Download Free Medical Carcinoma of Unknown Primary: The Role of Transoral Robotic Surgery PowerPoint Presentation

Carcinoma of Unknown Primary: The Role of Transoral Robotic Surgery PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Head and Neck Cancer, which is titled "Carcinoma of Unknown Primary: The Role of Transoral Robotic Surgery", to know about carcinoma of unknown primary and the role of transoral robotic surgery.

Tags : Head, Neck Cancer, Carcinoma, Unknown Primary, Transoral Robotic Surgery

Published on : May 18, 2021 | Views : 1961 | Downloads : 3

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Carcinoma of Unknown Primary: The Role of Transoral Robotic Surgery Christine M. Kim, MS4 Georgetown University School of Medicine
Slide 2-

CC: Right neck swelling HPI: JD is a 63M initially presented to PCP with a painful R neck mass after URI, thought to be neck abscess Saw outside HNS and received antibiotics and needle aspiration showing frank pus Sent to WHC ED and admitted to HNS ROS: Negative
Slide 3-

CC: Right neck swelling PMH: HTN PSH: Lithotripsy for left renal calculus, arthroscopy R knee Meds: Atenolol-Chlorthalidone, Aspirin FamHx: Denies Social Hx: Employed as mailman. Never smoked. Occasional EtOH
Slide 4-

Physical Exam Gen: NAD, AAOx3 Eyes: EOMI, PERRLA Ant nares: Clear Ears: Clear, TM intact OC/OP: Tonsils symmetric 1+ b/l, tongue mobile, no palpable masses, no erythema Neck: Rightlevels II and III LAD. Salivary glands soft and symmetric b/l.Thyroid normal to palpation. Trachea midline, no masses or tenderness.
Slide 5-

Flexible laryngoscopy Nasal mucosa: no signs of inflammation Turbinates: normal morphology Polyps: No polyps or masses Septum: No performations Nasopharynx: No significant adenoid enlargement, eustachian tube orifices clear Oropharynx: Pharyngeal walls normal Hypopharynx: No pooling of secretions; no lesions or erythema Larynx: Vocal cord motion is normal; no lesions Vocal Folds: No vocal fold lesions
Slide 6-

CT
Slide 7-

Evaluation FNA: no signs of malignancy Taken to OR for LN biopsy and I&D of neck abscess: 2 large nodes  Frozen (+) for metastatic SCCa DL completed PET/CT
Slide 8-

PET/CT
Slide 9-

Evaluation FNA: no signs of malignancy Taken to OR for LN bx and I&D of neck abscess: 2 large nodes. Frozen positive for metastatic SCCa. DL completed PET/CT: Concordant FDG-PET and CT images with necrotic LAD R neck R MRND: 2/44 R level III nodes with metastatic SCCa Diagnosis: TxN2bM0 SCCa, primary site unknown
Slide 10-

Carcinoma of unknown primary Definition Presentation Evaluation Management Emerging diagnostic modalities - TORS Outcomes
Slide 11-

Carcinoma of unknown primary WHO definition: histologicdx of malignant neoplasm metastatic to cervical LN without identifiable 1o tumor following comprehensive evaluation SCC: 53-77% of CUP histologies1 Constitutes 2-4% of head and neck SCCa2 Presentation3 Neck mass 94-100% Pain 9% Weight loss 7% Dysphagia 4% M:F = 75% : 25% Mean age 55 1. Strojan P et al. Contemporary management of lymph node metastases from an unknown primary to the neck, I: a review of diagnostic approaches. Head Neck, 2013. 2. Nieder et al. Curr Treat Options Oncol, 2000; Karni et al; Laryngoscope, 2011 3. Issing et al; Eur Arch ORL, 2003, Grau et al; RadiotherOncol, 2000. Photo: http://www.aafp.org/afp/2002/0901/p831.html
Slide 12-

Evaluation H&N exam, FFL, CT, FNA, panendoscopy, PET/CT Directed biopsies Only 17 – 63% of primary tumors identified1,2 Failure to find primary3: Small size Cryptic location Tumor regression Most common primary sites identified in workup of CUP are palatine tonsils and BOT4 1. Mehta et al. “A new paradigm for diagnosis and management of unknown primary tumors of the head and neck: a role for transoral robotic surgery.” Laryngoscope, 2009 2. Haas I et al. “Diagnostic strategies in cervical carcinoma of an unknown primary.” Eur Arch Otorhinolaryngol 2002 3. Eisele, D. “Squamous cell carcinoma of the neck with unknown primary.” Auto-Digest Otolaryn 2013. 4. Cianchetti M et al. “Diagnostic evaluation of SCC metastatic from an unknown primary to neck: II. A review of therapeutic options.” Head Neck 2013.
Slide 13-

Waldeyer’s Ring
Slide 14-

What if 1o site is not found? Remaining true CUP cases are treated with either primary wide-field radiation or chemoradiation therapy with or without neck dissection 5-year actuarial survival1: 69% for N1 58% for N2 30% for N3 1. Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB. "Cervical lymph node metastases from unknown primary tumors.” RadiotherOncol 2005.
Slide 15-

ppt slide no 15 content not found
Slide 16-

ppt slide no 16 content not found
Slide 17-

ppt slide no 17 content not found
Slide 18-

Toxicity of chemoradiation 25% with grade 2 xerostomia 32% grade 3 radiation dermatitis 72% grade 1-2 dysphagia  95% had G tube for median of 6 mo 50% grade 3 mucositis 46% esophageal stricture 40% skin fibrosis Madani I, Vakaet L, Bonte K, Boterberg T, De Neve W. Intensity-modulated radiotherapy for cervical lymph node metastases from unknown primary cancer. Int J RadiatOncolBiolPhys 2008. Top photo: http://www.headandneckcancerpatient.com/uploads/1/3/8/1/1381721/1368688.jpg?922. Bottom photo: http://ida.cdeworld.com/courses/4587-Oral_Pretreatment_of_the_Cancer_Patient
Slide 19-

N=44 CUP patients from the University of Pittsburgh Match-paired analyses Improved overall, disease-free, and cause-specific survival
Slide 20-

5-year overall survival: 95.7% (1o found) vs. 52% (1o not found)
Slide 21-

TORS daVinci robot system with 3D magnified view Improved visualization Freedom of motion Access to OP subsites Useful for both ablative purposes and potentially as diagnostic modality Top: http://www.uphs.upenn.edu/pennorl/education/images/daVinci_ Machine2.jpg Bottom: http://www.medicalgrapevineasia.com/mg/2013/03/17/ minimally-invasive-head-and-neck-surgery/
Slide 22-

N = 10 CUP patients from the University of Pittsburgh All patients underwent cervical bx, PET/CT, formal endoscopy, bilateral tonsillectomy, random bx BOT When 1o site not found  TORS lingual tonsillectomy 9/10 (90%) with pathologic exam revealing invasive SCCa Mean diameter = 0.9 cm
Slide 23-

Multi-institutional study: University of Washington, MD Anderson, University of Alabama-Birmingham, UT-Houston, Johns Hopkins, Oregon Health Sciences N = 47 patients with CUP Tumor siteidentified by TORS in 34 of 47 (72.3%) 18 with no suspicious findings  72.2% identified Suggests that regardless of the preoperative findings, TORS had a consistently high diagnostic rate JAMA Otolaryngol Head Neck Surg. 2013
Slide 24-

Primary identified Management appropriate for size and extent of disease Allows options for surgical resection Better definition of primary tumor target volume Focused radiation field Assists in post-treatment surveillance Eisele, D. “Squamous cell carcinoma of the neck with unknown primary.” Auto-Digest Otolaryngology 2013.
Slide 25-

N = 22 at Ohio State University Long-term QOL scores collected at baseline, 3 weeks, 3 months, 6 months, 12 months post-op Four domains: speech, eating, aesthetics, social disruptions
Slide 26-

ppt slide no 26 content not found
Slide 27-

Patient JD Palatine tonsillectomy and TORS lingual tonsillectomy Path: Infiltrating SCC, moderately differentiated, left BOT Chemoradiation for definitive treatment
Slide 28-

Conclusions CUP is a devastating diagnosis with previously poor treatment options and prognoses Wide-field radiation therapy causes significant morbidity Finding primary site leads to much better survival outcomes TORS has potential to improve both discovery of primary tumor sites and overall survival in these pts Analysis of quality-of-life studies after TORS has shown minimal disruptions in day-to-day functions
Slide 29-

Thank you
Slide 30-

TORS Quality-of-Life study SCC detected in palatine tonsil in 12 pts (54.5%) and BOT in four pts (18.2%) No primary tumor identified in six patients (27.3%) Complete tumor resection with negative margins achieved in 12 of 16 pts (75%)
Slide 31-

SCC detected in palatine tonsil in 12 pts (54.5%) and BOT in four pts (18.2%) No primary tumor identified in six patients (27.3%) Complete tumor resection with negative margins achieved in 12 of 16 pts (75%)
Slide 32-

Grau et al; RadiotherOncol, 2000
Slide 33-

ppt slide no 33 content not found
Slide 34-

ppt slide no 34 content not found