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    耳鼻喉科 分級與對應治療總整理

    國考筆記
    二階國考 耳鼻喉科
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      TinyNotes last edited by TinyNotes

      0_1498203482987_耳鼻喉科.png

      鼻咽癌NPC (TNM參考即可)[i][ii]

      • 和EBV有關、東南亞多、男性較多、成人頸部腫塊、中耳炎要想到

      • 組織可以分成有角化(預後最差)/沒有角化(再分成『有分化』『沒分化』)
        →EBV感染造成的NPC,屬於沒有角化且沒分化(type III),比例高預後佳

      • TMN staging (2010)
        T1:侷限在鼻腔/或延伸到口咽/鼻部、但是沒有鼻咽旁侵犯
        T2:鼻咽旁(parapharyngeal)侵犯
        T3:侵犯到顱底、鼻竇
        T4:侵犯到顱內、腦神經、下咽部、顳下窩、眼窩等
        N1:小於6cm,單側頸淋巴轉移;單/雙側咽後轉移
        N2:小於6cm,雙側頸淋巴轉移;N3:大於6公分/鎖骨上轉移

      • Stage 1:T1N0;Stage 2:T1N1、T2N0、T2N1
        Stage 4:有T4、N3、轉移都直接算到第四期
        其他都第三期

      • 治療:對放射線敏感,扮演重要的腳色!
        Stage I:R/T
        Stage II:CCRT
        Stage III~IVB:CCRT (是否加adjuvant C/T仍有爭議)
        Stage IVC:化療

      口腔癌(TNM參考即可)[iii][iv]

      • 口腔癌以SCC最常見,癌前病灶包括白斑leukoplakia和紅斑erythroplakia

      • TNM staging (2010)
        T1:腫瘤最大徑小於2cm
        T2:最大徑2-4cm
        T3:最大徑超過4cm
        T4a:中度局部侵犯能力;T4b:高度局部侵犯能力

        N1:同側、小於3cm
        N2:同側 3-6cm;同側多顆(<6cm);雙側(<6cm)
        N3:大於6cm

      • Stage I:T1N0
        Stage II:T2N0
        Stage IV:只要到N3、T4b、M1→都是第四期
        其他都是第三期

      • 治療

        • 第一第二期:手術為主;margin若太近或不乾淨,建議再開刀

        • 第三期與第四期:手術(包含modified radical neck dissection)+術後RT
          如果開刀的margin不clear,考慮做術後CCRT

      喉癌[v][vi]

      • 喉癌以SCC為主,可以分成聲門、聲門上(supra-)、聲門下(sub-)腫瘤

      • 聲門癌最常見(60-70%),淋巴循環少,較不易造成淋巴轉移
        聲門上癌(30-40%):淋巴循環豐富,最易發生淋巴轉移
        聲門下癌最少見,淋巴循環少,不易發生淋巴轉移

      • TNM請自行查閱

      • 治療

        • 早期(stage I和II)
          →放射線治療 或是 喉部保留手術
          →若是聲門上癌,建議同時做頸部治療(至少清II~IV的淋巴結)
          →術後若margin不乾淨、合併淋巴血管侵犯→做R/T

        • Stage III和IV:優先選擇功能性器官保留策略
          →包括CCRT、induction C/T後給R/T等
          →如果不適合功能性器官保留策略,考慮全喉切除

      Reference

      [i] Hui EP, Chan AT, Le QT (2016). Treatment of early and locoreginally advanced nasopharyngeal carcinoma. Retreived 2016 Jul 25th from www.uptodate.com
      [ii] Hui EP, Chan AT, Le QT (2016). Treatment of recurrent and metastatic nasopharyngeal carcinoma. Retreived 2016 Jul 25th from www.uptodate.com
      [iii] Gross ND, Lee NY, Okuno S, Rao SS (2015). Treatment of early (stage I and II) head and neck cancer: The oral cavity. Retreived 2016 Jul 25th from www.uptodate.com
      [iv] Gross ND, Lee NY, Okuno S, Rao SS (2014). Treatment of advanced (stage III and IV) head and neck cancer: The oral cavity. Retreived 2016 Jul 25th from www.uptodate.com
      [v] Sher DJ, Stenson KM, Brockstein BE (2016). Treatment of early (stage I and II) head and neck cancer: The larynx and hypopharynx. Retrieved 2016 Jul 25th from www.uptodate.com
      [vi] Sher DJ, Stenson KM, Brockstein BE (2016). Treatment of locoregionally advanced (stage III and IV) head and neck cancer: The larynx and hypopharynx. Retrieved 2016 Jul 25th from www.uptodate.com

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