Oro/Hypopharyngeal Carcinoma

Define the anatomic boundaries and discuss the lymphatic drainage of the oropharynx.

Describe epidemiology and transmission of HPV.

What are the mucosal HPV types and which are high risk? Include information on the risk of oropharyngeal cancer in patients with HPV and the relative risk of cancer in HPV compared to alcohol and tobacco.

Compare and contrast the clinical presentation, histopathology, biomarkers of HPV and non-HPV related oropharyngeal cancer.

Discuss the use of PET/CT in oropharyngeal cancer.

Reference(s):

Taghipour, M., Sheikhbahaei, S., Marashdeh, W., Solnes, L., Kiess, A., & Subramaniam, R. M. (2016). Use of 18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography for Patient Management and Outcome in Oropharyngeal Squamous Cell Carcinoma: A Review. JAMA Otolaryngology– Head & Neck Surgery, 142(1), 79–85.

A patient with tonsillar cancer complains of ipsilateral ear pain. Explain the pathways for this phenomenon.

Tell us about the 8th edition AJCC staging system for oropharyngeal cancer. What is new and different?

A healthy patient presents with a p16- T2N1M0 SCCA of the tonsil. How will you manage this patient? What if the primary was in the base of tongue? Soft palate?

How would you manage occult neck disease in soft palate vs. tonsil vs. base of tongue SCCA?

Describe surgical approaches to the oropharynx, as well as the advantages and limitations of each. Don’t forget to discuss lasers and robots!

Discuss reconstructive options after total glossectomy. What are the long-term results in terms of speech and swallow.

What is the role of organ-preservation protocols in the treatment of carcinoma of the tongue base?

Do patients with advanced oropharyngeal carcinoma benefit from concomitant chemoradiation compared with radiation therapy alone?

When should patients with advanced oropharyngeal carcinoma undergo post-treatment neck dissections?

Treatment of early stage vs locally advanced oropharyngeal cancer.

Reference(s):

Kumar, B., Cipolla, M. J., Old, M. O., Brown, N. V, Kang, S. Y., Dziegielewski, P. T., … Teknos, T. N. (2016). Surgical management of oropharyngeal squamous cell carcinoma: Survival and functional outcomes. Head & Neck, 38 Suppl 1, E1794-802.

For patients undergoing chemoradiation, should they undergo placement of prophylactic gastrostomy tube or a reactive NG tube?

Reference(s):

Sethugavalar, B., Teo, M. T., Buchan, C., Ermis, E., Williams, G. F., Sen, M., & Prestwich, R. J. D. (2016). Impact of prophylactic gastrostomy or reactive NG tube upon patient-reported long term swallow function following chemoradiotherapy for oropharyngeal carcinoma: A matched pair analysis. Oral Oncology, 59, 80–85.

Should all patients with oropharyngeal SCCA be placed on a PPI or H2 blocker?

Reference(s):

Papagerakis, S., Bellile, E., Peterson, L. A., Pliakas, M., Balaskas, K., Selman, S., … Wolf, G. (2014). Proton pump inhibitors and histamine 2 blockers are associated with improved overall survival in patients with head and neck squamous carcinoma. Cancer Prevention Research (Philadelphia, Pa.), 7(12), 1258–1269.