Head And Neck Cancer

Question 1

What is the T1 and T2 and T3 and T4 oral cavity tumour?

Answer 1

Less than 2cm T1
Less than 4cm T2 
More than 4 cm T3 
Invading adjacent structures 
T4a still regarded as resectable 
T4b unresectable surgically

Question 2

Which is the most important indicator of prognosis in head and neck cancers?

Answer 2

HPV status

Question 3

A patient has a neck node with scc Unknown primary , which investigation should be done first?

Answer 3

PET CT

Do before EUA and biopsies or get false positives!

Question 4

Where do pleomorphic adenomas crop up?

Answer 4

Salivary gland

Question 5

You remove a 4cm pleomorphic adenoma from the parotid with a 2mm margin. What further treatment is needed?

Answer 5

Nothing they are benign with a good prognosis.
Indications for DXT include:
Involved margins for which more auth not possible
Recurrent
Spill at surgery

Question 6

3 indications for DXT after surgery for a pleomorphic adenoma

Answer 6

1. Involved margins for which more surgery is not possible
2. Recurrent
3. Spill at surgery

Question 7

Salivary gland tumours in which locations should be considered especially for post op DXT?

Answer 7

Sublingual

Submandibular

Question 8

Of all the head and neck cancers which is the one with its own staging system.

Answer 8

Nasopharyngeal

Question 9

A nasopharyngeal tumour extends into the skull base. What’s the T stage?

Answer 9

T3 (it’s got it’s own staging system)

Question 10

What does a Nasopharyngeal cancer have to have in order to be T4?

Answer 10

Invasion of the cranial nerves

Question 11

What is N1 disease in nasopharyngeal cancer?

Answer 11

Unilateral nodes

Question 12

Best treatment for early tumours of the larynx involving anterior commissure?

Answer 12

Radiotherapy

Early tumours can also be treated with-
Laser
Partial laryngectomy

But ant commissure better result for voice with DXT

Question 13

A patient who has had DXT for a laryngeal cancer 18 months later has new pain and poor speech quality. 2 sets of biopsies don’t show any tumour. What is management?

Answer 13

Total laryngectomy for symptom control and disease salvage

New symptoms suggest he has recurrence even if biopsies are negative

Question 14

For stage 3 and 4 oropharyngeal cancer what is the maximum age for which patients should get chemo rad (instead of just rad)?

Answer 14

The trial says less than age 72

Question 15

A patient with stage 3 oropharyngeal cancer has a EGFR of 45. What should you do?

Answer 15

Chemo RT but switch cis to carboplatin

There is not enough data to say switch to cetuximab

Question 16

For stage 3 and 4 oropharyngeal cancer what is the maximum age for which patients should get chemo rad (instead of just rad)?

Answer 16

The trial says less than age 72

Question 17

If you do decide to use induction chemotherapy which regimen should be used?
NB induction chemo is not standard

Answer 17

TPF
Docetaxel
Cisplatin
5FU

It is better than cis 5fu

Question 18

In patients with a solitary LN SCF where is the site of metastatic disease?

Answer 18

Almost exclusively below the clavicles