lymph node mets? |
|
Definition
|
|
Term
| treatment options for laryngeal cancer: low grade, invasive |
|
Definition
low grade = close follow up, repeat laryngoscopy, quit smoking
invasive: surgery, RT, chemo |
|
|
Term
| what is done for pts with laryngeal cancer that fail conservative therapy? |
|
Definition
|
|
Term
| presentation of nasal cavity and paranasal sinus cancers |
|
Definition
| usually present late stage and are attributed to more mundane etiologies |
|
|
Term
| epistaxis, nasal congestion, headache and facial pain |
|
Definition
| nasal cavity and paranasal sinus cancer |
|
|
Term
| how does optic involvment of nasal/paranasal cancer present? |
|
Definition
| proptosis, orbital pain, diplopia, epiphora, and vision loss |
|
|
Term
| what are benign lesions associated with the nasal/paranasal region? |
|
Definition
| papillomas, hemagniomas, benign fibrous hisitocytoma, fibromatosis, myxoma, osseous lesions |
|
|
Term
| intranasal lesions may extend into the nasal area as what? |
|
Definition
| encephaloceles, meningioceles, or pituitary tumors |
|
|
Term
| treatment for sinonasal malignancies |
|
Definition
| surgical resection, radiation or chemoradiation (high grade) |
|
|
Term
| what are the unresectable sinonasal malignancies |
|
Definition
| those with brain or bilateral optic nerve involvement, or carotid artery encasement |
|
|
Term
| MC benign tumor of the nasopharynx (often affects young males) |
|
Definition
|
|
Term
| nasal obstruction, serous otitis with effusion, conductive hearing loss, epistaxis, nasal drainage |
|
Definition
|
|
Term
| what is suggestive of malignancy in the sinonasal region |
|
Definition
| cervical mass, headache, otalgiia, trismus, and cranial nerve involvement |
|
|
Term
| how do you diagnose sinonasal malignancies? |
|
Definition
rigid or flexible nasopharyngoscope
CT/MRI to determine bony destruction, soft tissue involvement and intracranial extension |
|
|
Term
| how can you avoid facial incisions with sinonasal surgery? |
|
Definition
| endoscopic surgery, also allows for shorter hospital stays |
|
|
Term
| hearing loss, vertigo, eustachian tube dysfunction with serous otitis media, cranial nerve deficits, pulsatile tinnitus, drainage, deep "boring" pain |
|
Definition
| ear and temporal bone malignancy |
|
|
Term
| how do you diagnose ear and temporal bone problems? |
|
Definition
audiology and vestibular testing
CT to eval bony involvement |
|
|
Term
| treatment of ear/temporal bone malignancy |
|
Definition
resection of those structures at risk for involvement.
Prosthetic ears provide acceptable rehabilitation when total auriculectomy has to be performed. |
|
|
Term
| acute or chronic inflammation of a salivary gland |
|
Definition
|
|
Term
| common causes of sialadenitis |
|
Definition
bacterial = staph aureus
viral = mumps |
|
|
Term
| obstructive calcification in a salivary duct |
|
Definition
|
|
Term
| benign lymphoepithelial lesions are associated with what disease? |
|
Definition
|
|
Term
| what is sialolithiasis often misdiagnosed as? |
|
Definition
|
|
Term
| how do you diagnose salivary gland pathology? |
|
Definition
| FNA cytology of the salivary gland with excision of the gland |
|
|
Term
| how do you tx salivary gland pathology? |
|
Definition
| surgical excision, RT for high grade malignancy, facial nerve preservation |
|
|
Term
| MCC of neck masses in kids? |
|
Definition
|
|
Term
| MCC of neck masses in adults? |
|
Definition
|
|
Term
| form during development of the embryo. They occur when tissues in the neck and collarbone area fail to develop normally. |
|
Definition
|
|
Term
| complication of brachial cleft sinus/cyst |
|
Definition
|
|
Term
| formation of an opening that will close spontaneously (5-7d) |
|
Definition
tracheotomy
refers to the operation itself |
|
|
Term
| formation of a permanent opening that remains open after removal of the tube |
|
Definition
tracheostomy
refers to the opening itself |
|
|
Term
| when is a tracheostomy often placed? |
|
Definition
pts requiring mechanical ventilation (after 3 days of intubation - 2-3 weeks)
other reasons: chronic aspiration, acute airway obstruction, perioperatively during radical cancer ablation |
|
|
Term
| complications of tracheotomy |
|
Definition
| bleeding, aspiration, pneumothorax, pneumomediastinum, hypoxia, recurrent laryngeal nerve injury --> vocal cord paralysis |
|
|
Term
| causes of laryngeal muscle paralysis |
|
Definition
| CNS lesion, peripheral nerve injury, malignancies of the thyroid, esophagus, or larynx, compression |
|
|
Term
how do you diagnose vocal cord paralysis?
tx? |
|
Definition
dx: laryngoscopy
tx: intracordal injection, medialization (removal of thyroid cartilage and replacement with silicone to push the cord medially closed) |
|
|
Term
| treatment of bilateral vocal cord paralysis |
|
Definition
| immediate reintubation or tracheotomy |
|
|
Term
| general priciples of reconstruction |
|
Definition
| reconstruct underlying bony framework, replace skin with skin of matching quality, minimize scar visibility and contracture, reconstruct in zones of facial units |
|
|
Term
| venous drainage from the breast occurs via |
|
Definition
| the axillary, subclavian, and intercostal veins |
|
|
Term
| lymph drainage from the breast occurs via |
|
Definition
| mostly the axillary nodes (75%), remainder via the internal mammary nodes |
|
|
Term
| how does lymph drainage flow? |
|
Definition
|
|
Term
| what is the rationale of sentinel node biopsy? |
|
Definition
| lowest node draining the cancer is biopsied, if negative further lymph node dissection is avoided. |
|
|
Term
| contents of the axilla include how many groups of lymph nodes? |
|
Definition
|
|
Term
| subclavicular nodes in the axilla are contiguous with what? |
|
Definition
| the supraclavicular nodes in the neck and the interpectoral nodes |
|
|
Term
| how do the internal mammary nodes probably drain? |
|
Definition
| independently from the breast |
|
|
Term
| what causes ductal budding and formation of acini |
|
Definition
| hormonal production during puberty |
|
|
Term
| what are acini lined with? |
|
Definition
| secretory cells for milk production |
|
|
Term
| preovulatory estrogen leads to |
|
Definition
| proliferation of the breast ductal system |
|
|
Term
| what happens post ovulation? |
|
Definition
| decreasing estrogen and progesterone lead to a decrease in breat ductal proliferation |
|
|
Term
| what happens post-menopausally? |
|
Definition
| breast parenchyma is replaced by adipose tissue |
|
|
Term
| this occurs in > 1/2 of adolescent males |
|
Definition
|
|
Term
| in aging men this is relative to hyperestrinism as plasma testosterone levels decrease and androgens are increasingly converted to estrogen in peripheral tissues |
|
Definition
|
|
Term
| fat secretes ______ that leads to ______. |
|
Definition
|
|
Term
| MC breast tumor in young women |
|
Definition
|
|
Term
| MCC of bloody nipple discharge |
|
Definition
|
|
Term
| firm nodular cysts with epithelial hyperplasia |
|
Definition
|
|
Term
| appears to represent an exaggerated response of breast stroma and epithelium to a variety of hormones |
|
Definition
|
|
Term
premenstrual cyclic breast pain, tenderness, nodularity.
mammogram = bilateral symmetrically diffuse or focal radiologically dense tissue |
|
Definition
|
|
Term
| dull, diffuse, and commonly bilateral upper outer quadrants produced by normal ovarian hormones |
|
Definition
|
|
Term
| more likely to be the result of non-breast etiology associated with cervical radiculopathy, costochondritis, or intercostal muscle strain |
|
Definition
|
|
Term
| breast cellulitis that causes pain with skin changes characteristic of a bacterial infection |
|
Definition
|
|
Term
| marker of incresing risk of developing ductal or lobular carcinoma |
|
Definition
| lobular carcinoma in situ (LCIS) |
|
|
Term
| pre-invasive form of ductal cancer |
|
Definition
| ductal carcinoma in situ (DCIS) |
|
|
Term
| MC invasive breast cancer |
|
Definition
| infiltrating ductal carcinoma |
|
|
Term
| presents with Peau d'orange and has poor prognosis |
|
Definition
|
|
Term
| Paget's disease is associated with |
|
Definition
| malignancy (usually, not always) |
|
|
Term
| risk factors for malignant disease (8) |
|
Definition
| increasing age, +FHx, HRT, alcohol consumption, early menarche, late menopause, nulliparity, radiation exposure, |
|
|
Term
| how do you dx breast cancer? |
|
Definition
FNA
Mammography (most sensitive and specific)
US
CT
MRI (good for dense breasts, scar tissue, and implants) |
|
|
Term
| staging system for breast cancer |
|
Definition
|
|
Term
| other factors to consider when treating breast cancer |
|
Definition
ER+ status
histopathologic grade of the tumor
mitotic index
Her-2-Neu oncogen (if + = poorer prognosis, tx with herceptin) |
|
|
Term
| treatment for breast cancer |
|
Definition
surgery
radiation
adjuvent therapy to decrease systemic recurrence (chemo and hormone) |
|
|
Term
| goal of breast cancer surgery |
|
Definition
| excision of the malignancy with wide margin of normal tissue |
|
|
Term
| when is a lumpectomy used? |
|
Definition
DCIS, invasive carcinoma
followed by RT |
|
|
Term
| removal of the entire breast, axillary dissection is performed (removing level 1 and 2 nodes), no muscle removed |
|
Definition
|
|
Term
| removal of the entire breast, level 1, 2 and 3 lymph nodes, and chest wall muscle |
|
Definition
|
|
Term
| duration of normal RT for breast cancer |
|
Definition
used after lumpectomy to prevent recurrence
x 6 wks |
|
|
Term
| what is used to treat ER+ breast cancer? |
|
Definition
|
|
Term
| what medication decreases circulating estrogen levels? |
|
Definition
|
|
Term
| complications of breast cancer surgery |
|
Definition
lymphedema
poor cosmetic result
wound infection
seroma/hematoma
local recurrence |
|
|
Term
| complications of bresat cancer chemo/hormonal/RT |
|
Definition
| N/V, leukopenia, thrombocytopenia, alopecia, cardiotoxicity, sepsis, hemorrhagic cystitis |
|
|
Term
| breast cancer follow up treatment |
|
Definition
bilateral mammograms 6m post RT completion, yearly thereafter
after modified radical: contralateral mammogram yearly
PE q 3-6m x 3 yrs then annually |
|
|
Term
breast reconstruction doesn't have ______.
Type done depends on ________. |
|
Definition
doesn't have natural sensation.
type depends on your body type, age, and cancer treatment. |
|
|
Term
| phase of tumor transformation described as a series of sequential genetic mutations |
|
Definition
|
|
Term
| phase of tumor transformation described as "initiated cells become tumor cells. Exposure to promoting agents or conditions is required." |
|
Definition
|
|
Term
| phase of tumor transformation described as "invasive growth of the lesion into a highly metastatic tumor." |
|
Definition
|
|
Term
| external (somatic) factors of tumor formation |
|
Definition
| exposure to physical or chemical carcinogens |
|
|
Term
| germline mutations in tumor formation |
|
Definition
| morphologic changes from normal mucosa to cancer |
|
|
Term
|
Definition
intravasation: detachment of some tumor cells from the primary tumor and infiltration into the bloodstream or lymphatics.
extravasation: reciprocal process occurs in other areas of the body |
|
|
Term
| strong link exists between _____ and skin cancer |
|
Definition
| sun exposure (particularly UVB) |
|
|
Term
|
Definition
|
|
Term
| other changes caused by solar radiation |
|
Definition
| wrinkling, telangiectasias, actinic keratosis, solar elastosis |
|
|
Term
| where are most skin cancer changes noted? |
|
Definition
| head, neck, and dorsum of the hands |
|
|
Term
| this type of cancer grows slowly and is non-aggressive |
|
Definition
|
|
Term
| 3 types of basal cell carcinoma |
|
Definition
nodular: smooth, dome shaped or round, pearly papule, develops central necrosis, bleeds with trauma.
pigmented: has melanocytes that give it a dark brown or blue-black color. Easily confused with melanoma
Fibrosing: indurated yellow plaque with poorly defined borders, looks shiny & taut, scarlike |
|
|
Term
|
Definition
correctly ID the lesion, complete tumor removal (<0.5cm = cryotherapy), electrodessication, curretage.
optimal surgery = excision with a 1cm margin |
|
|
Term
| what causes SCC of the lip and mouth? |
|
Definition
|
|
Term
| what has graeter potential for mets, BCC or SCC? |
|
Definition
|
|
Term
|
Definition
head and neck
MC site = lower lip |
|
|
Term
| erythematous firm papule, forms a nodule with central ulceration, crusts and scabs |
|
Definition
|
|
Term
| difference in tx of BCC and SCC |
|
Definition
| with SCC lymph node dissection may be necessary. |
|
|
Term
|
Definition
2/3 of pts with mets into sc tissue may die.
nearly all pts with lymph node involvement will die. |
|
|
Term
|
Definition
| skin check every 6 months |
|
|
Term
| surgery performed for areas where wide excision is not possible, usually done out pt with local anesthetic, has the highest cure rate for BCC |
|
Definition
|
|
Term
| causes 77% of deaths from skin cancer |
|
Definition
|
|
Term
| has the greatest malignant potential |
|
Definition
|
|
Term
| 50-60% of this arises from or near benign nevi |
|
Definition
|
|
Term
|
Definition
excisional biopsy is preferred (full thickness skin and sc tissue are excised)
incisional biopsy if done must include some of the thickest part of the pigmented lesion for micostaging. |
|
|
Term
|
Definition
total lesion removal
staging
skin graft prn
sentinel node biopsy
RT for brain mets |
|
|
Term
| what is ineffective in the tx of melanoma? |
|
Definition
|
|
Term
| type of lymphoma with a bimodal presentation |
|
Definition
| Hodgkins, late 20's and mid 70's |
|
|
Term
|
Definition
| asx cervical LAD, Reed Sternberg cells. |
|
|
Term
| what indicates a worse prognosis in Hodgkins lymphoma? |
|
Definition
| "B" symptoms: fever, night sweats, wt loss |
|
|
Term
| treatment of Hodgkin lymphoma |
|
Definition
RT for early stage disease
chemo, RT for advanced disease |
|
|
Term
| type of lymphoma associated with asx diffuse LAD |
|
Definition
|
|
Term
|
Definition
|
|
Term
| dx of Non-Hodgkin lymphoma |
|
Definition
| labs, CXR, CT of chest, abd, pelvis, bone marrow biopsy |
|
|
Term
| rx of Non-Hodgkin lymphoma |
|
Definition
depends on stage
surgery, RT, chemo |
|
|
Term
| rare tumor derived from the embryonic mesoderm |
|
Definition
|
|
Term
| most common sites for sarcoma |
|
Definition
extremities (66%)
trunk (20%)
retroperitoneum (13%) |
|
|
Term
|
Definition
usually asx so they grow quite large.
don't usually invade tissue but rather push on other structures |
|
|
Term
|
Definition
surgical resection with a 2cm margin of normal tissue.
RT |
|
|
