24 Neoplastic - OC/OP/HP/Mandible

Question 1

What is DOI for tongue SCCa that is a/w higher incidence of LN mets

Answer 1

4 mm (30% vs 7% if 4 mm or less invasion)

Question 2

T/F: Disease-free, but not overall, survival is improved in pts with early oral tongue CA who undergo elective neck dissection

Answer 2

True

Question 3

When SCCa grossly invades the adventitia of the carotid, how will artery resection impact survival?

Answer 3

It will not improve long-term survival

Question 4

T/F: Hypopharyngeal CA has the worst prognosis of all H&N CA

Answer 4

True: 70% of pts p/w advanced dz (III and IV) and the 5-yr dz specific survival is only 33%

Question 5

What are the m/c and least common sites of tumor involvement of HP

Answer 5

Pyriform sinus is m/c 75%

Postcricoid is least common 3-4%

Question 6

How does behavior of pyriform sinus tumors differ from postcricoid and posterior pharyngeal wall tumors

Answer 6

Tumors of the pyriform sinus tend to infiltrate deeply at early stages, whereas those of postcricoid area and posterior pharyngeal wall tend to remain superficial until achieving an advanced stage

Question 7

What features of HP tumors distinguish them from other H&N tumors

Answer 7

Propensity for early submucosal spread and skip lesions

Question 8

What significance does this have on tx

Answer 8

Wide margins 4-6 cm inferior to gross, 2-3 cm superior to gross and wide RT

Question 9

What is the incidence of cervical metastases at the time of presentation of pyriform sinus tumors? What percent are bilateral or fixed?

Answer 9

60%; 25%

Question 10

T/F: size of primary lesion is related to incidence of LN mets in tumors of HP

Answer 10

False

Question 11

Where do posterior pharyngeal wall tumors met?

Answer 11

Bilaterally to level II, mediastinum, superiorly to nodes of Rouviere at the skull base

Question 12

Which site of the hypopharynx drains bilaterally into levels IV and VI

Answer 12

Postcricoid area

Question 13

T/F: The involvement of the medial (as opposed to lateral) wall of the pyriform sinus significantly increases the likelihood of bilateral cervical metastasis.

Answer 13

True

Question 14

T/F: Due to the high incidence of cervical metastases, treatment of the neck is necessary in all patients with hypopharyngeal cancer.

Answer 14

True

Question 15

What is the incidence of a 2nd primary at the time of dx in pts with hypopharyngeal CA

Answer 15

5-8%

Question 16

What are the m/c presenting sx in pts w/ tumor of retromolar trigone

Answer 16

referred otalgia and trismus

Question 17

How many yrs does it take for a former smoker to have the same probability of developing an oral cavity CA as a nonsmoker

Answer 17

16 yrs

Question 18

What is chance that a pt cured of an oral cavity CA will develop a 2nd primary if the continue to smoke

Answer 18

40%

Question 19

What is incidence of cervical mets from BOT, tonsil, soft palate SCCa

Answer 19

70, 60, 40%

Question 20

Incidence of malig in adults with asymmetric tonsils w/ normal appearing mucosa and no cervical LAD

Answer 20

5%

Question 21

What percent of T3/T4 tumors of the tonsil can be salvaged after failing primary RT

Answer 21

50%

Question 22

What are RF for osteosarcoma in mandible/maxilla

Answer 22

H/o ionizing RT, fibrous dysplasia, retinoblastoma, prior exposure to thorium oxide (radioactive scanning agent)

Question 23

What chromosomal abnlity do osteosarcoma and retinoblastoma have in common

Answer 23

deletion of long arm of chromosome 13

Question 24

T/F: there is a much lower risk of distant mets with osteosarcoma of H&N than that of long bones

Answer 24

true

Question 25

What is mcc of death in osteosarc of H&N

Answer 25

Intracranial extension

Question 26

Optimal tx for osteosarc H&N

Answer 26

Surg and RT

Question 27

T/F: A patient with T3N2aM0 SCCA of the base of tongue has a complete response to external-beam radiation therapy both at the primary site and the neck. A planned neck dissection should be done to increase the rate of regional control.

Answer 27

True

Question 28

3 m/c odontogenic tumor

Answer 28

ameloblastoma, cementoma, odontoma

Question 29

3 m/c odontogenic cysts

Answer 29

Radicular (65%), OKC, dentigerous

Question 30

What are odontomas composed of

Answer 30

Enamel, dentin, cementum, pulp

Question 31

Where does a radicular or periapical cyst occur

Answer 31

along the root of a nonviable tooth, as the liquefied stage of a dental granuloma

Question 32

Where do dentigerous cysts develop

Answer 32

around the crown of an unerupted, impacted tooth

Question 33

Multiple odontogenic keratocysts are a manifestation of what syndrome

Answer 33

Basal cell nevus synd

Question 34

What is Pindborg tumor

Answer 34

Calcified epithelial odontogenic tumor that is less aggressive than ameloblastoma and is a/w impacted tooth

Question 35

What mandibular tumor or cyst produces white, keratin containing fluid

Answer 35

Odontogenic keratocyst

Question 36

What is incidence of recurrence after excision of OKC

Answer 36

62% in first 5 yrs