Head and Neck

Question 1

Patients with HPV-associated oropharyngeal cancer have higher survival rates compared with those with HPV-negative cancer. T or F?

Answer 1

T

Question 2

Relationship between p16 expression and HPV?

Answer 2

p16 is unregulated when HPV E7 oncoprotein degrades the Rb protein, while p16 in HPV-negative tumors is silenced by epigenetic promoter methylation or genetic mutation.

Question 3

Every year how many head/neck cancer patients develop a second primary?

Answer 3

3-7%

Question 4

What are the risk factors for head and neck cancer?

Answer 4

Tobacco, alcohol, HPV types 16 and 18 (oropharyngeal cancer), EBV (nasopharyngeal and paranasal sinus cancers)

Question 5

Primary tumors of the oral cavity or oropharynx that are >= 4 cm are T4. T or F

Answer 5

F. They are T3. Those with massive local invasion of adjacent structures are classified as T4.

Question 6

Vocal cord paralysis with a primary tumor in the larynx or hypopharynx indicates a T stage of no less than —

Answer 6

T3

Question 7

What is the treatment for T1 or T2, N0 or N1, and M0 head/neck cancer?

Answer 7

Surgery or radiation (with salvage surgery as necessary). 5-yr OS can be 90%.

Question 8

Treatment for higher volume stage III and stage IVA or IVB (without distant mets)?

Answer 8

Surgery followed by adjuvant radiation or chemorad OR definitive chemorad with surgery reserved for persistent disease or for recurrence of resectable disease. Cure rates range from 10% to 65%.

Question 9

Treatment for cancer of unknown primary in the neck?

Answer 9

Neck dissection followed by XRT to include the likely primary sites and concurrent chemo if extracapsular extension of nodal disease is present.

Question 10

When should metastatic adenoid cystic cancer and adenocarcinoma be treated?

Answer 10

Systemic treatment should be delayed until substantial to tumor growth can be appreciated on serial imaging studies within a six-month timeframe

Question 11

What is the treatment for high-grade mucoepidermoid carcinoma

Answer 11

The same regimens used for squamous cell cancers from other sites

Question 12

What are the different histologies of thyroid cancer?

Answer 12

Well differentiated thyroid cancer, anaplastic thyroid cancer, and medullary thyroid cancer

Question 13

What are the etiologies for thyroid cancer?

Answer 13

The only well-documented etiology is radiation.

Question 14

What is the treatment for thyroid cancer?

Answer 14

The mainstay of treatment is thyroid surgery. Radioactive iodine is used to ablate any normal thyroid remnant. If metastatic, radioactive iodine is the treatment of choice. Chemotherapy is reserved for disease that is refractory to radioactive iodine.

Question 15

What I do chemo drugs used in thyroid cancer?

Answer 15

Doxorubicin with or without cisplatin.

Question 16

Mutations in papillary carcinoma?

Answer 16

RET/PTC, BRAF, RAS

Question 17

Treatment for locally recurrent or metastatic differentiated thyroid cancer?

Answer 17

Sorafenib, axitinib, pazopanib

Question 18

Treatment for anaplastic thyroid cancer?

Answer 18

Resection if possible. Definitive or adjuvant chemorad with doxorubicin or doxo/cis. Radioactive iodine has no role.

Question 19

Mutation in medullary thyroid cancer?

Answer 19

RET

Question 20

Treatment for medullary thyroid cancer?

Answer 20

Total thyroidectomy. No adjuvant radiation. For advanced cases, vandetanib–an inhibitor of VEGFR, RET, and EGFR–or cabozatinib. Follow calcitonin and CEA. Chemo is not efficacious.