Clinical oncology 3

Question 1

structures of the head and neck

Answer 1

1) oral cavity
- floor of mouth
- anterior 2/3 tongue
- alveolus
- retromolar trigone
- hard palate
2) nasopharynx
3) oropharynx
4) larynx
- supraglottis
- glottis
- post cricoid
5) hypopharynx
6) sinuses

Question 2

types of skin lesions

Answer 2

• SCCC
• BCC
• malignant melanoma
• merkel cell tumour

Question 3

HPV

Answer 3

DNA virus
can cause cervial and oropharyngeal SCC
often not smokers or heavy alcohol drinkers

Question 4

patterns of spreda

Answer 4

locally
lymph nodes via lymphatic drainage
vascular (secondary spread from drainage)

Question 5

management of HC cancer

Answer 5

1. Surgery
2. Radiotherapy
3. Chemotherapy
4. Targeted therapies
5. Laser therapy
6. Best supportive care

Question 6

investigations required

Answer 6

Investigations needed

• clinical examination
• blood tests
• examination under LA/GA
• biopsy
• imaging (of primary, MRI/CT scan) and potential sites of metastatic disease (FDG-PET scan, CT scan thorax/CRX)

Question 7

management principles of early stage cancer

Answer 7

surgery or radiotherapy
tx depends on functional outcome and pt choice
surgery allows review of tumour ,magins and lymph node stasus

Question 8

management of locally advanced tumour

Answer 8

surgery followed with chemo
chemoradio alone
induction chemo followed by chemoradiotherary

Question 9

management of metastatic dsease

Answer 9

palliative radiotherapy/chemo

supportive care

Question 10

why would radio be preferred over surfgucal

Answer 10

organ preservation

can be used alongside to increase chance of cure

Question 11

early side effects vs late

Answer 11

• develop during or shortly after RT
• very common
• mostly always resolve
  Late – chronic
• develop months to yrs after
• rare
• irreversible and often severe

Question 12

early side effect list

Answer 12

• Xerostomia
• Altered/loss of taste
• Mucositis
• Loss of hair
• Fatigue
• Cough
  Soreness of skin
• Dry desquamation
• Moist desquamation

Question 13

late side effect list

Answer 13

• Xerostomia
• Altered taste
• Osteo-radio necrosis
• Alopecia
• Hypothyroidism
• Sub-cutaneous fibrosis
• Second malignancy
• Altered pigmentation

Question 14

dental pre assessments

Answer 14

sites treated
dose/fractiation
high risk dose 60gy

Question 15

osteoradionecrosis of the jaw

Answer 15

can occur anytime after RT
due to death of bone and damage to blood vessels from RT
tx
-	surgical debridement
-	pentoxifylline
-	hyperbaric oxygen

Question 16

concurrent chemoradiotheraoy

Answer 16

• cisplatin every 3 wks during radiotherapy

- usually 70 gy dose

Question 17

induction chemotherapy

Answer 17

• combination cisplatin based chemo prior to radiotherapy for fit pts with bulky tumours
• cisplatin x3 every 3 wks

Question 18

palliative chemotherpoay

Answer 18

• cisplatin and 5FU every 4 wks

Question 19

cetuximab vs cisplatin

Answer 19

less effective than cisplati
but effects are better when given with RT
can give skin rash