Doctor Exam 2

Question 1

Epidemiology of carcinoma of the nasopharynx

Answer 1

• Uncommon in US, more common in China and Chinese ethnicities
• Can happen in young people
• M:F 3:1

Question 2

Etiology of carcinoma of the nasopharynx

Answer 2

• Carcinogens
• Genetics
• EBV

Question 3

Defn of Nasopharynx

Answer 3

Transition zone between the nasal cavity and the oropharynx

Question 4

Patterns of spread for carcinoma of the nasopharynx

Answer 4

Up to base of skull, down along the pharyngeal walls, nasal cavity

Question 5

carcinoma of the nasopharynx travels through

Answer 5

directly of through involvement of the retropharyngeal LN

Question 6

Carcinoma of the nasopharynx distant mets?

Answer 6

LN, Lung, bone and liver

Question 7

Symptoms of carcinoma of the nasopharynx

Answer 7

Painless neck mass, nasal obstruction, ear infection, sore throat, neurological deficits,

Question 8

Work up for carcinoma of the nasopharynx

Answer 8

Fibroptic exam, CT and MR, Chest scan, PET scan

Question 9

Histology of carcinoma of the nasopharynx

Answer 9

Most common is squamous cell carcinoma

Question 10

Standard treatment for carcinoma of the nasopharynx?

Answer 10

Radiation therapy w/wo chemotherapy

Treat LN level 2-5

Question 11

Prescription dose for carcinoma of the nasopharynx

Answer 11

Initial volume to 40 Gy, Off-cord to 54, Boost to ~70

Question 12

Carcinoma of the nasopharynx 5 yr survival?

Answer 12

60-70%

Question 13

Epidemiology of Carcinoma of the Oropharynx

Answer 13

• 8000 cases/year
• M:F 4:1
• Usually seen in older patients but increase incidence in young people with HPV

Question 14

Etiology of Carcinoma of the Oropharynx

Answer 14

Tobacco, alcohol, p53 mutation

Question 15

Symptoms of Carcinoma of the Oropharynx

Answer 15

Otalgia, painless neck mass*, dysphagia, trismus, face numbness

Question 16

Patterns of spread of Carcinoma of the Oropharynx

Answer 16

Typically a neck mass w/unknown origin, LYMPH NODES

Question 17

work-up of Carcinoma of the Oropharynx

Answer 17

Direct laryngoscopy, CT, MR, PET, Dental eval

Question 18

Histology of Carcinoma of the Oropharynx

Answer 18

Most common is squamous cell carcinoma

Question 19

Treatment of Carcinoma of the Oropharynx

Answer 19

Early stage: Surgery and RT*

Late Stage: organ preservation with RT and maybe chemo

Question 20

margin for tumor of Carcinoma of the Oropharynx

Answer 20

2 cm

Question 21

Earl stage 5 yr survival of Carcinoma of the Oropharynx

Answer 21

70-80%

Question 22

Epidemiology of carcinoma of the hypopharynx

Answer 22

Male, 60s or older, common recurrence, poor prognosis,

Question 23

Etiology carcinoma of the hypopharynx

Answer 23

Tobacco, alcohol, iron deficiency

Question 24

Most common tumor loc for carcinoma of the hypopharynx

Answer 24

pyriform sinus

Question 25

symptoms of the carcinoma of the hypopharynx

Answer 25

Dysphagia, otalgia, painless neck mass, airway obstruction, hoarseness,

Question 26

work up for the carcinoma of the hypopharynx

Answer 26

Direct laryngoscopy, CT, MR, PET

Question 27

Treatment for carcinoma of the hypopharynx

Answer 27

Early stage: surgery plus or minus radiation | Late stage: Organ preservation w/ RT

Question 28

radiation treatment for carcinoma of the hypopharynx

Answer 28

2 cm margin of primary tumor, bilateral cervical nodes, retropharyngeal nodes, supraclav nodes

Question 29

Epidemiology of carcinoma of the larynx

Answer 29

9500 cases, 70 years old, more males, good prognosis

Question 30

Etiology of carcinoma of the larynx

Answer 30

Smoking*, alcohol, occupational, prior radiation

Question 31

Patterns of spread

Answer 31

Not as common to go to LN, Most glottis cancers arise from the free margin of the true vocal cord. Spreads to supraglottic and subglottic regions. Mets is uncommon but if it does, goes to lung and liver

Question 32

Symptoms for carcinoma of the larynx

Answer 32

Hoarseness*, vocal change*

Question 33

work-up for carcinoma of the larynx

Answer 33

Direct laryngoscopy, CT, chest x-ray, PET, fiberoptic, pulmonary function test

Question 34

histology of carcinoma of the larynx

Answer 34

squamous cell carcinoma

Question 35

early treatment of carcinoma of the larynx

Answer 35

early stage: tripping (remove w/o damaging the vocal cords) + RT late stage: total laryngectomy, maybe RT **Typically 3D planning

Question 36

radiation prescription for carcinoma of the larynx

Answer 36

40 to all, 50-54 off cord, boost to 70

Question 37

Epidemiology of breast cancer

Answer 37

more white women diagnosed, black women present with more advanced stages, 1/8 women will have, 1% of breast cancer patients are male

Question 38

Estimated new breast cancer statistics?

Answer 38

about 250,000

Question 39

Estimated deaths from breast cancer

Answer 39

about 40,000

Question 40

Risk factors for breast cancer?

Answer 40

age, over weight, 1st degree relative, genetic mutations, Estrogen exposure, dense breast tissue,

Question 41

Most common s/sx for breast cancer?

Answer 41

95% present with a non palpable, asymptomatic mass seen on a screening exam

Question 42

Detection and diagnosis for average risk women for breast cancer?

Answer 42

40+ annual mammogram, self exam | 20-39 clinical breast exam every 3 years, monthly self breast exam

Question 43

detection and diagnosis for high risk

Answer 43

mammogram beginning at 30, annual breast MRI, genetic counseling, clinical exam yearly

Question 44

Histology of breast cancer

Answer 44

20% non invasive 75-80% invasive 1-3% inflammatory

Question 45

DCIS

Answer 45

WBI b/c it can move along the ducts | without treatment, about 30% will progress to invasive cancer