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Oncology > Head And Neck > Flashcards

Head And Neck Flashcards

1
Q

The second commonest cancer and most frequent cause of cancer deaths

A

Lung cancer

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2
Q

80–90% of lung cancers are due to

A

Smoking

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3
Q

<10% of lung cancers occur in

A

neversmokers, usually women
Passive smoking
Asbestos
Previous radiotherapy to the chest
Radon gas, polycyclic aromatic hydrocarbons, nickel, chromate, or inorganic arsenicals.

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4
Q

Screening and prevention of lung cancer ?

A

Lung cancer is a preventable disease.

Stop smoking,do regular spiral CT scans

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5
Q

Lung cancer types? And origin?

A
  1. Small-cell carcinoma (15–20%): neuroendocrine cells
  2. SCC (30%) : Basal epithelial cells
  3. Adenocarcinoma (40%): alveolar type 2 epithelial cells
  4. Large-cell carcinoma : various epithelial cells
  5. Adenosquamous carcinoma
  6. Sarcomatoid carcinoma
  7. Carcinoid tumour
  8. Carcinomas
  9. Unclassified carcinomas
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6
Q

Genetics of lung cancer?

A

EGFR(70%SCLC,40%Adeno) : stimulation of Proliferative pathway
Point mutation of KRAS or L-MYC : activation of signal transduction
TSG inactivated: p53, high BCL2 expression in SCLC protect against apoptosis
High levels of VEGF : angiogenesis = 50% lung Cancer
NSCLC: EGFR TK
ALK: adenocarcinoma

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7
Q

Symptoms of lung cancer?

A

• Persistent cough(m/c)
, haemoptysis, dyspnoea.
• Recurrent chest infections.
• Pleural effusion.
• Chest pain (constant, progressive).
• Hoarse voice (vocal cord palsy).
• Wheeze, stridor.
• SVC obstruction (SVCO).
• Horner’s syndrome, neurological deficit
• Fatigue,anorexia, weight loss.
• Paraneoplastic syndromes

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8
Q

Diagnosis of lung cancer?

A

Bronchoscope with direct biopsy, brushing for cytology, transbronchial biopsy of lung or LN
Core biopsy or FNA from palpable disease

Pleural aspirate cytology or pleural biopsy

• FNA or core biopsy of peripheral lung lesion

• FNA or core biopsy in metastatic disease

• Mediastinoscopy and lymph node biopsy

• Video-assisted thoracoscopic surgery (VATS) and biopsy

• Rarely, open lung biopsy

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9
Q

———————-has greater sensitivity and specificity for NSCLC

A

FDG-PET

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10
Q

——————-is required when PET-CT scan suggests localized lymph node spread.

A

Mediastinal lymph node biopsy

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11
Q

every patient with non-metastatic NSCLC should be considered for

A

Surgery

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12
Q

Preoperative assessment of lung cancer?

A

1.histological/cytological confirmation of the diagnosis
2.operable stage of the disease:
3.fitness for surgery,
4.pulmonary function tests,
5.cardiac assessment.

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13
Q

non-metastatic NSCLC should be considered for what treatment

A

Surgery

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14
Q

Surgery offered to which group of patients with NSCLC?

A

All stage 1 and 2

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15
Q

Which stage is called heterogeneous group for lung cancer?

A

Stage 3

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16
Q

In case of NSCLC, Adjuvant ChT should be offered to patients with ?

A

resected stage II and III NSCLC
stage IB disease and a primary tumour >4cm

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17
Q

EGFR TKIs

A

erlotinib or gefitinib

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18
Q

Which drug do we use for adenocarcinoma with chromosomal rearrangement leading to activation of ALK?

A

Crizotinib

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19
Q

patients with stages I–II NSCLC who are unfit for surgery • stages IIIA and IIIB disease that can be encompassed in a feasible volume, Rx?

A

Radical RT

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20
Q

The standard international dose for radical RT is

A

60–66 Gy in 30–33 fractions over 6wk.

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21
Q

for good PS 0–1 with stages II–III unresectable NSCLC.

A

Concurrent CRT

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22
Q

small inoperable tumours

A

Stereotactic RT

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23
Q

——-in patients receiving chemo-irradiation for stage III NSCLC

A

Prophylactic cranial irradiation (PCI)

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24
Q

……………..is the key 1° treatment for SCLC

A

chemotherapy: etoposide+ciplatin for 4-6 cycles

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25
Q

Limited-stage disease—

A

tumour confined to one hemithorax and regional lymph nodes and can be covered by tolerable radiotherapy

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26
Q

Extensive-stage disease—s.

A

disease beyond these bound

tumour confined to one hemithorax and regional lymph nodes and can be covered by tolerable radiotherapy

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27
Q

SCLC treatment regimen?

A

Etoposide + cisplatin

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28
Q

Side effects of chemotherapy?

A

Neutropenic sepsis
DVT & thromboembolism

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29
Q

SCLC is- radio——— disease • post-chemotherapy irradiation of the ——-(TI) improves the relapse-free and overall survival of patients with localized disease

A

Radiosensitive

thorax

30
Q

———is now standard treatment for non-metastatic SCLC

A

Concomitant chemoradiotherapy

31
Q

——is an effective treatment in patients relapsing after, resistant to, unfit for, or refusing chemotherapy

A

Palliative radiotherapy

32
Q

SCLC has a high propensity for ——metastases

A

brain

33
Q

—-halves the risk of brain metastases in patients in complete remission after chemotherapy

A

Low-dose PCI

34
Q

Esophageal cancer epidemiology?

A

9th commonest cancer
Males
Old age 45–54y and 65–74y

35
Q

The two main types of esophageal cancer?

A

SCC : proximal two thirds
Adeno: middle and distal esophagus

36
Q

Risk factors for SCCs of esophagus ?

A

smoking
alcohol consumption
dietary factors (nitrate-containing preserved foods), betel nut chewing;
achalasia
strictures
Paterson–Brown–Kelly syndrome
tylosis palmaris
HPV infection
mediastinal radiotherapy.

37
Q

Risk factors for esophageal adenocarcinomas include

A

gastroesophageal reflux disease
Barrett’s oesophagus (especially high-grade dysplasia)
achalasia
obesity.

38
Q

Symptoms of esophageal cancer?

A

Progressive dysphagia, initially to solids and later liquids
regurgitation of food
weight loss
anorexia & emaciation
odynophagia (painful swallowing)
hoarseness (recurrent laryngeal nerve invasion)
chest pain due to bolus impaction
respiratory symptoms
halitosis.

39
Q

——-may be considered for early esophageal neoplasms limited to the mucosa (T1a).

A

Endoscopic mucosal resection

40
Q

Which Esophageal cancers considered resectable?

A

Resectable tumours are T1b–T3 ± N1.
T4 tumours invading the diaphragm, pleura, or pericardium may also be considered candidates

41
Q

Surgery for esophageal cancer?

A

Ivor Lewis 2 stage transthoracic oesophagectomy, in which separate incisions are made in the chest and abdomen, and
transhiatal oesophagectomy

42
Q

Esophageal resection margin?

A

Proximal resection margin: 10cm
Distal: 5cm or more.
gastric tube as a conduit.

43
Q

Adjuvant / neoadjuvant for esophageal cancer?

A

Post op adjuvent is difficult
So preop chemo is given with cisplatin and fluorouracil.

44
Q

Treatment of dysphagia in the palliative setting is usually achieved by

A

dilatation of the malignant stricture and stent insertion. The majority of stents now used consist of a metallic mesh.

45
Q

Complications of stenting include.

A

migration
perforation
occlusion
tumour overgrowth

46
Q

Other palliative therapies for esophageal cancer include

A

laser ablation
alcohol injection
Photodynamic therapy

47
Q

——is recommended as a standard treatment for advanced untreated esophageal SCC

A

First-line ChT with a platinum and fluoropyrimidine

48
Q

——is one of the most commonly used regimens for advanced disease in esophagus

A

The combination of cisplatin and a fluoropyrimidine

49
Q

——has been the standard in the UK for adenocarcinomas of the oesophagus or GOJ.

A

Epirubicin+cisplatin+fluoropyrimidine

50
Q

is used in combination with cisplatin and a fluoropyrimidine in patients with HER2positive adenocarcinomas of the GO

A

Trastuzumab

51
Q

—-are the standard agents used for patients with adenocarcinomas, in combination with epirubicin, in the UK, based on the results of a large randomized clinical trial

A

The oral fluorouracil prodrug capecitabine and oxaliplatin

52
Q

Follow up recommendation for esophageal cancer?

A

The majority (90%) of relapses occur within the 2 years after completion of local therapy. Follow-up visits should concentrate on symptoms, nutrition and psychosocial support.

In case of complete response to definitive CRT, a 3-month follow-up based on endoscopy, biopsies and CT scan may be recommended to detect early recurrence

53
Q

Head and neck cancer Aetiology?

A

Infections-HPV, EBV,chronic syphilis infection

Smoking and alcohol
Diet - less vegetables and fruit, deficient in vitamins A and C. Nitrosamines in salted fish.
Precancerous lesions-leukoplakia, erythroplakia.
Genetic -germline mutations in p53 • certain MHC profiles are associated with nasopharyngeal cancer •
Fanconi anaemia have a markedly elevated risk of head and neck squamous cancer

54
Q

Most common type of head and neck cancer?

A

Squamous cell carcinoma

55
Q

Head and neck cancer spread through? And where they metastasize?

A

Spread via the lymphatics to regional lymph nodes.

Distant metastases may include mediastinal lymph node, lung, liver, and bone

56
Q

Head and neck cancer types?

A

SAMS
Squamous
Adeno
Melanoma
Sarcoma

57
Q

Nasopharyngeal cancer symptoms?

A

• Cervical lymphadenopathy
• Nasal symptoms—bleeding, obstruction, or discharge
• Unilateral hearing loss ± serous otitis media
• Headache
• Cranial nerve palsies due to base of skull invasion

58
Q

Oropharyngeal and hypo pharyngeal cancer symptoms?

A

Oropharyngeal cancer

• Sore throat or lump in the throat. • Pain referred to the ear.

Hypopharyngeal cancer

• Dysphagia and lump in the throat. • Odynophagia. • Pain referred to the ear. • Hoarse voice

59
Q

Investigation for head and neck cancer?

A

Tumour site and extent—including cytological or histological confirmation,staging
• Biopsy—if the 1° tumour is identified and accessible.
• FNA—of a metastatic lymph node mass
Physical Examination, blood work,
CT scan with IV contrast,
MRI of the head and neck,
PET-ct
Skeletal scintigraphy: • if bone metastases suspected, but not identified on CT

60
Q

Management of early stage of head and neck cancer?

A

Most head and neck cancers are treated with surgery, radiotherapy, or a combination.

T1–2, N0, M0: surgery or radiotherapy

Surgery alone-potential advantages of surgery alone include: • complete pathological staging of the disease • quick local clearance of the disease IMRT- radiotherapy regime might comprise 60–70Gy.IMRT is increasingly available, permits better control

Combined surgery and radiotherapy is generally the best choice for bulky tumours.

61
Q

Locally advanced head and neck cancer treatment?

A

Treatment of locally advanced unresectable disease:

Chemo-radiotherapy • >60% of squamous cell head and neck cancers have advanced locoregional disease at presentation (stages III/IV, M0) Combined-modality therapy: • the use of radiotherapy with concurrent chemotherapy Single-agent cisplatin • its role as a radiosensitizer • its cytotoxic effects on occult metastatic cells • the potential for limiting repair of radiation-induced DNA damage Biological therapies Cetuximab

62
Q

Management of metastatic head and neck cancer?

A

Chemotherapy: cisplatin, paclitaxel, fluorouracil, methotrexate

63
Q

Breast cancer risk factors?

A

Early menarche & late menopause
Nulliparity
HRT & OCPs
Alcohol & tobacco
Family history
Obesity
Diet
Radiation
Geographic regions

64
Q

Syndromes associated with breast cancer?

A

Ataxia–telangiectasia heterozygotes are at risk, but this is as yet unproven
PTEN (Cowden disease)
MSH1 or MSH2 (HNPCC)
p53 (Li–Fraumeni syndrome)

65
Q

Annual MRI of both breasts recommended for

A

• carriers of mutated BRCA1 or BRCA2 aged 30–50y
• carriers of mutated p53 aged >20y
• women with a 10y risk of breast cancer of >8% from age 30–39y
• women with a 10y risk of breast cancer of >20% from age 40–49y.

66
Q

Most common breast cancer?

A

left breast in upper outer quadrant.
• The commonest pathology is ductal carcinoma 90%

67
Q

On what basis we grade breast cancers?

A

The histological grade (I–III) of the tumour is assessed from three features and predicts the tumour behaviour (mnemonic : TNM)
• tubule formation
• nuclear pleomorphism
• mitotic frequency

68
Q

What is luminal A ?

A

ER+;PR+;HER-;ki67low
most common & best prognosis
Response to therapy: endocrine
Histology: grade 1 (well differentiated)

69
Q

What is luminal B ?

A

Luminal B is of 2 types:
1. Her2+ : endo / chemo / targeted
2. Her2- : endo / chemo
Histology: grade 2 (moderately differentiated)

70
Q

What is HER2+?

A

ER,PR-;HER2+;Ki67 high
Rx: chemo / targeted
Histology: little differentiated(grade3)

71
Q

Triple negative breast cancer?

A

Rx: chemo & PARP inhibitors
Ki67 high

Oncology (5 decks)

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