Bondad, Shehada M

BSN-4

1. What are the staging of Throat Cancer? Discuss each.

>Throat cancer (laryngeal cancer) is a general term that usually refers to
cancer of the pharynx and/or larynx (voice box). Regions included when
considering throat cancer include the pharynx (nasopharynx, oropharynx,
hypopharynx [cancers that occur in the tissues of the throat adjacent to the larynx],
glottis, supraglottis, and subglottis); about half of throat cancers develop in the
larynx (the part of the throat with the vocal cords), and the other half in the pharynx
(pharyngeal cancer).

 Stage 0 – Potentially cancerous cells develop in the throat but aren’t found
anywhere else. 
 Stage I – Tumor in the throat is less than 2 centimeters and has yet to spread
to a lymph node or local organ. As mentioned before, if not caught in time,
throat cancer patients may be contributing to the onset of esophageal cancer,
oropharyngeal cancer, or lung cancer.
 Stage II – Tumor is more than 2 centimeters but less than 4 centimeters.
Cancer has not reached the lymph nodes or other parts of the body. 
 Stage III – Tumor is larger than 4 centimeters or has spread to 1 or 2 lymph
nodes. It hasn’t yet spread elsewhere. Though tumor growth has increased,
the cancer cells haven’t spread elsewhere. 
 Stage IV – Tumor can be of any size, but cancer cells have spread to large
lymph nodes, local organs, or further regions of the body. At this point, the
 cancer patient must see an oncologist or cancer center as stage IV is the most
critical stage of the disease. 
Stages of supraglottic laryngeal cancer

AJCC stag Stage Stage description*

e grouping

0 Tis The tumor is only in the top layer of cells lining the inside
  N0 of the larynx and has not grown any deeper (Tis).
M0
The cancer has not spread to nearby lymph nodes (N0)
or to distant parts of the body (M0).

I T1 The tumor has grown deeper, but it is only in one part of

N0 the supraglottis, and the vocal cords move normally (T1).
M0
The cancer has not spread to nearby lymph nodes (N0)
or to distant parts of the body (M0).

II T2 The tumor has grown deeper, and it has grown into more
N0 than one part of the supraglottis (or glottis), and the
M0 vocal cords move normally (T2).

The cancer has not spread to nearby lymph nodes (N0)

or to distant parts of the body (M0).

  T3 The tumor is still only in the larynx, but it has caused a

N0 vocal cord to stop moving, OR the tumor is growing into
III M0 nearby areas such as the postcricoid area, paraglottic
space, pre-epiglottic (in front of the epiglottis) tissues, or
the inner part of the thyroid cartilage (firm tissue that
separates the thyroid gland from the front of the larynx)
 (T3).

The cancer has not spread to nearby lymph nodes (N0)

or to distant parts of the body (M0).

OR

T1 to T3 The tumor might or might not have grown into structures

N1 just outside the larynx, and it might or might not have
M0 affected a vocal cord (T1 to T3). The cancer has spread to
a single lymph node on the same side of the neck as the
tumor, which is no larger than 3 centimeters (cm) across
(N1).

The cancer has not spread to distant parts of the body

(M0).

  T4a The tumor has grown through the thyroid cartilage

N0 or N1 and/or is growing into tissues beyond the larynx (such as
IVA M0 the thyroid gland, trachea, esophagus, tongue muscles, or
neck muscles). This is also known as moderately
advanced local disease (T4a).

The cancer has not spread to nearby lymph nodes (N0),

or it has spread to a single lymph node on the same side
of the neck as the tumor, which is no larger than 3
centimeters (cm) across (N1). The cancer has not spread
to distant parts of the body (M0).

OR

T1-T4a The tumor might or might not have grown into structures
N2 outside the larynx (as far as moderately advanced
 M0 disease), and it might or might not have affected a vocal
cord (T1 to T4a). The cancer is N2:

 It has spread to a single lymph node on the same

side of the neck as the tumor, which is larger than
3 centimeters (cm) but no larger than 6 cm across,
OR
 It has spread to more than one lymph node on the
same side of the neck as the tumor, none of which
is larger than 6 cm across, OR
 It has spread to at least one lymph node on the
other side of the neck, none of which is larger than
6 cm across.

The cancer has not spread to distant parts of the body

(M0).

  T4b The tumor is growing into the area in front of the spine in
Any N the neck (the prevertebral space), surrounds a carotid
IVB M0 artery, or is growing down into the space between the
lungs. This is also known as very advanced local
disease (T4b).

The cancer might or might not have spread to nearby

lymph nodes (any N). It has not spread to distant parts of
the body (M0).

OR

Any T The tumor might or might not have grown into structures
N3 outside the larynx, and it might or might not have
M0 affected a vocal cord (any T).

The cancer has spread to at least one lymph node that is

 larger than 6 cm across, OR it has spread to a lymph node
and then grown outside of the lymph node (N3). It has
not spread to distant parts of the body (M0).

IVC Any T The tumor might or might not have grown into structures
Any N outside the larynx, and it might or might not have
M1 affected a vocal cord (any T).

The cancer might or might not have spread to nearby

lymph nodes (any N). The cancer has spread to distant
parts of the body (M1).

* The following additional categories are not listed on the table above: 

 TX: Main tumor cannot be assessed due to lack of information.

 NX: Regional lymph nodes cannot be assessed due to lack of information. 
 
Stages of glottic laryngeal cancer

AJCC stag Stage Stage description*

e grouping

0 Tis The tumor is only in the top layer of cells lining the inside
  N0 of the larynx and has not grown any deeper (Tis).
M0
The cancer has not spread to nearby lymph nodes (N0)
or to distant parts of the body (M0).

I T1 The tumor has grown deeper, but it is only in the vocal

N0 cords, and they move normally (T1).
M0
The cancer has not spread to nearby lymph nodes (N0)
 or to distant parts of the body (M0).

II T2 The tumor has grown into the supraglottis or subglottis,

N0 and/or the vocal cords do not move normally (T2).
M0
The cancer has not spread to nearby lymph nodes (N0)
or to distant parts of the body (M0).

  T3 The tumor is still only in the larynx, but it has caused a

N0 vocal cord to stop moving, OR the tumor is growing into
III M0 the paraglottic space, OR the tumor is growing into the
inner part of the thyroid cartilage (firm tissue that
separates the thyroid gland from the front of the larynx)
(T3).

The cancer has not spread to nearby lymph nodes (N0)

or to distant parts of the body (M0).

OR

T1 to T3 The tumor might or might not have grown into structures

N1 just outside the larynx, and it might or might not have
M0 affected a vocal cord (T1 to T3).

The cancer has spread to a single lymph node on the

same side of the neck as the tumor, which is no larger
than 3 centimeters (cm) across (N1). The cancer has not
spread to distant parts of the body (M0).

  T4a The tumor has grown through the thyroid cartilage

N0 or N1 and/or is growing into tissues beyond the larynx (such as
IVA M0 the thyroid gland, trachea, cricoid cartilage, esophagus,
tongue muscles, or neck muscles). This is also known
 as moderately advanced local disease (T4a).

The cancer has not spread to nearby lymph nodes (N0),

or it has spread to a single lymph node on the same side
of the neck as the tumor, which is no larger than 3
centimeters (cm) across (N1). The cancer has not spread
to distant parts of the body (M0).

OR

T1-T4a The tumor might or might not have grown into structures
N2 outside the larynx (as far as moderately advanced
M0 disease), and it might or might not have affected a vocal
cord (T1 to T4a). The cancer is N2:

 It has spread to a single lymph node on the same

side of the neck as the tumor, which is larger than
3 centimeters (cm) but no larger than 6 cm across,
OR
 It has spread to more than one lymph node on the
same side of the neck as the tumor, none of which
is larger t han 6 cm across, OR
 It has spread to at least one lymph node on the
other side of the neck, none of which is larger than
6 cm across.

The cancer has not spread to distant parts of the body

(M0).

  T4b The tumor is growing into the area in front of the spine in
Any N the neck (the prevertebral space), surrounds a carotid
IVB M0 artery, or is growing down into the space between the
lungs. This is also known as very advanced local
disease (T4b). The cancer might or might not have
 spread to nearby lymph nodes (any N). It has not spread
to distant parts of the body (M0).

OR

Any T The tumor might or might not have grown into structures
N3 outside the larynx, and it might or might not have
M0 affected a vocal cord (any T).

The cancer has spread to at least one lymph node that is

larger than 6 cm across, OR it has spread to a lymph node
and then grown outside of the lymph node (N3). It has
not spread to distant parts of the body (M0).

IVC Any T The tumor might or might not have grown into structures
Any N outside the larynx, and it might or might not have
M1 affected a vocal cord (any T).

The cancer might or might not have spread to nearby

lymph nodes (any N). The cancer has spread to distant
parts of the body (M1).

* The following additional categories are not listed on the table above: 

 TX: Main tumor cannot be assessed due to lack of information.

 NX: Regional lymph nodes cannot be assessed due to lack of information. 
 

Stages of subglottic laryngeal cancer

AJCC stag Stage Stage description*
e grouping

0 Tis The tumor is only in the top layer of cells lining the inside
  N0 of the larynx and has not grown any deeper (Tis).
M0
The cancer has not spread to nearby lymph nodes (N0)
or to distant parts of the body (M0).

I T1 The tumor has grown deeper, but it is only in the

N0 subglottis (T1).
M0
The cancer has not spread to nearby lymph nodes (N0)
or to distant parts of the body (M0).

II T2 The tumor has grown into the vocal cords, which might
N0 or might not move normally (T2).
M0
The cancer has not spread to nearby lymph nodes (N0)
or to distant parts of the body (M0).

  T3 The tumor is still only in the larynx, but it has caused a

N0 vocal cord to stop moving, OR the tumor is growing into
III M0 the paraglottic space, OR the tumor is growing into the
inner part of the thyroid cartilage (firm tissue that
separates the thyroid gland from the front of the larynx)
(T3).

The cancer has not spread to nearby lymph nodes (N0)

or to distant parts of the body (M0).

OR
 T1 to T3 The tumor might or might not have grown into structures
N1 just outside the larynx, and it might or might not have
M0 affected a vocal cord (T1 to T3).

The cancer has spread to a single lymph node on the

same side of the neck as the tumor, which is no larger
than 3 centimeters (cm) across (N1). The cancer has not
spread to distant parts of the body (M0).

  T4a The tumor is growing through the cricoid or thyroid

N0 or N1 cartilage and/or is growing into structures beyond the
IVA M0 larynx (such as the thyroid gland, trachea, esophagus,
tongue muscles, or neck muscles). This is also known
as moderately advanced local disease (T4a).

The cancer has not spread to nearby lymph nodes (N0),

or it has spread to a single lymph node on the same side
of the neck as the tumor, which is no larger than 3
centimeters (cm) across (N1). The cancer has not spread
to distant parts of the body (M0).

OR

T1-T4a The tumor might or might not have grown into structures
N2 outside the larynx (as far as moderately advanced
M0 disease), and it might or might not have affected a vocal
cord (T1 to T4a). The cancer is N2:

 It has spread to a single lymph node on the same

side of the neck as the tumor, which is larger than
3 centimeters (cm) but no larger than 6 cm across,
OR
 It has spread to more than one lymph node on the
same side of the neck as the tumor, none of which
 is larger than 6 cm across, OR
 It has spread to at least one lymph node on the
other side of the neck, none of which is larger than
6 cm across.

The cancer has not spread to distant parts of the body

(M0).

  T4b The tumor is growing into the area in front of the spine in
Any N the neck (the prevertebral space), surrounds a carotid
IVB M0 artery, or is growing down into the space between the
lungs. This is also known as very advanced local
disease (T4b).

The cancer might or might not have spread to nearby

lymph nodes (any N). It has not spread to distant parts of
the body (M0).

OR

Any T The tumor might or might not have grown into structures
N3 outside the larynx, and it might or might not have
M0 affected a vocal cord (any T).

The cancer has spread to at least one lymph node that is

larger than 6 cm across, OR it has spread to a lymph node
and then grown outside of the lymph node (N3). It has
not spread to distant parts of the body (M0).

IVC Any T The tumor might or might not have grown into structures
Any N outside the larynx, and it might or might not have
M1 affected a vocal cord (any T).

The cancer might or might not have spread to nearby

 lymph nodes (any N). The cancer has spread to distant
parts of the body (M1).

2. What are the targeted therapy use din Thyroid Cancer?

The treatment options for thyroid cancer might include:
> Surgery is the main treatment in nearly every case of thyroid cancer, except for
some anaplastic thyroid cancers. If thyroid cancer is diagnosed by a fine needle
aspiration (FNA) biopsy, surgery to remove the tumor and all or part of the
remaining thyroid gland is usually recommended.
>Thyroidectomy
>Lymph node removal
>Lobectomy

 Radioactive Iodine (Radioiodine) Therapy for Thyroid Cancer

 This treatment can be used to ablate (destroy) any thyroid tissue not
removed by surgery or to treat some types of thyroid cancer that have
spread to lymph nodes and other parts of the body.
 Radioactive iodine therapy helps people live longer if they have
papillary or follicular thyroid cancer (differentiated thyroid cancer)
that has spread to the neck or other body parts, and it is now standard
practice in such cases. But the benefits of RAI therapy are less clear
for people with small cancers of the thyroid gland that do not seem to
have spread, which can often be removed completely with surgery.

 Thyroid Hormone Therapy

 thyroid hormone (levothyroxine) pills to replace the natural hormone
and help maintain normal metabolism and possibly lower your risk of
the cancer coming back.

 External Beam Radiation Therapy for Thyroid Cancer

>External beam radiation therapy uses high-energy rays (or particles) to
destroy cancer cells or slow their growth. A carefully focused beam of
radiation is delivered from a machine outside the body.
 This type of radiation therapy is most often used to treat medullary thyroid
cancer and anaplastic thyroid cancer. For cancers that take up iodine (most
differentiated thyroid cancers) radioiodine therapy is usually a better
treatment.

 Chemotherapy for Thyroid Cancer

> Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein
or are taken by mouth. Chemotherapy is systemic therapy, which means that
the drug enters the bloodstream and travels throughout the body to reach
and destroy cancer cells.

 Targeted Drug Therapy for Thyroid Cancer

> The types of targeted drugs used to treat thyroid cancer are known
as kinase inhibitors. Kinases are proteins inside cells that normally relay
signals (such as telling the cell to grow). Blocking certain kinases can help
treat some cancers.
> Multikinase inhibitors
> RET inhibitors
> NTRK inhibitors

3. What is Glottic Cancer? What are the types? Discuss each.

 Glottic cancer is a malignancy of the larynx that involves the true
vocal cords and anterior and posterior commissures. Because of its
anatomical location, it can have profound effects on the basic vital
functions including, breathing, swallowing, voice, and, ultimately,
mortality.

CANCER TYPES:
Squamous cell carcinoma develops in the thin, flat cells that line much of the
throat. These cells look like fish scales when checked under a microscope. This type
of throat cancer is the most common in the United States.
Adenocarcinoma begins in the glandular cells of the throat.

Sarcoma is a less common type of throat cancer that develops in the muscle fibers
of the neck.

Laryngeal cancer and pharyngeal cancer are two of the most common types of
throat cancer.

Pharyngeal cancer is categorized by three types:

 Nasopharynx cancer forms in the upper part of the throat, behind the nose.
 Oropharynx cancer forms in the middle part of the throat, behind the mouth.
 Hypopharynx cancer forms in the bottom part of the throat, just above the
larynx, or voice box.

Laryngeal cancer refers to cancer that forms in the larynx. Treatments for cancer of
the larynx often depend on where the disease forms, whether it is above the glottis,
which is the part of the larynx consisting of the vocal cords and the opening between
them, below the glottis, or on the vocal cords themselves. Aside from squamous cell
carcinoma and adenocarcinoma, other types of laryngeal cancer are
lymphoepithelioma, spindle cell carcinoma, verrucous cancer, undifferentiated
carcinoma and cancers of the lymph nodes, which are called lymphomas.

4. What are alternative treatment for thyroid CA?

 Targeted Drug Therapy for Thyroid Cancer
> The types of targeted drugs used to treat thyroid cancer are known
as kinase inhibitors. Kinases are proteins inside cells that normally relay
signals (such as telling the cell to grow). Blocking certain kinases can help
treat some cancers.
> Multikinase inhibitors
> RET inhibitors
> NTRK inhibitors

5. What is Oral Squamous cell carcinoma?

>is cancer of the lining of the lips, mouth, or upper throat. In the mouth, it most
commonly starts as a painless white patch, that thickens, develops red patches, an
ulcer, and continues to grow. When on the lips, it commonly looks like a persistent
crusting ulcer that does not heal, and slowly grows.
Causes
 Tobacco
 Alcohol
 Human papillomavirus
 Betel nut
  Stem cell transplantation
 Premalignant lesions

OSCC may manifest as the following:

 A red lesion (erythroplakia)
 A granular ulcer with fissuring or raised exophytic margins
 A white or mixed white and red lesion
 An indurated lump/ulcer (ie, a firm infiltration beneath the mucosa)
 A nonhealing extraction socket
 A lesion fixed to deeper tissues or to overlying skin or mucosa
 Cervical lymph node enlargement, especially if hardness is present in a
lymph node or fixation. Enlarged nodes in a patient with oral carcinoma may
be caused by infection, reactive hyperplasia secondary to the tumor, or
metastatic disease. Occasionally, a lymph node is detected in the absence of
any obvious primary tumor. Nodal enlargement is a feature particularly in
oropharyngeal cancers

6. What are the test used to diagnose OSCC? Discuss how?

 better assess the size of the lesion (CT scan, MRI or PET scan with 18F-

fluorodeoxyglucose (FDG).
 look for other cancers in the upper aerodigestive tract (which may
include endoscopy of the nasal cavity/pharynx, larynx, bronchus,
and esophagus called panendoscopy or quadoscopy),
 spread to the lymph nodes (CT scan) or
 spread to other parts of the body (chest X-ray, nuclear medicine).
>Other, more invasive tests, may also be completed such as fine needle
aspiration, biopsy of lymph nodes, and sentinel node biopsy. When the cancer has
spread to lymph nodes, their exact location, size, and spread beyond the capsule (of
the lymph nodes) needs to be determined, as each can have a significant impact on
treatment and prognosis. Small differences in the pattern of lymph node spread, can
have a significant impact on treatment and prognosis. Panendoscopy may be
recommended, because the tissues of the entire upper aerodigestive tract are
generally affected by the same carcinogens, so other primary cancers are a common
occurrence.

7. How can IRON DEFICIENCY affect then development of Oral cancer?

> anemia reduces the number of red blood cells present, one common symptom is
paleness in the gums, which some have come to consider anemia gums. Instead of a
normal, healthy pink, they begin to take on a faded or even whiter shade of their
normal color. This paleness can also affect the tongue and the mucous membranes
inside your mouth, as well as your palms and the linings of your eyes.

8. Discuss the staging of oral Cancer.

TNM classification cancer of the oral cavity (does not apply to HPV+ or HPV-
oralpharyngeal cancers)

T: Primary tumor

TX Primary tumor cannot be assessed

Ti
Carcinoma in situ
s

T1 Tumor ≤ 2 cm with depth of invasion (DOI*) ≤5mm

Tumor ≤ 2 cm with DOI* >5mm or tumor >2 cm and ≤ 4 cm with DOI*
T2
≥10mm

Tumor > 2 cm and ≤4 cm with DOI* > 10mm or tumor >4 cm with DOI* ≤
T3
10mm

T4 Moderately advanced or very advanced local disease

T4a Moderately advanced local disease, tumor >4 cm with DOI*

>10mm or tumor invades adjacent structures only (cortical bone of
the mandible or maxilla (excluding superficial erosion of tooth
socket alone in gingival tumors) or involves the maxillary sinus or
 skin of the face)

Very advanced local disease. Tumor invades masticator space,

T4b pterygoid plates, or skull base and/or encases the internal carotid
artery

*DOI is depth of invasion and not tumor thickness.

N: Clinical Lymph nodes (separate classification for pathologic

classification)

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single ipsilateral lymph node, <3 cm and ENE(−)

Metastasis in a single ipsilateral lymph node, ≤3 cm or smaller and ENE(+)

or >3 cm and ≤6 cm and ENE(−); or metastases in multiple ispsilateral
N2
lymph nodes, none >6 cm and ENE(−); or in bilateral
or contralateral lymph nodes(s), non >6 cm ENE(−)

Metastasis in a single ipsilateral node <3 cm and ENE(+); or a single

N2a
ipsilatereral node ≥3 cm and <6 cm and ENE(−)

N2b Metastases in multiple ipsilateral nodes, <6 cm and ENE(−)

Metastases in bilateral or contralateral lymph nodes(s); <6 cm and

N2c
ENE(−)

Metastasis in a lymph node ≥6 cm and ENE(−); or metastasis in any

N3
nbodes(s) and clinically overt ENE(+)
 N3a Metastasis in a lymph node ≥6 cm and ENE(−)

N3b Metastasis in any nodes(s) and clinically overt ENE(+)

Note: A designation of "U" or "L" may be used for any N category to indicate
metastasis above (U) or below (L) the lower border of the cricoid. ENE(+/−)
indicates presence or absence of extranodal disease

M: Metastasis

cM0 No distant metastasis

cM1 Distant metastasis

pM1 Distant metastasis, microscopically confirmed

Spread of cancer beyond the capsule of a lymph node (ENE+).

TMN evaluation allows the person to be classified into a prognostic staging group; [38]

AJCC Prognostic Stage Groups[38]

When T is... And N is... And M is... Then the stage group is...

Tis N0 M0 0

T1 N0 M0 I

T2 N0 M0 II

T3 N0 M0 III
 T1,T2,T3 N1 M0 III

T4a N0,N1 M0 IVA

T1,T2,T3,T4
N2 M0 IVA
a

Any T N3 M0 IVB

T4b Any N M0 IVB

Any T Any N M1 IVC