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Solid Tumor Oncology > Head & Neck Cancer > Flashcards

Head & Neck Cancer Flashcards

1
Q

What are the high risk genotypes of HPV (4)

A

16
18
33
35

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2
Q

What is the mechanism by which HPV leads to cancer?

A

E6 oncoprotein interacts with p53. causing degradation. Therefore losing the tumor suppression of p53.
E7 protein interacts with Rb, leading to cell cycle activation and proliferation, upregulating p16 protein expression

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3
Q

What primary site of H&N cancer is HPV most closely related to?

A

Oropharyngeal

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4
Q

How does the survival of HPV+ oropharyngeal cancer compare to HPV negative oropharyngeal cancer?

A

HPV+ have better survival due to less locoregional failure

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5
Q

What is the difference in etiology/pathology between keratinizing and non-keratinizing nasoparynx cancer?

A

Keratinizing usually assocaited with tobacco and low prevalence of EBV.
Non-keratinizing has high prevalence of EBV

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6
Q

What is the preferred treatment approach for early oropharynx cancer?

A

XRT +/- systemic therapy

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6
Q

What is the preferred treatment approach for early oral cavity cancer?

A

Surgery

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7
Q

What is the preferred treatment approach for early laryngeal or hypopharyngeal cancer?

A

ChemoRT for organ preservation

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8
Q

What is the preferred treatment approach for early nasopharyngeal cancer?

A

XRT + systemic therapy

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9
Q

What is the most common pattern of failure for early H&N cancer?

A

Locoregional failure

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10
Q

Patient with oral cavity cancer, node negative. Patient undergoes surgery to remove the primary followed by post-operative radiation. He is now disease free. Is there anything else that can be added to improve his survival?

A

Elective neck dissection

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11
Q

Patient with locally advanced oropharyngeal cancer receives primary RT. What can be used to determine if a patient should get a neck dissection?

A

PET/CT. If there are residual LNs seen on PET - then should go for neck dissection.

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12
Q

How does Cetuximab + RT compare to RT alone in locally advanced H&N cancer in terms of LR control, OS, and distant mets?

A

Improved LR control and OS. No reduction in distant mets

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13
Q

How does Cetuximab + RT compare to Cisplatin + RT in HPV+ non-metastatic H&N cancer?

A

Cetuximab + RT had worse OS compared to Cisplatin + RT

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14
Q

What are poor risk features found during surgical resection for patients with H&N cancer? (5)

A

Extra-capsular extension of LN
Insufficient (<5 mm) or positive margins
Perineural invasion
LN+ level 4 or 5 in oral cavity or oropharynx
VTE

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15
Q

What is the role of induction chemotherapy in advanced H&N cancer?

A

Reduces the risk of distant mets, but OS is questionable. Can be considered for poor prognosis, bulky disease in lower neck

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16
Q

In locally advanced laryngeal cancer, what is the survival difference and laryngeal preservation in concurrent chemoRT vs RT alone vs induction chemotherapy followed by RT?

A

All 3 have similar OS. Laryngeal preservation is more common in concurrent RT, but laryngectomy-free survivalw as similar between induction chemo and chemoRT

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17
Q

Which patients with locally advanced laryngeal cancer are appropriate for larynx preservation? (3)

A

Good PS
No contraindications for chemo
No T4 tumors with cartilage invasion

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18
Q

For a patient with locally advanced H&N cancer who receive up front surgery, what treatment could be offered in adjuvant setting?

A

Concurrent chemoRT with cisplatin Q3 weeks for 3 cycles

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19
Q

In adjuvant chemoradiation, what is the difference between weekly cisplatin and Q3 week cisplatin?

A

Weekly is non-inferior and better tolerated

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20
Q

What is the standard of care for most patients with locally advanced nasopharyngeal cancer?

A

Induction chemotherapy with Gem/Cis followed by Concurrent Cisplatin+RT

21
Q

What patients with locally advanced nasopharyngeal cancer were excluded from the trial that established induction chemo + concurrent chemoRT as standard?

A

Excluded T3-T4N0

22
Q

You have a patient with locally advanced nasopharyngeal cancer treated with induction chemotherapy followed by concurrent chemoRT. Is there any adjuvant therapy you can offer them with survival benefit?

A

Adjuvant capecitabine can improve OS and recurrence free survival

23
Q

What is the first line treatment for recurrent/metastatic H&N cancer?

A

Platinum + 5-FU + Pembrolizumab

24
Q

What are two treatment options for a patient with recurrent/metastatic H&N cancer with PD-L1 CPS >1?

A

Pembro alone
Platinum + 5-FU + Pembro

25
Q

What virus is most important in risk factor for developing Nasopharyngeal cancer?

A

EBV

26
Q

Patient has early stage oral cavity SCC and undergoes upfront surgical resection. What are 8 adverse features that could be found at surgery?

A

Positive margins
Extranodal extension
Close margins
pT3 or pT4
pN2 or pN3
Nodal disease in levels IV or V
+LVI
+PNI

27
Q

Patient with early stage oral cavity cancer undergoes surgery and is found to have +LVI and +PNI. What next?

A

Adjuvant radiation because of adverse features

28
Q

What is the difference between stage IVA IVB and IVC oral cavity?

A

IVA: N2 disease or T4aN0-2
IVB: N3 disease or T4bN0-3
IVC: M1 disease
N2 is mets to single ipsi LN less than 6 cm and no ECE
N3 is mets to LN >6 cm and ENE

29
Q

Patient with early oral cavity cancer undergoes primary resection and found to have T2N1 disease. He was found to have extranodal extension and positive margins. What to do now?

A

Chemoradiation

30
Q

How long to wait after a patient completes chemoradiation before getting a restaging PET scan?

A

At least 12 weeks

31
Q

Patient has locally advanced SCC of the hypopharynx. He completes induction chemotherapy with TPF and has a complete response. What is the next step?

A

Radiation

32
Q

Patient has locally advanced SCC of the hypopharynx, undergoes induction chemotherapy with TPF and is found to have a partial response. What is next?

A

Surgical resection and adjuvant radiation. (adjuvant chemoRT if adverse features are seen)

33
Q

For hypopharyngeal cancer, induction chemotherapy is an option for which patients? (2)

A

T2-3 Nany
T1 N+

34
Q

Patient with SCC found in the left pyriform sinus that invades into the thyroid cartilage. No other sites of disease are seen. What is the T stage? What is the treatment?

A

T4a (hypopharyngeal cancer)
Surgery with neck dissection, followed by adjuvant RT. Avoid Induction chemo and chemoRT

35
Q

For hypopharyngeal cancers, what is the difference between T4a and T4b?

A

T4a: invasion of thyroid/cricoid cartilage, hyoid bone, thyroid gland, esophageal muscle or central compartment soft tissue
T4b: Tumor invading prevertebral fascia, encasement of carotid artery, involvement of mediastinal structures

36
Q

Treatment of choice for T4b hypopharyngeal cancer? (2 options)

A

Concurrent chemoRT or induction chemo followed by RT+/-chemo

37
Q

Treatment for HPV+ oropharyngeal cancer that is T0-3,N3 or T4,N0-3

A

Chemoradiation with cisplatin

38
Q

T stage of HPV+ oropharynx cancer

A

T1: 2 cm or smaller
T2: 2-4 cm
T3: >4 cm or exntesion to lingual surface of epiglottis
T4: Invades the larynx, extrinsic muscles of the tongue, medial pterygoid, hard palate, or mandible and beyond

39
Q

N stage of HPV+ oropharyngeal cancer

A

N1: 1 or more ipsilateral LNs, none larger than 6 cm
N2: Contralateral or bilateral LNs, none larger than 6 cm
N3: Any LN larger than 6 cm

40
Q

For locally advanced laryngeal cancer, which treatment strategy has the highest likelihood of laryngeal preservation?

A

Concurrent chemoRT with cisplatin.

41
Q

A patient with parotid gland tumor undergoes resection and found to have T3N0 disease. What should be offered in adjuvant setting?

A

Adjuvant RT

42
Q

What is the indication for adjuvant RT in the setting of salivary gland tumors? (6)

A

T3 or T4
Intermediate or high grade tumor
+PNI
+LVI
+Lymph nodes

43
Q

Two treatment options for T1-2, N0-1 HPV- oropharyngeal cancers

A

Definitive RT
Resection of primary with ipsilateral or bilateral neck dissection

44
Q

Two treatment options for second line metastatic/recurrent H&N cancers

A

Pembrolizumab
Nivolumab

45
Q

Patient with a history of Fanconi anemia is diagnosed with T2N1 HPV- oropharyngeal cancer. What is the treatment option for him and what types of treatment should he NOT get?

A

Surgery
Should not get chemotherapy or RT since Fanconi patients are exquisitely sensitive to alkylating agents

46
Q

What are two high risk features in nasopharyngeal cancer that would cause you to consider adding systemic therapy to RT?

A

Bulky tumor volume
High serum EBV DNA copy number

47
Q

What is the preferred chemotherapy regimen for metastatic nasopharyngeal cancer?

A

Gemcitabine + Cisplatin

48
Q

What is the preferred treatment for T3-4, N1-3 nasopharyngeal cancer?

A

Induction chemo followed by chemoRT

49
Q

What is the preferred treatment for T(any), N2-3 nasopharyngeal cancer?

A

Induction chemo followed by chemoRT

50
Q

For HPV+ oropharyngeal cancers, T1-2, N0-1. What is the preferred treatment?

A

Definitive RT alone.

51
Q

Patient with Locally advanced HPV- oropharyngeal cancer. Has a history of renal failure and baseline CrCL is 35, also has baseline hearing loss and neuropathy. What is the best treatment for him?

A

Carboplatin+5-FU + RT

Solid Tumor Oncology (20 decks)

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