272 - Head and Neck Cancer Flashcards

1
Q

What two tests need to be done to see if a cancer is HPV related?

A
  • p16
    • Sensitive, but not specific; do this first
  • HPV ISH
    • Do this if p16 is positive

Gold standard is E6/E7 mRNA detection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pathophysiology of HPV-driven squamous cell carcinoma?

A

Usually caused by HPV-16

HPV infects cells…

  • Viral protien E6 inhibits p53
    • -> uncontrolled proliferation
  • Viral protien E7 inhibits RB
    • -> Uncontrolled proliferation
    • -> Activation of E2F
    • -> p16 increases in reaction to try to control the cell cycle
  • Thank you @Lauren Smith!*
  • p16 is a surrogate marker for HPV+ oropharyngeal carcinoma*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is field cancerization?

A

The “field” of tissue all exposed to the carcinogen may have multiple sites of pre-malignant lesions/high-risk areas

Leads to high recurrence rate following resection

Ex: smokeless tobacco can increase cancer risk in multiple sites in the oral cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What head and neck malignancies are associated with heavy tobacco and alcohol use?

A
  • Tobacco
    • Smokeless -> oral cavity, oropharynx
  • Alcohol
    • Upper digestive tract

Alcohol and tobacco compound on each other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In which patient populations is HPV-driven head and neck cancer most common?

A

Young, otherwise healthy patients

Prognosis is good

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the general treatment for head and neck cancer?

  • Early:
  • Locally advanced:
  • Metastatic/recurrent:
A
  • Early: Cured with radiation or surgery
  • Locally advanced: Multi-modal
  • Metastatic/recurrent: Palliative chemo, immune or targeted therapy

Note: Surgery and radiation used to be standard of care; now we use more chemo in an effort to avoid loss of organ function, disfigurement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What anatomic sites in the head and neck are typically affected by EBV-related carcinoma?

A

Nasopharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What percentage of patients with 1 smoking-related malignancy will develop another?

A

15-20%

Due to field cancerization; multiple areas of pre-malignant/malignant tissue due to exposure to the same carcinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What anatomic sites in the head and neck are typically affected by HPV squamous cell carcinoma?

A

Oral / oropharynx

vs. EBV = nasopharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

“keratin peals” are associated with what type of cancer?

(broadly)

A

Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly