Oropharynx Flashcards
Tobacco use and alcohol use are “both” considered as etiologic factors for oropharyngeal carcinoma.
TRUE or FALSE?
True.
They are considered the classic etiologic factors for Oropharyngeal Cancer.
What virus is associated with the development of oropharyngeal carcinoma?
HPV (Human Papillomavirus)
HPV-associated oropharyngeal cancers have a significantly worse prognosis compared to non-HPV-associated cancers.
TRUE or FALSE?
False.
HPV-associated cancers have a significantly more favorable prognosis that is platform dependent.
A reanalysis of RTOG 0129, a randomized study comparing cisplatin administered with either accelerated concomitant boost RT or conventionally fractionated RT, HPV status was independently associated with improved outcomes.
Epidemiology:
What percent of the annual, worldwide incidence of H&N SCC is comprised of oropharyngeal cancers?
Approximately 10%.
Incidence of oropharyngeal cancer is higher (and increasing) for developed countries than in developing countries.
TRUE or FALSE?
TRUE.
The putative cause of this is the increasing incidence of HPV-associated cancers.
Describe HPV’s morphology.
The HPV is a circular, double-stranded DNA virus.
What “is” the most common HPV type identified in human tumors and is associated with >90% of all HPV-associated related oropharyngeal cancers?
Infection with this type confers an approximate 14-fold increase in the risk of oropharyngeal cancer.
HPV 16
What are the three oncoproteins that the HPV genome encodes?
Which of them primarily mediate/s oncogenesis?
E5,6,7; E6 and 7
The HPV genome encodes three oncoproteins (E5, E6, and E7).
Oncogenesis is primarily mediated via the E6 and E7 proteins.
E7 is believed to be the major transforming oncogene during early carcinogenesis, with E6 functioning later.
What gender is predominantly affected by oropharyngeal cancers?
Male. With a M:F ratio of 4:1.
for HPV associated, it’s 3:1
What is the gold standard technique to detect HPV in oropharyngeal biopsy specimens?
demonstration of HPV E6/E7.
The gold standard is demonstration of HPV E6/E7 in clinical specimens. However, this approach is clinically impractical because it is very difficult to detect viral RNA from cytologic fluid and paraffin-embedded tissues.
Oropharyngeal cancer is usually detected in patients who are on their __to__ decades of life, and __to__ years younger for HPV-associated type.
Fifth and sixth decade.
5 to 10 years younger.
Describe the common histopathologic description of HPV-associated oropharyngeal cancers.
poorly-differentiated, nonkeratinizing or basaloid.
in contrast to NPC where HPV is more commonly associated with keratinizing histology
Which is “NOT” commonly associated with wild-type p53, p16 amplification and infrequent amplification of cyclin D?
Choices:
HPV-associated vs. HPV-unassociated
HPV-unassociated
What are the anatomic boundaries of the oropharynx?
anterior - oral cavity
posterior/inferior - larynx and hypopharynx
superior - nasopharynx
What are the three anatomic subregions of the oropharynx?
tonsil, base of tongue, and soft palate
Describe the mucosal lining of the palatine tonsil.
keratinized stratified squamous epithelial mucosal lining.
What are the borders of the base of tongue?
Anterior: circumvallate papillae
Posterior-inferior: hyoid and epiglottis
Lateral: glossopharyngeal sulci
What separates the base of tongue and the epiglottis which is a 1 cm mucosal strip that is considered part of the base of tongue?
Vallecula
What are the sensory innervation of the base of tongue?
Glossopharyngeal (CN IX)
and in part by the internal laryngeal nerve (CN X).
Anatomic boundaries of Neck Node Levels:
Level I
Bounded by posterior belly of digastric, hyoid bone inferiorly, and body of mandible superiorly
Anatomic boundaries of Neck Node Levels:
Level II
Bounded by skull base superiorly to level of hyoid bone inferiorly
Anatomic boundaries of Neck Node Levels:
Level III
Bounded by hyoid bone superiorly to cricothyroid membrane inferiorly
Anatomic boundaries of Neck Node Levels:
Level IV
Bounded by cricothyroid membrane superiorly to clavicle inferiorly
Anatomic boundaries of Neck Node Levels:
Level V
Bounded by anterior border of trapezius posteriorly, posterior border of SCM anteriorly, and clavicle inferiorly