Head & Neck Flashcards

1
Q

Poor prognostic factors in papillary thyroid cancer

A

1) Old (age over 55)
2) gross soft tissue invasion (extrathyroidal) of the tumor into the airway, nerves, or major vessels of the neck
3) extensive microscopic vascular invasion
4) inappropriately elevated serum thyroglobulin after initial therapy

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2
Q

Histologic subtypes of papillary thyroid cancer with worse prognosis

A

tall cell, insular, and hobnail variants

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3
Q

Biomarker for recurrence in papillary thyroid cancer

A

Serum thyroglobulin

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4
Q

Biomarker for recurrence in papillary thyroid cancer

A

Serum thyroglobulin

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5
Q

Genetic syndromes associated with increased risk for head and neck

A
  • fanconi anemia
  • dyskeratosis congenita
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6
Q

oral cavity in head and neck anatomic compartment

A
  • buccal mucosa, floor of mouth, anterior 2/3s of tongue, alveolar ridge, hard palate
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7
Q

oropharyngeal in head and neck anatomic compartment

A
  • tongue base
  • tonsils
  • inferior soft palate
  • posterior phalanx
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8
Q

Localized oral cavity management

A

Upfront surgery

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9
Q

Adjuvant in head and neck generally speaking

A

Typically chemoradiation

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10
Q

When surgery is preferred over CRT in laryngeal

A

1) Poor laryngeal function
2) At risk of chronic aspiration (ENT/rad onc will decide)
3) *T4

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11
Q

Indications for adjuvant chemoradiation in head and neck

A

1) Positive margins
2) ECE

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12
Q

Stage I nasopharyngeal management

A
  • XRT alone
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13
Q

Systemic therapy for induction chemotherapy in locally advanced nasopharyngeal

A
  • cisplatin/gemcitabine
    *now phase III data for cisplatin/gemcitabine/sintilimab
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14
Q

Systemic therapy for metastatic nasopharyngeal

A

Toripalimab + gemcitabine 1000 mg/m2/cisplatin 80 mg/m2

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15
Q

1) First line systemic therapy for metastatic head and neck 2) based on PD-L1

A

Independent of PD-L1 (Dr. Walsh) AND liver mets OR substantial burden of disease, carbo (AUC5)/taxol (175)/pembro (PREFERRED over carbo/5-Fu, better tolerated and doesn’t involve continuous infusion. Robust Phase II data. KEYNOTE-B10 – ORR 48%, PFS 6 months but different dosing AUC 5 and taxol 175 (Gyn onc dosing) (can also do weekly carbo/taxol per Phase II)
IF CPS >20% AND no liver mets or rapidly progressive disease, pembrolizumab monotherapy (ORR ~20%, Hasn’t been compared to platinum/5-fu/pembro, only to extreme regimen in Keynote-048, most experts are starting with pembro and salvaging with chemo)
IF CPS < 1, carbo/taxol/pembro
IF immunotherapy ineligible, cetuximab + carbo/taxol
IF taxol contraindication or hypersensitivity, Carboplatin/5-Fu/pembrolizumab (BOARDS MAY SAY THIS IS SOC)

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16
Q

RF for keratinizing vs. non-keratinizing nasopharyngeal

A

keratinizing = tobacco
non-keratinizing = EBV

17
Q

Management of locally advanced laryngeal with CR to induction chemotherapy

A

Definitive radiation

18
Q

Second line for metastatic head and neck after progression on extreme regimen

A

Pembro or Nivo

19
Q

When is p16 testing indicated

A
  • oropharyngeal
    NOT oral cavity
20
Q

Adjuvant management of adenoid cystic carcinoma

A
  • XRT (relatively high rate of local recurrence)
21
Q

first line for recurrent metastatic differentiated thyroid cancer (eg papillary)

A

sorafenib or lenvatinib

22
Q

Major prognostic factor in EBV associated nasopharyngeal

A
  • postreatment EBV DNA levels
    NO evidence of pretreatment EBV-DNA levels
23
Q

What are reasons when larynx can’t be salvaged with CRT

A
  • history of aspiration PNA
  • nonvocal
  • nasopharyngoscopic examination w/ diffuse hypomobility throughout his larynx, deep invasion of thyroid cartilage
    *NOT cord immobility
24
Q

First line for metastatic nasopharyngeal

A

Toripalimab + gemcitabine 1000 mg/m2/cisplatin
*Board answer is still probably cis/gem

25
Q

What is considered locally advanced in nasopharyngeal?

A

N2- Bilateral cervical mets
T3 - Tumor with infiltration of bony structures at skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses
*NOT extension to parapharyngeal space

26
Q

what is mammary analogue secretory carcinoma?

A

Secretory salivary gland carcinoma

27
Q

Tumor profiling of metastatic mammary analogue secretory carcinoma

A

NTRK