1.07 - H&N Cancer

Question 1

What percentage of brain tumours are benign?

Answer 1

50%

Question 2

What causes the signs and symptoms associated with brain tumours?

Answer 2

• local brain invasion
• increased intracranial pressure
• compression of adjacent structures

Question 3

What is the location and function of oligodendrocytes?

Answer 3

Location: CNS

Function: myelination of axons and electrical insulation.

Question 4

What is the location and function of Schwann cells?

Answer 4

Location: PNS

Function: myelination of axons and electrical insulation.

Question 5

What is the location and function of astrocytes?

Answer 5

Location: CNS

Function: Repair processes and establishing the blood brain barrier.

Question 6

What is the location and function of ependymal cells?

Answer 6

Location: CNS

Function: Single-layered columnar and cuboidal cells that line the ventricles and the central canal.

Question 7

What is the location and function of microglial cells?

Answer 7

Location: CNS

Function: Protective and phagocytic immune-based function.

Question 8

What is the location and function of satellite cells?

Answer 8

Location: PNS

Function: Cover the PNS ganglia for support.

Question 9

Location of brain mass and respective deficit / symptom.

Temporal lobe.

Answer 9

• Wernicke’s aphasia
• homonymous superior quadranopsia
• mild contralateral facial weakness

Question 10

Location of brain mass and respective deficit / symptom.

Frontal lobe.

Answer 10

• drowsiness
• decreased attention
• seizures
• altered judgement

Question 11

Location of brain mass and respective deficit / symptom.

Parietal lobe.

Answer 11

• impaired position sense
• focal sensory and motor seizures
• homonymous hemianopsia

Question 12

Location of brain mass and respective deficit / symptom.

Cerebellum.

Answer 12

• ataxia
• nystagmus
• ipsilateral incoordination of arm and leg movements with intention tremor

Question 13

Location of brain mass and respective deficit / symptom.

Brainstem.

Answer 13

• facial weakness
• dysphagia
• cranial nerve palsy

Question 14

Most frequently occurring primary brain tumours.

Answer 14

Gliomas.

Question 15

Risk factors for brain tumours.

Answer 15

• 50-55 years old
• male > female
• synthetic rubber
• vinyl chloride

Question 16

Signs and symptoms of gliomas.

Answer 16

• headaches
• seizures
• memory loss
• motor weakness
• visual symptoms
• language deficit
• cognitive / personality change

Question 17

Headache features of gliomas.

Answer 17

• headache on exertion
• headache onset at night or early morning
• headache with neurological signs
• valsalva worsening (ie. coughing, sneezing, bending over)

Question 18

Examination of gliomas.

Answer 18

• mental status
• cranial nerve exam
• motor system exam
• reflexes
• sensation

Question 19

Gold standard imaging for gliomas.

Answer 19

Gadolinium-enhanced MRI.

Question 20

Management of gliomas.

Answer 20

• maximal surgical resection
• adjuvent chemotherapy
• post-operative radiation

Question 21

Prognostic factors for CNS tumours.

Answer 21

• age
• tumour grade
• extent of surgical resection
• molecular alterations
• KPS score

Question 22

Most common type of oral cancer.

Answer 22

• squamous cell carcinoma

Question 23

Risk factors for oral cavity cancer (OCC).

Answer 23

• tobacco
• alcohol use
• sun exposure
• betel nut chewing
• previous radiation exposure
• poor oral hygiene

Question 24

Premalignant conditions of the oral cavity.

Answer 24

• leukoplakia: white, well-defined keratotic pathces)
• erythroplakia: red mucosal plaques

Both are caused by chronic inflammation.

Question 25

Prevention of oral cavity cancer.

Answer 25

- avoidance of tobacco - alcohol avoidance - good oral hygiene - regular dental appointments - HPV vaccination

Question 26

Symptoms of oral cavity cancer.

Answer 26

- painful oral lesion / mass - oral cavity bleeding - loose teeth - dysphagia - halitosis - numbness of lower teeth - referred otalgia (CNVc)

Question 27

Signs of oral cavity cancer.

Answer 27

- asymmetry on tongue extension - trismus - halitosis - numbness of lower teeth

Question 28

Imaging of oral cavity cancer.

Answer 28

- biopsy on initial presentation - CT / MRI

Question 29

Treatment of oral cavity cancer.

Answer 29

- surgical resection - radiation therapy - chemotherapy - targeted therapy - immunotherapy

Question 30

Prognostic factors for oral cavity cancer.

Answer 30

- depth of tumour invasion - close surgical margins - positive cervical nodes - extracapsular spread

Question 31

Layers of the eye.

Answer 31

1) sclera - white outer part visible to the eye. 2) uvea - heavily pigmented and vascular, providing nutrients to the retina and lens. 3) retina - nerve fibres that sense light that are sent through the optic nerve to the brain.

Question 32

Components of the uveal tract.

Answer 32

1. Iris 2. Ciliary body 3. Choroid

Question 33

Function of the iris.

Answer 33

Sphincter pupillae constrict the pupil in bright light (parasympathetic). Dilator pupillae dilate the pupil in dark light (sympathetic).

Question 34

Function of the ciliary body.

Answer 34

Ciliary smooth muscle fibres result in the accommodation reflex under parasympathetic control. Contains epithelial cells that produce aqueous humour.

Question 35

Most common primary intraocular malignancy.

Answer 35

Uveal melanoma

Question 36

Risk factors for uveal melanoma.

Answer 36

- fair skin - BRCA1 mutation - family history - UV light exposure -

Question 37

Risk factors that dispose pre-existing iris nevi into developing malignancy.

Answer 37

ABCDEF risk factors: Age at presentation ≤40 years Blood (spontaneous hyphema) Clock hour location (inferior quadrant) Diffuse involvement of the entire iris Ectropion uvaea Feathery edges

Question 38

Presentation of uveal melanoma.

Answer 38

- incidental finding on ophthalmic examination - vision loss - flashes / floaters

Question 39

Imaging for uveal melanoma.

Answer 39

Optical coherence tomography (OCT).

Question 40

Treatment of uveal melanoma.

Answer 40

- observation - radiation - laser therapy - surgical resection - thermotherapy

Question 41

Risk factors for thyroid cancer.

Answer 41

- radiation exposure - female sex - FAP - chronic TSH elevation - goitre

Question 42

Prevention of thyroid cancer.

Answer 42

Diet with adequate amounts of iodine.

Question 43

Signs and symptoms of thyroid cancer.

Answer 43

- painless swelling in neck - goitre / tight collar - persistant cough - dysphagia - difficulty breathing - hoarseness of voice

Question 44

Diagnostic workup of thyroid nodule.

Answer 44

- neck ultrasound - fine need aspiration

Question 45

Most common type of thyroid cancer.

Answer 45

- papillary carcinoma (80%) - follicular carcinoma - anaplastic carcinoma (<1%) Anaplastic carcinoma is the most aggressive type and is fast growing with early spread.

Question 46

What is the difference in matastatic spread between papillary carcinoma vs follicular carcinoma.

Answer 46

Papillary carcinoma: lymphatic metastasis. Follicular carcinoma: haematogenous metastasis.