Head and neck/Thyroid Cancer Flashcards
Which type of nasopharyngeal carcinoma are EBV related
non-keratinizing (formerly WHO type II)
Do you need neck dissection in node negative oral cavity SCC
Yes. Elective dissection improves OS
What is the benefit of IMRT over 3d conformational RT
IMRT has less xerostomia, no PFS/OS benefit
What are the indications for post-op chemo RT in resected OP, Larynx or hypopharynx cancers?
PNI
ECE of LN
What is the benefit of adjuvant Chemo/RT following surgery?
improves local regional control and PFS but not rate of distant metastasis
What is standard of care for Stage III-IV NP cancer?
Cis/XRT-> Adjuvant 5-FU/Cis x 3 cycles
Adjuvant CAPE is also an option
What regimen was tested in the EXTREME trial of patients with metastatic/recurrent HNSCC
Cis/5-FU + Cetuximab
Prolonged OS by 2.7 months over carbo/taxol
What is CPS cutoff for benefit of Pembro monotherapy over EXTREME regimen?
CPS >/= 1
What is the age cutoff for staging of differentiated thyroid cancers?
- Older=worse
Histology of thyroid cancer in MEN syndrome
Gene Mutation?
MEDULLARY
RET mutation
Thyroid cancer histology in family with FAP
Papillary thyroid cancer
Type of thyroid cancer with Cowden Syndrome
Follicular
Who needs Adjuvant RAI in differentiated thyroid cancer (3)
- -Gross Extrathyroid extension
- -Incomplete tumor resection
- -distant met
TSH suppression goals in metastatic differentiated thyroid cancer
<0.1 but not undetectable
TSH suppression goal in Stage I/low risk differentiated thyroid cancer
0.5-2
When is PET/CT most helpful in differentiated thyroid cancer (2)
Thyroglobulin >10 or poorly differentiated
Definition of RAI-Refractory Disease (4)
No uptake at known sites of disease
Progression with 6-12 months of RAI
Total cumulative dose >600
PET avid disease
Medications for metastatic DTC with NTRK mutation (2)
Larotrectinib
Entrectinib
What benefit is seen with sorafenib in metasatic DTC?
PFS only
What cells are origin of medullary thyroid cancer
C-Cells of the thyroid
Tumor markers in medullary thyroid cancer (2)
Calcitonin
CEA
What is TSH goal in Medullary thyroid cancer?
NORMAL
No benefit from RAI
What is cell of origin for anaplastic thryoid cancer?
Follicular cell
What mutation should be checked for in metastatic anaplastic thryoid cancer?
BRAF mutation. Dabrafenib/Trametinib approved in this setting
