H&N

Question 1

Early Stage HNSCC Treatment (T1-T2, N0-N1)

Answer 1

Surgery + neck dissection if OP/NP (not if oral cavity)
or
RT x 7 weeks 70Gy

HPV+ T1-T2N0 - consider chemoRT

Question 2

Areas included in oropharynx

Answer 2

base of tongue, tonsil, posterior pharyngeal wall, soft palate

Question 3

How to treat NP tumors

Answer 3

NP stage T1N0 –> definitive RT and elective RT to neck

Localized beyond T1N0 -> chemoRT followed by adjuvant chemo or induction chemo followed by chemo/RT

Locally advanced / metastatic disease –> Cis + RT –> Cisplatin/5FU

Recurrent disease –> cis/gem

Question 4

T and N staging H&N cancer

Answer 4

T1 = < 2 cm
T2 = 2-4 cm
T3 = > 4 cm
T4 = local invasion

N1 = LN < 3 cm
N2 = contralateral
N3 = LN > 6 cm

Question 5

HPV vaccine

Answer 5

Guardasil 9
Covers strains 6, 11, 16, 18, 31, 33, 45, 52, 58
Approved for 9-45 yo males and females
2 dose vaccine, typically given around age 11 or 12 (3 doses after age 15 or immunocompromised individuals)

Question 6

Adenoid cystic carcinomahttps://www.brainscape.com/decks/10086298/cards/quick_new_card

Answer 6

-RT offered as adjuvant therapy after surgery if T2 or above
-VEGF TKIs are effective
Lenvatinib

Question 7

Treatment thymoma and thymic carcinoma

Answer 7

Localized Treatment:
Surgical Resection
Thymoma: RT if positive margins
Thymic Carcinoma: ChemoRT if positive margins

Advanced Treatment:
Thymoma
Neoadjuvant/adjuvant chemotherapy =
carboplatin/paclitaxel

Thymic Carcinoma
Neoadjuvant/adjuvant chemotherapy =
cisplatin/doxorubicin/cyclophosphamide