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ENT > ENT Neoplasms > Flashcards

ENT Neoplasms Flashcards

1
Q

ENT neoplasms

-risk factors

A
  • smoking
  • alcohol
  • viral (EBV, HPV, HIV)
  • occupational exposure (dry cleaning agents, pesticides, plastic and rubber products, hair dressers)
  • radiation
  • poor oral hygiene and periodontal disease
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2
Q

What are the types of oral tumors?

  • mucosal
  • salivary gland
A

mucosal

  • leukoplakia
  • erythroplakia
  • oral lichen planus
  • oral carcinoma

salivary gland

  • parotid
  • warthlin’s tumor
  • pleomorphic adenoma
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3
Q

Mucosal: Leukoplakia

  • what
  • what % progress to carcinoma within 10 years?
  • common in people who use what?
  • dx
A

what
-precancerous lesion that presents as white patches or plaques on oral mucosa that cannot be removed by rubbing/scraping

-between 1 and 20% of lesions progress to carcinoma within 10 years

common in
-smokeless tobacco users

dx
-biopsy to rule out SCC

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4
Q

Mucosal: Erythroplakia

  • what
  • what % of cases are dysplasia or carcinoma
  • specific risk factors
  • dx
A

what
-similar to leukoplakia except it has a red erythematous component

-90% of cases are dysplasia or carcinoma

risk factors
-alocohol/tobacco

dx
-bx to confirm

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5
Q

Mucosal: Oral Lichen Planus

  • what
  • presentation
  • dx
  • tx
A

What
-chronic inflammatory autoimmune disease

Presentation

  • lace-like white patches on buccal mucosa
  • erosions on gingival margin

Dx
-bx or exfoliative cytology

tx

  • aimed at managing pain and discomfort
  • corticosteroids
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6
Q

Mucosal: Oral Cancer

  • MC type
  • MC locations
  • sx
A

MC type
-90% of all oral cancers of squamous cell carcinoma

MC location
-tongue, tonsils, gums, floor of mouth

Sx

  • MC is sore in mouth that does no heal
  • red or white patch in mouth
  • persistent sore throat or something caught in throat
  • hoarseness or change in voice
  • may have chronic bad breath, difficulty moving tongue and jaw
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7
Q

Mucosal: Oral Cancer

  • Dx
  • Tx
A

Dx

  • Good history for risk factors
  • close insepction of the oral cavity
  • endoscopy
  • bx (fine needle aspiration, open biopsy, oral brush)
  • CT/MRI/US

Tx

  • Surgery
  • radiation
  • -combo or primary tx, used for pts that cant undergo surgery
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8
Q

Salivary Gland Tumors

  • MC site
  • other sites
  • MC type of benign salivary gland tumor?
  • MC type of malignant salivary gland tumor?
A

MC site
-parotid (80-85%)

other sites
-submandibular gland, sublingual, minor salivary glands

MC type of benign salivary gland tumor?
-Pleomorphic adenoma (parotid)

MC type of malignant salivary gland tumor?
-mucoepidermoid carcinoma and adenoid cystic carcinoma

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9
Q

What is the only salivary gland tumor associated with smoking?

A

Warthin’s tumor

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10
Q

Salivary Gland Tumors

  • Presentation
  • workup
A

Presentation

  • painless mass or swelling of the salivary glands
  • depending on location: nasal obstruction, congestion, vision changes, trismus

*minor salivary glands arising within oral cavity present: sub-mucosal mass, mucosal ulceration of the palate, lips, or buccal mucosa

Workup

  • Good hx, PE
  • CT/MRI/US (with Warthin need to image both parotid glands, tendency to be bilateral)
  • bx (fine needle aspiration cytology, ultrasound guided core bx)
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11
Q

Salivary Gland Tumors

  • Tx
  • Parotid
  • pleomorphic adenoma
  • warthin’s tumor
  • Submandibular glands
  • Sublingual glands
  • Minor salivary glands
A

Tx
-Usually surgery, radiation, or combo

  • Parotid Gland:
  • -depends on size, involvement, benign, malignant, or facial involvement
  • -Conservative: partial parotidectomy without fully dissecting facial nerve
  • -Superficial: parotidectomy of entire superficial lobe and dissection along facial nerve
  • -Total: removal of entire lobe and surrounding tissue with preservation of the facial nerve
  • Pleomorphic adenoma=superficial resection
  • Warthin’s tumor=conservative
  • Submandibular glands
  • -submandibular sialoadenectomy and resection of submandibular gland
  • -Benign=simple excision of gland
  • Sublingual glands
  • -resection of floor of mouth and involved sublingual gland, as well as ipsilateral submandibular gland
  • Minor Salivary gland
  • -Surgical resection with radiation preferred
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12
Q

Salivary: Pleomorphic Adenoma

  • Tumor of what gland
  • progression
  • dx
  • tx
A

-Most common benign tumor of PAROTID

Progression
-slowly growing, painless, solitary, firm, smooth, moveable mass without nerve involvement

Dx
-CT/MRI/FNA (fine needle aspiration)

Tx
-Superficial parotidectomy

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13
Q

Salivary: Warthin’s Tumor

  • Tumor of what gland
  • bilateral or unilateral
  • risk factor
  • common in what age group
  • Tx
A

Tumor of what gland
-PAROTID

bilateral or unilateral
-tends to be bilateral

risk factor
-SMOKING (only salivary gland tumor with this risk factor)

common in what age group
-older people…

Tx
-conservative resection

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14
Q

Nasal and Sinus Tumors

  • MC site?
  • other sites
  • causes and risk factors
A

MC site
-maxillary sinus

Other sites

  • nasal cavity
  • ethmoid sinuses
  • sphenoid or frontal sinus (rare)

Causes/Risk factors

  • smoking and tobacco smoke
  • exposure to dust from wood
  • leather or textiles
  • inhaling vapors from glue
  • formaldehyde
  • solvents
  • nickel
  • HPV particles
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15
Q

Nasal and Sinus Tumors

  • signs and sx
  • dx
  • tx
A

Signs and sx

  • persistent nasal congestion, especially on one side
  • pain in the forehead, cheek, nose, or around the eyes or ear
  • post nasal drip
  • frequent/persistent nose bleeds
  • present late stage

Dx

  • hx and PE
  • small fiberoptic scope may be used to look in the nasal cavity and sinuses
  • bx (FNA, open bx)
  • CT/MRI/PET

Tx

  • Surgery +/- radiation or chemo
  • radiation
  • chemo
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16
Q

Nasal and Sinus Tumors

  • types of malignant
  • types of benign
A

Malignant

  • Squamous Cell Carcinoma (SCC) is MC
  • Adenocarcinoma (occurs in sinus lining)
  • Lymphomas
  • Esthesioneuroblastoma (develop from nerves at base of skull where they enter the nasal cavity and provide sense of smell)

Benign

  • Osteomas (usually do not cause sx, can impede frontal, ethmoid, or maxillary sinuses)
  • viral infections (HPV) can cause papillomas (wart-like growths in the nose or sinus)
17
Q

Pharyngeal Tumors: Nasopharyngeal cancer

  • Common in what populations
  • strongly correlated with what virus
  • most common type of nasopharyngeal cancer
  • preferred tx
A

Common in what populations
-asians and southeastern asian

strongly correlated with what virus
-EBV

most common type of nasopharyngeal cancer
-SCC

preferred tx
-radiotherapy

18
Q 
Pharyngeal Tumors: Nasopharyngeal cancer
Describe:
-Keratinizing
-non-keratinizing
-undifferentiated subtype
A

Keratinizing

  • well differentiated cells that produce keratin
  • common in the US

non-keratinizing
-tends to metastasize to regional lymph nodes

undifferentiated subtype

  • often occurs in conjunction with high numbers of lymphocytes
  • more common in Asia
  • tends to metastasize to regional lymph nodes
19
Q

Pharyngeal Tumors: Nasopharengeal Cancer

-Signs and sx

A
  • lump in nose or neck
  • sore throat
  • trouble breathing or speaking
  • nosebleeds
  • trouble hearing
  • pain or ringing in ears
  • headaches
20
Q

Pharyngeal Tumors: Oropharyngeal cancer

  • Most common type
  • sites
  • risk factors
A

Most common type
-SCC

Sites

  • Base of tongue
  • tonsillar region *most common site for primary cancers of the oropharynx
  • soft palate/uvula
  • pharyngeal wall

Risk Factors

  • Tobacco
  • poor nutrition
  • heavy alcohol consumption
  • Eastern Asian descent
  • HPV
21
Q

Pharyngeal Tumors: Oropharyngeal cancer

signs and sx

A
  • sore throat that does not go away
  • lump in back of mouth, throat, or neck
  • dull pain behind the breastbone
  • cough
  • trouble swallowing
22
Q

Pharyngeal Tumors: Hypopharyngeal cancer

  • Most common type
  • risk factors
  • signs and sx
A

Most common type
-SCC
(although hypopharyngeal cancer is the least common type of pharyngeal cancer)

Risk Factors

  • Excessive drinking
  • smoking
  • poor nutrition
  • male gender
  • HPV

Signs and sx

  • sore throat that does not go away
  • ear pain
  • lump in neck
  • painful or difficulty swallowing
  • change in voice
23
Q

Pharyngeal Tumors

  • Dx
  • Nasopharengeal cancer dx
  • hypopharengeal cancer dx
  • Tx
A

Dx

  • Hx and PE
  • Head, neck, and chest Xrays
  • CT/MRI/PET
  • Endoscopy
  • Bx (FNA, open bx)
  • HPV testing

Nasopharengeal cancer dx

  • nasoscopy
  • EBV test

Hypopharengeal cancer dx

  • Barium esophagogram
  • esophagoscopy
  • brochoscopy

Tx

  • Surgery is mainstay*
  • -exception: nasopharyngeal cancer is primarily treated with radiation
  • -The keratinizing form is much less responsive to radiotherapy than non-keratinizing forms that benefit from surgery
  • radiation (alone or with chemo)
  • chemo
24
Q

Laryngeal Tumors

  • most common type
  • commonly arise from what region
  • most pts have a hx of what?
A

Most common type
-SCC

Commonly arise from what region
-Glottic (vocal cords)

Most pts have a hx of what?
-smoking and alcohol use

25
Q 
Laryngeal Tumors
Describe the following subtypes
-Glottic Carcinoma
-Supraglottic carcinoma
-Subglottic carcinoma
-Transglottic carcinoma
A
  • Glottic Carcinoma: involves true vocal cords (most common)
  • Supraglottic carcinoma: confined to supraglottic area
  • Subglottic carcinoma: arise more than 10mm below free margin of vocal cords
  • Transglottic carcinoma: cross ventricle from supraglottic area to involve true and false vocal cords
26
Q

Laryngeal Tumors

  • risk factors
  • presentation
  • workup
  • tx
A

risk factors

  • tobacco/alcohol
  • poor diet and oral hygiene
  • HPV
  • GERD

presentation

  • progressive continuous hoarseness is cardinal system
  • dyspnea
  • stridor
  • dysphagia
  • have to keep lung cancer in mind

workup

  • CT/MRI/PET
  • Chest xray
  • Direct laryngoscopy (can obtain bx)
  • FNA cytology

tx

  • early stages: radiation or surgical techniques to preserve laryngeal fuction
  • advanced stages: total laryngectomy, reconstruction, and post op chemo/radiation

ENT (10 decks)

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