management of head and neck cancer

Question 1

What are the 2 most prevalent sites of head and neck cancer?

Answer 1

In the larynx and the tonsils.

Question 2

What is the next step in patient care following a positive biopsy?

Answer 2

A diagnostic work-up involving further examination and investigations.

Question 3

How is the grading of cancer cells achieved?

Answer 3

Done based on histological appearance and how the cells differentiate, rate of cell division and how likely they are to spread.

Question 4

What does the staging of cancer cells tell you?

Answer 4

The extent of the cancer and whether it has metastasised.

Question 5

What does T1 represent in terms of tumour size?

Answer 5

A tumour measuring 2cm or less.

Question 6

What does T2 represent in terms of tumour size?

Answer 6

A tumour measuring greater than 2cm but LESS than 4cm.

Question 7

What does T3 represent in terms of tumour size?

Answer 7

A tumour measuring greater than 4 cm with NO local invasion.

Question 8

What does T4 represent in terms of tumour size?

Answer 8

A tumour measuring greater 4cm with local involvement.

Question 9

What does N0 represent in tumour staging?

Answer 9

No nodal involvement.

Question 10

What does N1 represent in tumour staging?

Answer 10

Single ipsilateral node involvement measuring less than 3cm.

Question 11

What does N2 represent in tumour staging?

Answer 11

Ipsilateral node measuring greater than 3cm but greater than 6cm or bilateral nodes.

Question 12

What does N3 represent in tumour staging?

Answer 12

Nodal involvement in any nodes measuring greater than 6cm.

Question 13

What does M0 represent in tumour staging?

Answer 13

No metastases.

Question 14

What does M1 represent in tumour staging?

Answer 14

Metastases.

Question 15

Which stage corresponds to T1 N0 M0?

Answer 15

Stage 1

Question 16

Which stage corresponds to T2 N0 M0?

Answer 16

Stage II

Question 17

Which stage corresponds to T3 N0 M0 or any N1?

Answer 17

Stage III

Question 18

Which stage corresponds to T4 N2 or N3 M1?

Answer 18

Stage IV

Question 19

Which diagnostic imaging test is based on levels of glucose metabolism?

Answer 19

PET scan

Question 20

Why is chest imaging mandatory in cancer diagnosis?

Answer 20

As this confirms whether the disease has spread to the lungs.

Question 21

Which type of imaging scan is useful to assess undiagnosed neck lumps and guide a fine needle aspiration to allow cell cytology?

Answer 21

An ultrasound scan.

Question 22

What are the 2 aims of treatment?

Answer 22

Either curative or palliative.

Question 23

Which types of lesions is surgery most commonly used to target?

Answer 23

Larger and more extensive tumours.

Question 24

Describe the basis of radiotherapy.

Answer 24

The use of high energy waves (similar to x-rays) to kill the cancer cells.

Question 25

Name some short-term side effects of radiotherapy.

Answer 25

- Sore skin. - Sore mouth. - Difficulty swallowing.

Question 26

5 long-term implications of radiotherapy:

Answer 26

- Xerostomia - impact of radiotherapy on the salivary glands. - Loss of taste due to xerostomia. - Risk of osteoradionecrosis. - Trismus - Mucositis

Question 27

What is the newer form of radiotherapy with a narrower beam which has been shown to reduce radiation-induced xerostomia?

Answer 27

Intensity-modulated radiotherapy (IMRT)

Question 28

Can chemotherapy alone cure head and neck cancer?

Answer 28

No.

Question 29

What are the 3 timings chemotherapy can be delivered?

Answer 29

1. Neoadjuvant/Induction - before treatment. 2. Concurrently with radiotherapy. 3. Adjuvant - after radiotherapy.

Question 30

Name the 2 most common chemotherapy drugs for mouth and oropharyngeal cancer:

Answer 30

1. Cisplatin 2. Fluorouracil (5FU) (or methotrexate)

Question 31

Which type of cancer therapy uses drugs to target the differences in cancer cells that help them to grow and survive.

Answer 31

Immunotherapy

Question 32

Name 3 drugs used in immunotherapy treatment for mouth and oropharyngeal cancer.

Answer 32

1. Cetuximab 2. Nivolumab 3. Pembrolizumab

Question 33

How do Monoclonal Antibodies work?

Answer 33

By recognising and finding specific proteins on cancer cells.