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chardy
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Where does H & N met to first
Lung
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the oral cavity includes
- anterior 2/3 of tongue
- lip
- buccal mucosa
- retromolar trigone
- floor of mouth
- hard palate
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What is the # 1 cause of head and neck cancers
smoking and alcohol
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The nasopharynx includes
posterosuperior pharyngeal walls, lateral pharyngeal walls, eustachian tubes , and adenoids
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What is the #1 site for head and neck cancer
Larynx
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Is head and neck cancer more common in men or women
men 2:1
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Which h&N cancer is the # 1 cranial nerve involvement?
Nasopharynx
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Epstein Barr virus is linked to
nasopharyngeal cancer
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80% of H&N are _____carcinoma
squamous cell
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Salivary glands are ______carcinoma
adenocarcinoma
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Typical chemo drugs for H&N
5 FU and Cisplatin
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For head and neck, what are marked on the CT
canthus, scars, commissures, and palpable nodes
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Name 4 clinical presentations for Oral cancer
- Poor oral and dental hygeine
- Plummer-Vinson syndrome (iron deficiency in females)
- Leukoplakia (white patches on the tongue) or erythroplasia(red patch on tongue)
- Non healing ulcers
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You would typically treat a lip with
electron, not usually surgery for cosmetic reasons
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The lip drains to
submandibular, submental, preauricular, and facial nodes
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Lip doses are generally
50-60GY
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Floor of mouth drains to
submaxillary and jugular nodes
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Doses for head and neck are typically
50-70 GY
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What is the most common site for oral cavity cancer
lip
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Oropharynx consists of
- base of tongue
- tonsils
- soft palate
- oropharyngeal walls
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#1 site for oropharynx cancer
tonsils
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What is a typical field for oral cavity
- opposed lats and boost
- Anterior portion of the mandible
- Posterior behind vetebral bodies
- Superior 1.5cm above tongue and
- Inferior thyroid notch
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Main lymphnode drainage for H&N
jugulodigastric
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Oropharynx is located behind the mouth from the ___ ___ to the ______
soft palate to the hyoid bone
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The nasopharynx is located behind the ____ and extending from the ______ to the level of the ______ but does not include it
- nose
- posterior nares
- soft palate
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The Hypopharynx is at the level of the ___ ___ and teminates in the ___
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3 clinical presentations for a pharynx cancer
- persistent sore throat
- painful swallowing
- referred otalgia
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Hypopharynx usually presents at stage
4
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Hypopharynx includes
- pyriform sinus
- postcricoid and lower posterior phayngeal walls below the base of the tongue
- C3-C6
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The most common site for hypopharynx
pyriform sinus
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#1 sign for nasopharynx cancer
bloody discharge
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Nasopharynx treatment borders
- Superior- 2cm beyond tumor to include base of skull and sphenoid sinus
- Posterior- 2cm beyond mastoid process, or post margin may extend further to allow a 1.5 cm margin on enlarged nodes
- Anterior-include posterior 1/3 of maxillary sinus and nasal cavity
- Inferior- thyroid notch to spare larynx
- Lower neck- anterior scv with larynx block
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Larynx tx fields include
- Glottis-
- Superior-upper thyroid notch
- Inferior cricoid cartilage C6
- Anterior 1-1.5cm flash over skin and vocal cords
- Posterior- anterior to vetebral body including pharyngeal wells
- The supra and subglottis are the same except a little larger to include the jugulodigastric, cervical and scv nodes since the glottis normally does not have nodal involvement
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Laryngitis occurs at what dose
50GY
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What % of H and N cancers are Glottic
65%
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If vocal cord is fixed when patient speaks then it is automatically staged a T
T3
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What is the treatment of choice for laryngeal cancers
radiation due to the preservation of the voice
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What is the 5 year survival rate for glottis without cord fixation and also with cord fixation
80-90% without and 50-60% with cord fixation
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What is the 5 year survival rate for supraglottic with and without nodal involvement
80-90% without nodal involvement and 30-50% with nodal involvement
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What is the staging for larynx cancer
T1
T2
T3
T4
- T1- limited to cord with normal mobility
- T2-extends to supraglottis/subglottis and or cord impairment (but cord can still move)
- T3-Limited to larynx with cord fixation
- T4-invades beyond larynx
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What is the largest salivary gland and what is the Td5/5
parotid 3200
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What is the tx of choice for the parotid
surgery
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At what dose does xerostomia occur
20 Gy and permanently at 40Gy
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What is the typical treatment for nasopharynx
- RT#1
- 70 GY 3 field techique Ant and 2 lats and then electron boost to cervical nodes posteriorly
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What is the typical treatment for the lip
surgery unless larger than 4cm then treat with electrons
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