Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

Oropharyngeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the preferred treatment approach for early oropharynx cancer?

A

XRT +/- systemic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

ChemoRT for organ preservation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the preferred treatment approach for early nasopharyngeal cancer?

A

XRT + systemic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

Locoregional failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

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

A

Weekly is non-inferior and better tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions