Head and neck/Thyroid Cancer

Question 1

Which type of nasopharyngeal carcinoma are EBV related

Answer 1

non-keratinizing (formerly WHO type II)

Question 2

Do you need neck dissection in node negative oral cavity SCC

Answer 2

Yes. Elective dissection improves OS

Question 3

What is the benefit of IMRT over 3d conformational RT

Answer 3

IMRT has less xerostomia, no PFS/OS benefit

Question 4

What are the indications for post-op chemo RT in resected OP, Larynx or hypopharynx cancers?

Answer 4

PNI

ECE of LN

Question 5

What is the benefit of adjuvant Chemo/RT following surgery?

Answer 5

improves local regional control and PFS but not rate of distant metastasis

Question 6

What is standard of care for Stage III-IV NP cancer?

Answer 6

Cis/XRT-> Adjuvant 5-FU/Cis x 3 cycles

Adjuvant CAPE is also an option

Question 7

What regimen was tested in the EXTREME trial of patients with metastatic/recurrent HNSCC

Answer 7

Cis/5-FU + Cetuximab

Prolonged OS by 2.7 months over carbo/taxol

Question 8

What is CPS cutoff for benefit of Pembro monotherapy over EXTREME regimen?

Answer 8

CPS >/= 1

Question 9

What is the age cutoff for staging of differentiated thyroid cancers?

Answer 9

55. Older=worse

Question 10

Histology of thyroid cancer in MEN syndrome

Gene Mutation?

Answer 10

MEDULLARY

RET mutation

Question 11

Thyroid cancer histology in family with FAP

Answer 11

Papillary thyroid cancer

Question 12

Type of thyroid cancer with Cowden Syndrome

Answer 12

Follicular

Question 13

Who needs Adjuvant RAI in differentiated thyroid cancer (3)

Answer 13

• -Gross Extrathyroid extension
• -Incomplete tumor resection
• -distant met

Question 14

TSH suppression goals in metastatic differentiated thyroid cancer

Answer 14

<0.1 but not undetectable

Question 15

TSH suppression goal in Stage I/low risk differentiated thyroid cancer

Answer 15

0.5-2

Question 16

When is PET/CT most helpful in differentiated thyroid cancer (2)

Answer 16

Thyroglobulin >10 or poorly differentiated

Question 17

Definition of RAI-Refractory Disease (4)

Answer 17

No uptake at known sites of disease
Progression with 6-12 months of RAI
Total cumulative dose >600
PET avid disease

Question 18

Medications for metastatic DTC with NTRK mutation (2)

Answer 18

Larotrectinib

Entrectinib

Question 19

What benefit is seen with sorafenib in metasatic DTC?

Answer 19

PFS only

Question 20

What cells are origin of medullary thyroid cancer

Answer 20

C-Cells of the thyroid

Question 21

Tumor markers in medullary thyroid cancer (2)

Answer 21

Calcitonin

CEA

Question 22

What is TSH goal in Medullary thyroid cancer?

Answer 22

NORMAL

No benefit from RAI

Question 23

What is cell of origin for anaplastic thryoid cancer?

Answer 23

Follicular cell

Question 24

What mutation should be checked for in metastatic anaplastic thryoid cancer?

Answer 24

BRAF mutation. Dabrafenib/Trametinib approved in this setting