Med Management

Question 1

Medical Management: Physical exam includes what types of evaluations?

Answer 1

1. Medical, anesthetic, surgical assessment
2. Lab Evaluation
3. Electrocardiogram
4. Pulmonary Function Test

Question 2

Medical Management: When are electrocardiograms necessary?

Answer 2

For patients over 55 years old, with diabetes, HTN or other cardiac risk factors

Question 3

Medical Management: When are pulmonary function tests indicated?

Answer 3

In those with preexisting pulmonary disease

Question 4

Imaging Modalities: Describe when Panoramic Radiography is used

Answer 4

Usually for dental treatment planning prior to cancer therapy

Question 5

Imaging Modalities: Describe what ultrasonography is used for

Answer 5

To assess nodal metastasis in the neck to guide the fine-needle aspiration biopsy.

Question 6

Imaging Modalities: Describe when computed tomography is used

Answer 6

Asses extent of tumor, lymph node involvement

Question 7

Imaging Modalities: Describe what magnetic resonance imaging (MRI) is used for

Answer 7

Soft tissue assessment, perineural spread, bone marrow invasion, non calcified-cartilage involvement

Question 8

Imaging Modalities: Describe when positron emission tomography (PET) is used

Answer 8

To further assess the tumor extent and metastasis

Question 9

Imaging Modalities: Describe what the combined PET/CT detects

Answer 9

Detection of head and neck cancer

Question 10

Imaging Modalities: Describe what plain film chest x-rays screens for

Answer 10

Lung metastasis

Question 11

The National Comprehensive Cancer Network Recommendations: What type of treatment is recommended for early stage tumors

Answer 11

Surgery

Question 12

The National Comprehensive Cancer Network Recommendations: What type of treatment is recommended for advanced staged tumors

Answer 12

Surgery or definitive concurrent chemoradiotherapy

Question 13

What does radiation therapy accomplish?

Answer 13

1. Causes DNA damage in irradiated cells

Question 14

How is radiation therapy formated?

Answer 14

Fractional formation
Daily treatments over several weeks
1.8 to 2.0 Gy per fraction
Total of 50-70 Gys

Question 15

What are the three types of radiation therapy

Answer 15

Conventional
Intensity-modulated
3D conformal

Question 16

When is chemotherapy recommended?

Answer 16

In high risk patients, when combined with radiation therapy (more helpful) vs radiation alone

Question 17

Give two specific examples of when chemotherapy is recommended

Answer 17

Locally advanced head and neck cancer

Multiple positive lymph node involvement

Question 18

What are three types of chemotherapy

Answer 18

Cisplatin
Cetuximab
Docetaxel

Question 19

Which type of chemotherapy is the standard of care in high risk postoperative head and neck cancer?

Answer 19

Cisplatin

Question 20

Describe how immunotherapy works

Answer 20

Immune checkpoint pathways

Programmed death receptor-1 (PD-1) and its ligand (PD-L1)

Question 21

What are two examples of immunotherapy

Answer 21

Nivolumab

Pembrolizumab

Question 22

What does Blocking PD-1 do?

Answer 22

Prevents the inhibition of T cell activity in the tumor -> allows for cytotoxicity of tumor cells

Question 23

Describe how Brachytherapy works

Answer 23

Involves direct placement of radiation sources into the tumor

Question 24

What are the advantages of brachytherapy?

Answer 24

Shortened treatment times, reduced dose of external beam radiation therapy

Question 25

When is brachytherapy usually used?

Answer 25

After a recurrence

Question 26

Describe how Proton Beam Therapy works

Answer 26

Delivers the radiation dose more precisely to the tumor , reducing dose to surrounding normal tissues

Question 27

What are the advantages of Proton Beam Therapy?

Answer 27

Dose is delivered at the end of a linear track -> dose then falls quickly to zero after the peak -> limits the scatter dose to the surrounding tissue

Question 28

Describe treatment time of proton beam therapy

Answer 28

15-30 min per day for five days per week for 4-7 weeks