Warning:
JavaScript is turned OFF. None of the links on this page will work until it is reactivated.
If you need help turning JavaScript On, click here.
This Concept Map, created with IHMC CmapTools, has information related to: Head and Neck Malignancy, Head and Neck Malignancy Oropharyngeal CA -95% SqCC -Poor Px Oropharynx -Base of tongue, soft palate, uvula, tonsillar pillars, tonsils, glossotonsillar sulci, *orophary walls*, Head and Neck Malignancy Laryngeal Cancer Glottis -50-75% of laryn CA Inf border: 1cm below apex of ventricle -Stratified squamous epith -Early presentation: HOARSE -Barriers to spread: conus elasticus, vocal ligament, thyroglottic ligament) Embryology: from 6th branchial arch Invasion: through ant commissure to thy cart Spread: Nodes II, III, IV (but rare spread) Vocal fold fixation: invasion of mm, cricoarytenoid joint, or perineural, Head and Neck Malignancy Laryngeal Cancer Subglottis ɚ% -rare primary site Sx: BIPHASIC STRIDOR, etc Inf border: cricoid cart -Ciliated pseudostrat col epith -Often silent -Usually extends to cricoid cart Tx: TLx, BLT neck diss, adj XRT Px: POOR-late presentation ង% regional mets, Head and Neck Malignancy Oropharyngeal CA -95% SqCC -Poor Px Tx: Single-modality -T1-T2 w/out base of tongue Multi-modal -T3-T4 or T1,2 w/ base of tongue -excision w/ reconstruction + adj XRT vs primary XRT w/ salvage surgery N0:elective BND vs. XRT N1-N3: Rad Neck Diss, Supraglottic CA -30-40% of laryn CA Sx: sore throat, hemoptysis +generic Sx -Ciliated, pseudostratified columnar epith SUBSITES:suprahyoid epigottis, infrahyoid epiglottis (most common), AE fold, arytenoids, false cords Embryology: 3-4th branchial arches (barrier between supra and glottis) Invasion: sup/anterior-> tongue base or pre-epiglottic space (thru epi fenestra) Spread: 25-75% regional mets, to levels II, III, IV Tx Early (T1N0-T2N0) -primary external beam XRT vs. supraglottic laryngectomy N0 neck: BLT neck dissection vs elective XRT regardless of LNs N1-N3: radical neck diss for LNs Adjuvant XRT if close margins, mult (+) LNs, extracapsular, perineural/intravasc invasion, bone, cart, soft tissue, or for emergent tracheotomy (seed), Glottis -50-75% of laryn CA Inf border: 1cm below apex of ventricle -Stratified squamous epith -Early presentation: HOARSE -Barriers to spread: conus elasticus, vocal ligament, thyroglottic ligament) Embryology: from 6th branchial arch Invasion: through ant commissure to thy cart Spread: Nodes II, III, IV (but rare spread) Vocal fold fixation: invasion of mm, cricoarytenoid joint, or perineural Staging T1a: 1 vocal fold T1b: 2 vocal folds (ɝ% regional mets) T2: impaired VF mobility 5-10% mets T3: vocal fold fixation 10-20% mets T4: thyroid cart or beyond larynx: 25-40% mets, Head and Neck Malignancy Laryngeal Cancer Supraglottic CA -30-40% of laryn CA Sx: sore throat, hemoptysis +generic Sx -Ciliated, pseudostratified columnar epith SUBSITES:suprahyoid epigottis, infrahyoid epiglottis (most common), AE fold, arytenoids, false cords Embryology: 3-4th branchial arches (barrier between supra and glottis) Invasion: sup/anterior-> tongue base or pre-epiglottic space (thru epi fenestra) Spread: 25-75% regional mets, to levels II, III, IV, Head and Neck Malignancy Oral Cancer Oral Cavity -*Lips*, Ant 2/3 tongue, Floor, buccal mucosa, gingival, retromolar trigone, hard palate -post border-circumvallate papillae, ant tonsillar pillar, jcn of soft palate -Lips: 90% in lower lip, 90% SqCC, 90% 5-yr survival if T1 -Upper lip-usually Basal Cell Ca -drain to ipsi levels I-III -Lower lip- drain to BLT I-III, Supraglottic CA -30-40% of laryn CA Sx: sore throat, hemoptysis +generic Sx -Ciliated, pseudostratified columnar epith SUBSITES:suprahyoid epigottis, infrahyoid epiglottis (most common), AE fold, arytenoids, false cords Embryology: 3-4th branchial arches (barrier between supra and glottis) Invasion: sup/anterior-> tongue base or pre-epiglottic space (thru epi fenestra) Spread: 25-75% regional mets, to levels II, III, IV Tx Advanced (T3-T4) Multimodal: TLx + Adjuvant XRT vs XRT+CTX-salvage/nonoperable, Head and Neck Malignancy Oropharyngeal CA -95% SqCC -Poor Px Hypopharynx -Sup border hyoid down to inf border of cricoid -Pyriform sinus -Post. pharyngeal walls -Postcricoid region (esophageal introitus), Head and Neck Malignancy Oral Cancer T1: primary ɚcm T2: 2-4cm T3: ɰcm T4: invades adjacent -mandible, hard palate, mm of tongue, larynx, pterygoid mm, Subglottis ɚ% -rare primary site Sx: BIPHASIC STRIDOR, etc Inf border: cricoid cart -Ciliated pseudostrat col epith -Often silent -Usually extends to cricoid cart Tx: TLx, BLT neck diss, adj XRT Px: POOR-late presentation ង% regional mets Staging T1: limited to subglottis T2: involves VFs, NL mobility T3: limited to larynx, fixed VFs T4: invades thyroid cart, beyond, Head and Neck Malignancy Oropharyngeal CA -95% SqCC -Poor Px T1: primary ɚcm T2: 2-4cm T3: ɰcm T4: invades adjacent -mandible, hard palate, mm of tongue, larynx, pterygoid mm, Head and Neck Malignancy Nodal Staging N0: no regional LNs N1: mets to 1 ipsi LN ɛcm N2a: 1 ipsi LN 3-6cm N2b: 2 ipsi LN ɞcm N2c: bilat or contralat LN ɞcm N3: LN ɲcm anywhere, Glottis -50-75% of laryn CA Inf border: 1cm below apex of ventricle -Stratified squamous epith -Early presentation: HOARSE -Barriers to spread: conus elasticus, vocal ligament, thyroglottic ligament) Embryology: from 6th branchial arch Invasion: through ant commissure to thy cart Spread: Nodes II, III, IV (but rare spread) Vocal fold fixation: invasion of mm, cricoarytenoid joint, or perineural Tx Early Glottic -Single modality -limited field XRT vs surgical-cordectomy, endoscopic, partial Lx if failed/denies XRT -Neck: NO neck diss unless rare clinical LNs->mod neck diss, Head and Neck Malignancy Laryngeal Cancer Spaces -Pre-epiglottic- Sup: hypoepiglottic liga, valleculae Ant: thyrohyoid liga Post: epiglottis, thyroiepglottic liga, Head and Neck Malignancy Oral Cancer Most Common H&N Site-30% ᢒ% are SqCC, Glottis -50-75% of laryn CA Inf border: 1cm below apex of ventricle -Stratified squamous epith -Early presentation: HOARSE -Barriers to spread: conus elasticus, vocal ligament, thyroglottic ligament) Embryology: from 6th branchial arch Invasion: through ant commissure to thy cart Spread: Nodes II, III, IV (but rare spread) Vocal fold fixation: invasion of mm, cricoarytenoid joint, or perineural Tx Advanced Glottic (T3-T4) Multimodal: TLx + adj XRT vs organ preservation CTX+XRT->salvage Lx Neck: elective ipsi rad neck diss regardless of nodal status, Supraglottic CA -30-40% of laryn CA Sx: sore throat, hemoptysis +generic Sx -Ciliated, pseudostratified columnar epith SUBSITES:suprahyoid epigottis, infrahyoid epiglottis (most common), AE fold, arytenoids, false cords Embryology: 3-4th branchial arches (barrier between supra and glottis) Invasion: sup/anterior-> tongue base or pre-epiglottic space (thru epi fenestra) Spread: 25-75% regional mets, to levels II, III, IV Staging Staging: T1: one subsite (SS) - 20% mets T2: mucosa of adjacent SS or outside supraglottis - 40% T3: vocal cord fixation or in postcricoid, preepiglottic, or deep tongue base - 60% T4: invades thyroid cart, soft tissues, thyroid or esophagus - 80%, Head and Neck Malignancy Laryngeal Cancer 2nd most common - 1-5% of all CA S/Sx: Hoarseness, aspiration, sore throat, dysphagia, odynophagia, stridor, wt loss, referred otalgia, globus sensation -mostly SqCC (95%) -BASALOID SQUAMOUS-high grade, aggressive -Verrucous (Akerman's tumor)-slow -locally destructive, but rare mets -excellent Px -mostly in glottis Tx: single-modality XRT vs surgery -AdenoCA - 1% of CA - supra & subglottic (glands) -more aggressive than SqCC