Head and neck cancer 2

Question 1

what is involved with surveillance and follow up in generally

Answer 1

Fiberoptic examination with ENT
TSH if neck irradiated

Question 2

what does CRT stand for

Answer 2

chemoradiotherapy

Question 3

imaging typically used to assess for residual disease after CRT

Answer 3

PET/CT

Question 4

Procedure ENT does for examining pharynx

Answer 4

Laryngoscopy

Question 5

Management of locally advanced

Answer 5

IF PS good → Primary surgery +/- Radiation
IF declined surgery → concurrent chemo + RT

Question 6

Role for cetuximab in locally advanced head and neck cancer

Answer 6

Second line if platinum failure
locally advanced: cetuximab + radiation can be used instead of cisplatin + radiation but no comparative data

Question 7

Head and neck cancer presentation and red flags

Answer 7

Red flags: otalgia +

Question 8

locally advanced head and neck cancer treatment for nonsurgical candidates

Answer 8

chemoradiation

Question 9

Preferred chemo regimen

Answer 9

cisplatin

Question 10

Chemo for cisplatin inelligble

Answer 10

cetuximab

Question 11

T1-2 cancer of the lip initial therapy

Answer 11

Upfront surgery
*no elective neck dissection needed (probability of harboring nodal mets is low)

Question 12

Adjuvant management of T1-T2 lip head and neck cancer with positive margins, LVI or PNI

Answer 12

LVI or PNI –> RT alone
Positive margin –> re-resection

Question 13

Areas of lips with higher risk of nodal mets

Answer 13

Upper lip + commissural areas

Question 14

Adjuvant management of T3 or higher or nodal involvement lip head and neck cancer with positive margins, LVI or PNI

Answer 14

• re-resection +/- ipsilateral or bilateral neck dissection

Question 15

What defines the “oral cavity” in head and neck cancer

Answer 15

• buccal mucosa, floor of the mouth, hard palate, retromolar trigone, alveolar ridge, anterior tongue

Question 16

What are the high risk HPV subtypes?

Answer 16

16,18,31,33

Question 17

Why do you need to closely monitor TSH/treat hypothyroidism in thyroid cancer

Answer 17

TSH can stimulate the growth of cells derived from the thyroid follicular epithelium; therefore, levothyroxine to maintain low TSH levels is considered optimal for patients with a high risk of recurrence,

Question 18

Early stage papillary thyroid cancer management

Answer 18

Thyroidectomy with neck dissection

Question 19

Stage I nasopharyngeal carcinoma mgmt

Answer 19

Definitive radiation therapy
*surgical resection not reasonable due to high morbidity

Question 20

Stage II nasopharyngeal carcinoma mgmt

Answer 20

Definitive cisplatin-based chemoradiation (increased distant failure rates)

Question 21

Salivary gland tumor IHC unique to salivary gland

Answer 21

androgen receptor (responds to GNRH agonists)

Question 22

First line for metastatic papillary thyroid cancer

Answer 22

RAI therapy (confirm)

Question 23

locally advanced nasopharyngeal carcinoma mgmt

Answer 23

Induction chemotherapy w/ cisplatin 80 mg/m2 + gemcitabine 1000 mg/m2 for 3 cycles, then concurrent chemoradiation therapy (CRT) (Phase III - improved RFS)

Question 24

adjuvant management of T2 adenoid cystic carcinoma

Answer 24

XRT (relatively high rate of local recurrence)

Question 25

What does oropharyngeal encompass anatomically?

Answer 25

• Tonsils
• base of tongue
• a few others (include)
  NOT anterior tongue

Question 26

when is HPV testing indicated in head and neck?

Answer 26

Oropharyngeal only

Question 27

Stage IVb management for a patient who isn’t a candidate for upfront CRT

Answer 27

Induction chemo followed by CRT

Question 28

What is TPF?

Answer 28

Docetaxel, cisplatin, and 5-Fu

Question 29

metastatic nasopharyngeal preferred systemic therapy

Answer 29

Cisplatin and gemcitabine

Question 30

when is adjuvant CRT recommended in locally advanced T3-4, N0-3 oral cavity SCC

Answer 30

ENE and or positive margins

Question 31

5 yr OS of locoregionally advanced HPV-associated oropharyngeal cancer treated with CRT

Answer 31

70-90%

Question 32

Prognostic biomarker for nasopharyngeal carcinoma

Answer 32

Posttreatment EBV DNA levels

Question 33

Intermediate risk factors for oral cavity cancer indicating need for adjuvant XRT

Answer 33

T4
PNI
LVI

Question 34

High risk factors for oral cavity cancer warranting adjuvant CRT

Answer 34

ENE or positive margins

Question 35

Preferred first line systemic therapy for recurrent metastatic head and neck cancer

Answer 35

Carboplatin/5-Fu/pembrolizumab