Head and neck cancer 2 Flashcards
what is involved with surveillance and follow up in generally
Fiberoptic examination with ENT
TSH if neck irradiated
what does CRT stand for
chemoradiotherapy
imaging typically used to assess for residual disease after CRT
PET/CT
Procedure ENT does for examining pharynx
Laryngoscopy
Management of locally advanced
IF PS good → Primary surgery +/- Radiation
IF declined surgery → concurrent chemo + RT
Role for cetuximab in locally advanced head and neck cancer
Second line if platinum failure
locally advanced: cetuximab + radiation can be used instead of cisplatin + radiation but no comparative data
Head and neck cancer presentation and red flags
Red flags: otalgia +
locally advanced head and neck cancer treatment for nonsurgical candidates
chemoradiation
Preferred chemo regimen
cisplatin
Chemo for cisplatin inelligble
cetuximab
T1-2 cancer of the lip initial therapy
Upfront surgery
*no elective neck dissection needed (probability of harboring nodal mets is low)
Adjuvant management of T1-T2 lip head and neck cancer with positive margins, LVI or PNI
LVI or PNI –> RT alone
Positive margin –> re-resection
Areas of lips with higher risk of nodal mets
Upper lip + commissural areas
Adjuvant management of T3 or higher or nodal involvement lip head and neck cancer with positive margins, LVI or PNI
- re-resection +/- ipsilateral or bilateral neck dissection
What defines the “oral cavity” in head and neck cancer
- buccal mucosa, floor of the mouth, hard palate, retromolar trigone, alveolar ridge, anterior tongue
What are the high risk HPV subtypes?
16,18,31,33
Why do you need to closely monitor TSH/treat hypothyroidism in thyroid cancer
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,
Early stage papillary thyroid cancer management
Thyroidectomy with neck dissection
Stage I nasopharyngeal carcinoma mgmt
Definitive radiation therapy
*surgical resection not reasonable due to high morbidity
Stage II nasopharyngeal carcinoma mgmt
Definitive cisplatin-based chemoradiation (increased distant failure rates)
Salivary gland tumor IHC unique to salivary gland
androgen receptor (responds to GNRH agonists)
First line for metastatic papillary thyroid cancer
RAI therapy (confirm)
locally advanced nasopharyngeal carcinoma mgmt
Induction chemotherapy w/ cisplatin 80 mg/m2 + gemcitabine 1000 mg/m2 for 3 cycles, then concurrent chemoradiation therapy (CRT) (Phase III - improved RFS)
adjuvant management of T2 adenoid cystic carcinoma
XRT (relatively high rate of local recurrence)
What does oropharyngeal encompass anatomically?
- Tonsils
- base of tongue
- a few others (include)
NOT anterior tongue
when is HPV testing indicated in head and neck?
Oropharyngeal only
Stage IVb management for a patient who isn’t a candidate for upfront CRT
Induction chemo followed by CRT
What is TPF?
Docetaxel, cisplatin, and 5-Fu
metastatic nasopharyngeal preferred systemic therapy
Cisplatin and gemcitabine
when is adjuvant CRT recommended in locally advanced T3-4, N0-3 oral cavity SCC
ENE and or positive margins
5 yr OS of locoregionally advanced HPV-associated oropharyngeal cancer treated with CRT
70-90%
Prognostic biomarker for nasopharyngeal carcinoma
Posttreatment EBV DNA levels
Intermediate risk factors for oral cavity cancer indicating need for adjuvant XRT
T4
PNI
LVI
High risk factors for oral cavity cancer warranting adjuvant CRT
ENE or positive margins
Preferred first line systemic therapy for recurrent metastatic head and neck cancer
Carboplatin/5-Fu/pembrolizumab
