Amanuel Negussie DOS 531 Week I

Oropharynx Sign and Symptoms: Patients with carcinoma of oropharynx present:1 Sore throat (the most common symptom) Dysphagia (difficulty swallowing) Otalgia (ear pain) - related to anastomotictympanic nerve of Jacobson Trismus (uncontrolled inability to open the mouth or jaw) - late manifestation if masseter or pterygoid muscle is involved Mass in the cervical region Carcinoma of tonsil are usually ulcerated and sometimes exophytic

Diagnostic Procedures: Diagnostic work-up for oropharyngeal cancer includes:1 Complete blood counts, chemistry profiles, and urinalysis Physical examination: evaluation of the neck for detection of metastatic lymph nodes as well as a search for distal metastasis Digital examination: evaluation for submucosal involvement of glossopalatine sulcus, base of the tongue, buccal mucosa, or lateral pharyngeal wall Mirror or fiberoptic examination of nasopharynx, hypopharynx, and larynx: to detect tumor extension or associated pathology Panendoscopy: evaluation for second primaries in upper digestive tract Laryngoscopy Fine needle aspiration of palpable lymph nodes Imaging studies include; o Chest x-ray o Radiography of neck or mandible o Computed tomography (CT) scan

o Magnetic resonance imaging (MRI) o Radionuclide bone scan (optional)

Hypopharynx Sign and Symptoms: Patients with carcinoma of hypopharynx present:1 Mild sore throat Dysphagia (difficulty swallowing) Otalgia (ear pain) Odynophagia (painful swallowing) Blood streaked saliva (due to necrosis or trauma to tumor bed) Saliva drooling Neck stiffness Hot potato voice (due to laryngeal or base of tongue invasion) Hoarsness (due to tumor invasion of the larynx or cricoarytenoid joint) Weight loss in advanced disease Tongue paralysis (rare) (due to hypoglossal nerve invasion lymph node level II and III)

5-15% of patients with hypopharynx require emergency tracheotomy

Diagnostic Procedures: Diagnostic work-up for hypopharyngeal cancer include:1 Physical examination: indirect laryngoscopy and a flexible endoscopic Panendoscopy Fine needle aspiration Bronchoscopy (to determine the inferior tumor extension) Esophagoscopy (to determine the inferior tumor extension) Radiologic evaluation o Chest radiograph o Computed tomography (CT) scan with contrast of head and neck region o Magnetic resonance imaging (MRI)

o Contrast laryngography o Positron emission tomography (PET)

Reference 1. Perez CA, Halperin EC, Brady LW. Principle & Practice of Radiation Oncology. 4th ed.U.S.A. Lippincott Williams &Wilkins; 2004.