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ENT Specialties MAIN > Head and Neck 2 > Flashcards

Head and Neck 2 Flashcards

1
Q

What are the treatment options for T1s, microinvasive, and Tl glottic carcinoma

A

Endoscopic surgical excision, laser excision, thyrotomy and cordectomy, or radiation.

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2
Q

What is immunologic gene therapy

A

Enhancement of an immune response specifically against tumor-associated antigens using viral vectors.

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3
Q

High expression of which growth factor receptor in head and neck SCCA can potentially predict lymph node metastasis

A

Epidermoid growth factor receptor (EGFR).

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4
Q

What are the boundaries of the pre-epiglottic space

A

Epiglottic cartilage posteriorly, thyrohyoid membrane and hyoid bone anteriorly, hyoepiglottic ligament superiorly.

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5
Q

What are the boundaries of the pre-epiglottic space

A

Epiglottic cartilage posteriorly, thyrohyoid membrane and hyoid bone anteriorly, hyoepiglottic ligament superiorly.

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6
Q

What structures are considered part of the supraglottis

A

Epiglottis, false vocal cords, aryepiglottic folds, and arytenoids.

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7
Q

What technique is most effective in preventing postoperative stenosis after VPL

A

Epiglottopexy.

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8
Q

What cells do mucoepidermoid tumors arise from

A

Epithelial cells of interlobar and intralobar salivary ducts.

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9
Q

According to Levine et al, SNUC is most likely a grade 4 variant of what tumor

A

Esthesioneuroblastoma or olfactory neuroblastoma.

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10
Q

What is the differential diagnosis of a small cell sinonasal tumor

A

Esthesioneuroblastoma, plasmacytoma, melanoma, lymphoma, sarcoma, poorly differentiated SCCA, Ewings sarcoma, PNET, and SNUC.

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11
Q

What is adoptive T -cell immunotherapy

A

Ex vivo enhancement of tumor immunogenicity; lymphocytes are removed from the patient then reinfused after in vitro activation against the patient’s own tumor cells.

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12
Q

What is the most serious complication of lateral pharyngotomy

A

Excessive retraction on the great vessels leading to thrombosis or embolism.

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13
Q

What is the purpose of vestibulectomy during excision of early glottic cancer

A

Excision of the false vocal cord enhances intraoperative and postoperative visualization of the entire vocal cord.

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14
Q

What is the cell of origin of parotid gland SCCA

A

Excretory duct cell.

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15
Q

Which type of cancer is most sensitive to RT: exophytic, infiltrative, or ulcerated

A

Exophytic.

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16
Q

How does this gene work

A

Expresses a viral thymidine kinase that is foreign to mammalian cells but phosphorylates the drug ganciclovir into a compound that terminates DNA synthesis in tumor cells.

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17
Q

During resection, which vessel can be sacrificed in most cases

A

External carotid artery.

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18
Q

What factors are predictors of occult regional disease in parotid cancer

A

Extracapsular extension, preoperative facial paralysis, age >54 years, and perilymphatic invasion.

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19
Q

What 3 signs are classically present in patients with sinonasal neoplasms

A

Facial asymmetry, tumor bulge in the oral cavity, and nasal mass; the presence of all 3 is seen in about 50% of patients and is significant for advanced disease.

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20
Q

T/F: TEP is not effective in patients reconstructed with gastric pull-up

A

False, although the voice quality is poor.

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21
Q

T/F: Cells undergoing DNA synthesis in the S phase are much more radiosensitive than cells in other phases of the cell cycle

A

False, they are much more radioresistant in the S phase.

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22
Q

T/F: Tumor size is related to the likelihood of distant metastasis

A

False.

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23
Q

T/F: The degree of differentiation of the primary correlates with distant metastasis

A

False.

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24
Q

T/F: Proton beams have poorer skin-sparing properties than electron beams

A

False.

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25
Q

T/F: The size of the primary lesion is related to the incidence of lymph node metastases in tumors of the hypopharynx

A

False.

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26
Q

What are the risk factors for developing melanoma

A

Family history, multiple atypical or dysplastic nevi, Hutchinson’s freckle, presence of large congenital nevi, blond or red hair, marked freckling on upper back, history of 3 or more blistering sunburns prior to age 20, presence of actinic keratoses.

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27
Q

What anatomic feature of the epiglottis facilitates extension of carcinoma into the pre-epiglottic space

A

Fenestrations/ dehiscences.

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28
Q

What anatomic feature of the epiglottis facilitates extension of carcinoma into the pre-epiglottic space

A

Fenestrations/ dehiscences.

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29
Q

What is the principle dose-limiting factor of RT

A

Fibrosis of the subcutaneous tissue and muscle.

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30
Q

What are the contraindications to VPL and laryngoplasty

A

Fixed vocal cord, involvement of the posterior commissure, invasion of both arytenoids, bulky transglottic lesions, invasion of the thyroid cartilage, subglottic extension >I em anteriorly (5 mm posteriorly), trans glottic lesions extending to the supraglottis.

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31
Q

What is unique about the path of growth of BCC

A

Follow the path of least resistance, which is typically along embryonic fusion planes.

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32
Q

When is stereotactic radiosurgery contraindicated in the treatment of recurrent glomus jugulare tumors

A

For larger tumors (>3.0 - 4.0 em).

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33
Q

When is a total rhinotomy approach most useful

A

For midline tumors where exposure of the cribriform plate and the bilateral ethmoids is necessary.

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34
Q

Which foramina of the skull lie in close proximity to the nasopharynx

A

Foramen lacerum, carotid canal, foramen spinosum, foramen ovale, foramen rotundum, hypoglossal canal, and jugular foramen.

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35
Q

What does the adenovirus vector do once it enters the host cell

A

Forms a nonreplicating, extrachromosomal entity called an episome that persists for 7 - 42 days.

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36
Q

What is the most common site of origin of nasopharyngeal cancer

A

Fossa of Rosenmi.iller.

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37
Q

What are the reconstructive options after total laryngectomy and total pharyngectomy

A

Free jejunal interposition graft, U-shaped pectoralis major + split thickness skin graft, tubed thin flap (radial forearm or de-epithelialized deltopectoral).

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38
Q

What is the classic physical finding of carotid body tumors

A

Freely moveable in the lateral direction but fixed in the cephalad-caudal direction.

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39
Q

What environmental factor is most strongly linked to NPC

A

Frequent consumption of dried salted fish.

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40
Q

What are the 3 subtypes of Schneiderian papillomas

A

Fungiform, inverting, and cylindrical.

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41
Q

What are the reconstructive options after total laryngopharyngectomy and cervical esophagectomy

A

Gastric pull-up, free jejunal graft.

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42
Q

What are the 5 histopathologic types of SCCA

A

Generic, adenoid, bowenoid, verrucous, and spindle-pleomorphic.

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43
Q

Which of these arises in areas of actinic change

A

Generic.

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44
Q

What are the two types of temporal bone paragangliomas

A

Glomus jugulare involving the adventitia of the jugular bulb and glomus tympanicum involving Jacobson’s nerve Uugulotympanic glomus if unable to discern site of origin).

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45
Q

What is the most common site of laryngeal cancer

A

Glottis.

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46
Q

What is the most significant prognostic factor in patients with mesenchymal tumors

A

Grade of the tumor.

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47
Q

What is the significance of the number of pathologically positive nodes on prognosis

A

Greater than 3 pathologically positive nodes is a negative prognostic indicator.

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48
Q

What is Shamblin’s classification system for carotid body tumors

A

Group I: small and easily excised. Group I I: adherent to the vessels; resectable with careful subadventitial dissection. Group Ill: encase the carotid; require partial or complete vessel resection

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49
Q

What is most common hormonal deficiency after RT for NPC

A

Growth hormone deficiency.

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50
Q

Which of these are classically associated with adenocarcinoma

A

Hardwood dusts and leather tanning substances.

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51
Q

What is the most common complication of parotidectomy

A

Hematoma.

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52
Q

What is the most commonly used gene for cytotoxic gene therapy

A

Herpes simplex virus-thymidine kinase gene (HSV -tk).

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53
Q

What are the indications for postoperative radiation after parotidectomy

A

High probability of residual microscopic disease; positive margins; advanced stage; high grade ~ deep lobe tumors; recurrent tumors; presence of regional metastases; angiolymphatic invasion.

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54
Q

Radiation is not as effective for tumors with which characteristics

A

High volume, cartilage-destroying, with bulky lymph node disease.

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55
Q

Which salivary gland tumors have the worst prognosis (5)

A

High-grade mucoepidermoid, adenocarcinoma, squamous cell carcinoma, undifferentiated carcinoma, and carcinoma ex-pleomorphic adenoma.

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56
Q

What is the gold standard for identification of subclinical disease

A

Histologic examination of the surgical specimen.

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57
Q

What are the risk factors for developing osteosarcoma in the mandible or maxilla

A

History of ionizing radiation, fibrous dysplasia, retinoblastoma, prior exposure to thorium oxide (radioactive scanning agent).

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58
Q

What histological pattern is characteristic of this tumor

A

Homer-Wright rosettes.

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59
Q

Which virus is thought to play a role in the etiology of sinonasal tumors

A

HPV, particularly types 6 and 12.

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60
Q

What electrolyte problem is disproportionately associated with gastric pull-up

A

Hypocalcemia secondary to impaired calcium absorption and inadvertent parathyroid resection during thyroidectomy.

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61
Q

Where are most synovial sarcomas of the head and neck located

A

Hypopharynx and parapharyngeal space.

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62
Q

What are the 3 most important factors leading to osteoradionecrosis (ORN)

A

Hypovascularity, hypocellularity, and hypoxia (the “3H’s”).

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63
Q

What % of patients undergoing supraglottic laryngectomy and unilateral neck dissection will fail in the contralateral neck

A

I 6°/o, despite receiving XRT to the area.

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64
Q

What % of patients with carcinoma in situ of the vocal cord will develop invasive SCCA after a single excisional biopsy

A

I in 6 (16.7%).

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65
Q

What % of patients with carcinoma in situ of the vocal cord will develop invasive SCCA after a single excisional biopsy

A

I in 6 (16.7%).

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66
Q

During endoscopic evaluation of a tumor of the hypopharynx, what 4 questions must be answered

A

I. Can the larynx be saved 2. Is a partial or total pharyngectomy necessary 3. Is a partial or total esophagectomy necessary 4. Does the tumor extend into the prevertebral fascia

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67
Q

When is total esophagectomy indicated

A

If the inferior margin during resection of a postcricoid tumor extends below the mediastinal inlet or if a second primary is present in the distal esophagus.

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68
Q

When should the submandibular gland be removed with the tumor

A

If the lesion involves the cheek, zygomatic area, nasolabial fold, or upper lip.

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69
Q

What are the indications for parotidectomy in addition to resection of the tumor

A

If the lesion involves the lateral forehead, temporal scalp, preauricular skin, or anterior ear.

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70
Q

What is the purpose of using a STSG to cover a small defect after excision of a tonsil cancer

A

If the pterygoid muscles are exposed during resection, placing a STSG will help prevent muscle fibrosis and trismus.

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71
Q

In which circumstance can a hemilaryngectomy be performed in the presence of vocal cord fixation

A

If the tumor does not extend through the cricothyroid membrane or the perichondrium of the thyroid cartilage.

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72
Q

What is Ohngren ‘s line and how is it significant

A

Imaginary line from the medial canthus to the angle of the mandible; tumors below the line have a better prognosis than tumors above the line (with the palate as an exception).

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73
Q

What are the next 3 most common sites of metastasis

A

In order of frequency, mediastinal lymph nodes, skeletal system, and liver.

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74
Q

What are the 2 most common reasons for tumor recurrence after hemilaryngectomy

A

Inability to recognize the inferior tumor margin and spread of tumor through the cricothyroid membrane.

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75
Q

What is the best organ-sparing treatment for a patient with stage III SCCA of the supraglottis

A

Induction chemotherapy followed by radiation therapy.

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76
Q

How should this flap be modified if reconstruction with a deltopectoral flap is planned

A

Inferior incision should be as low as possible.

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77
Q

What is the venous drainage of the cervical esophagus

A

Inferior thyroid vein.

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78
Q

In the staging system described by Ho, poorer prognosis is associated with cervical metastases to which area of the neck

A

Inferior to a plane spanning from the contralateral sternal head of the clavicle to the ipsilateral superior margin of the trapezius muscle.

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79
Q

What are the boundaries of the parapharyngeal space

A

Inferior: hyoid bone. Superior: petrous bone. Medial: soft palate, tonsils, superior pharyngeal constrictor. Lateral: medial pterygoid muscle, ramus of the mandible, posterior belly of the digastric. Dorsal: vertebral column and paravertebral muscles. Ventral: pterygomandibular raphe.

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80
Q

What type of resection would be best for a tumor confined to the floor of the maxillary antrum

A

Infrastructure maxillectomy.

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81
Q

That being said, which areas of the face are most susceptible to BCC

A

Inner canthus, philtrum, mid-lower chin, nasolabial groove, preauricular area, and retroauricular sulcus.

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82
Q

What is Whitnall’s tubercle

A

Insertion site of the lateral canthal tendon.

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83
Q

How does it appear on MRI

A

Intermediate intensity on T- I and T -2 weighted images, permeates sinus walls without gross displacement.

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84
Q

What is the most common cause of death in osteosarcoma of the head and neck

A

Intracranial extension.

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85
Q

How does one assess for involvement of the prevertebral fascia

A

Intraoperative evaluation is most accurate. During endoscopy, one can attempt to mobilize the posterior pharyngeal wall to assess for involvement. Video esophagography and CT scan are also helpful.

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86
Q

What is “microinvasive” SCCA of the vocal cord

A

Invades through the basement membrane but not into the vocalis muscle.

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87
Q

What is “microinvasive” SCCA of the vocal cord

A

Invades through the basement membrane but not into the vocalis muscle.

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88
Q

What factors make a tumor of the nose or paranasal sinuses unresectable

A

Invasion into the frontal lobe, prevertebral fascia, bilateral optic nerves, or • cavernous smus.

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89
Q

What is the significance of vocal cord fixation in laryngeal carcinoma

A

Invasion of the vocalis muscle has occurred, and lymph node metastasis is more likely.

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90
Q

What is the most common benign sinonasal neoplasm

A

Inverting papilloma.

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91
Q

What are the contraindications to VPL for treatment of postradiation tumor recurrence

A

Involvement of both vocal cords, involvement of body of arytenoid, subglottic extension >5 mm, fixed vocal cord, cartilage invasion, different tumor type from original primary.

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92
Q

What are the contraindications to laser excision of early glottic carcinoma

A

Involvement of the anterior or posterior commissure, subglottic extension.

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93
Q

According to Larson, what are the indications for orbital exenteration

A

Involvement of the periorbita, posterior ethmoid sinuses or orbital apex.

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94
Q

What are the contraindications to radical maxillectomy

A

Involvement of the sphenoid, nasopharynx, middle cranial fossa, or extensive infratemporal fossa; presence of bilateral cervical metastases or distant metastases.

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95
Q

What are the clinical features of Plummer-Vinson syndrome

A

Iron deficiency anemia, upper esophageal web, hypothyroidism, glossitis/cheilitis, gastritis, and dysphagia.

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96
Q

What histologic characteristic of recurrent basal cell cancers has prognostic significance

A

Irregularity in the peripheral palisade.

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97
Q

What happens to the carotid sheath with deep lobe parotid tumors extending into the parapharyngeal space

A

It is displaced posteriorly.

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98
Q

How does metastasizing pleomorphic adenoma differ from carcinoma ex-pleomorphic adenoma

A

It is histologically benign, lacking malignant epithelial components.

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99
Q

What is the relationship of the fossa of Rosenmuller to the parapharyngeal space

A

It lies at the convergence of the fascial planes that separate the parapharyngeal space into its three compartments (prestyloid, retrostyloid, and retropharyngeal).

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100
Q

Is melanoma radiosensitive

A

It may be sensitive to large dose fractions (600cGy) but not to standard fractionation radiotherapy ( 180 - 200cGy).

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101
Q

When SCCA grossly invades the adventitia of the carotid artery, how will resection of the artery affect survival

A

It will not improve long-term survival.

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102
Q

How does using cisplatinum avoid this problem

A

Its toxicity (hematologic) does not overlap with that of radiation therapy (mucositis).

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103
Q

Where does supraglottic carcinoma most often begin

A

Junction of the epiglottis and false cords.

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104
Q

Where is the fossa of Rosenmiiller

A

Just posterior-superior to the torus tubarius of the eustachian tube orifice.

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105
Q

What are the histologic features of SCCA of the skin

A

Keratin pearls in well-differentiated lesions; poorly-differentiated lesions may require identification with a cytokeratin or vimentin.

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106
Q

What is the name for a skin lesion, most commonly located on the nose, characterized by rapid growth with a central area of ulceration followed by spontaneous involution

A

Keratoacanthoma.

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107
Q

Which of these is the most aggressive

A

Keratotic.

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108
Q

What are the problems with physical methods of gene transfer

A

Lack of specificity and extremely low efficiency.

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109
Q

What EBV product is likely to play a role in malignant transformation of nasopharyngeal epithelium

A

Latent membrane protein (LMP-1 ).

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110
Q

Where do these tumors most often originate

A

Lateral nasal wall, adjacent to the middle turbinate.

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111
Q

Where do inverting papillomas most commonly arise

A

Lateral nasal wall.

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112
Q

What are other surgical approaches to the nasopharynx

A

Lateral rhinotomy with facial disassembly, trans palatal split, lateral cervical approach with mandibular swing, transparotid temporal bone approach, infratemporal fossa approach.

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113
Q

What are the three basic transfacial approaches to these procedures

A

Lateral rhinotomy, total rhinotomy, mid face degloving.

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114
Q

What are the three basic transfacial approaches to these procedures

A

Lateral rhinotomy, total rhinotomy, mid face degloving.

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115
Q

What is the most common site of recurrent/persistent NPC

A

Lateral wall of the nasopharynx.

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116
Q

What factors, described by Ho and Neel, are regarded as important adverse prognostic indicators in patients with NPC

A

Length and symptomatology of disease, extension of tumor outside of the nasopharynx, presence of inferior cervical adenopathy, keratinizing histologic architecture, cranial nerve and skull base extension, presence of distant metastases, and low A DCC titers.

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117
Q

How do most glomus jugulare tumors respond to external beam radiation

A

Less than 50% show tumor regression radiographically; lack of tumor growth is more common.

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118
Q

What is the somnolence syndrome

A

Lethargy, nausea, headache, cranial nerve palsies, ataxia presenting 2 - 3 months after R T and lasting 2 - 4 weeks.

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119
Q

What are the levels defined in Clark’s system

A

Level I: epidermis. Level II: invasion of basal lamina into the papillary dermis. Level III: fill the papillary dermis. Level IV: invasion into the reticular dermis. Level V: invasion into subcutaneous fat.

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120
Q

What happens if the orbital septum is violated during resection of a sinonasal tumor

A

Lid shortening and ectropion.

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121
Q

What is the primary limitation of the midface degloving approach

A

Limited exposure of the skull base and anterior ethmoid sinuses.

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122
Q

What is the Weber-Fergusson incision

A

Lip-splitting extension of the lateral rhinotomy incision that permits exposure for a radical maxillectomy.

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123
Q

What is the Weber-Fergusson incision

A

Lip-splitting extension of the lateral rhinotomy incision that permits exposure for a radical maxillectomy.

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124
Q

What is the most common cause of treatment failure

A

Local recurrence.

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125
Q

Patients with supraglottic cancer who undergo both surgery and radiation therapy (versus surgery alone) are at a significantly higher risk for what

A

Long-term gastrostomy feeding.

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126
Q

Other than UV light and genetics, what are some other factors that increase the risk of cutaneous malignancy

A

Long-term immunosuppression after organ transplantation, long-term treatment of psoriasis with photosensitizing chemicals, chronic ulcers, low-dose irradiation.

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127
Q

How does this assay predict survival

A

Low levels are associated with worse prognosis.

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128
Q

How is an altered fractionated schedule different

A

Lower dose per fraction, 2 or more fractions QD, decreased overall treatment time, with total dose same or higher.

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129
Q

What is the primary advantage of stereotactic radiosurgery for treatment of recurrent glomus jugulare tumors compared to surgery and conventional radiation

A

Lower incidence of cranial nerve injury.

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130
Q

How are the low-grade and high-grade varieties of adenoid cystic carcinoma defined

A

Low-grade tumors have less than 30°/o solid anaplastic histology; high-grade tumors have more than 30°/o solid anaplastic histology.

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131
Q

What is the most common cause of death from synovial sarcoma of the head and neck

A

Lung metastases.

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132
Q

What is the most common site of distant metastasis for adenoid cystic carcinoma

A

Lung.

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133
Q

What is the most common site of distant metastasis from laryngeal carcinoma

A

Lungs.

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134
Q

What is the greatest single cause of failure of supraglottic laryngectomy

A

Lymph node metastasis.

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135
Q

After SCCA, what is the 2”d most common malignant tumor of the nasopharynx

A

Lymphoma.

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136
Q

Which neck dissection incision results in the best cosmetic outcome

A

MacFee incision.

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137
Q

What are some known head and neck tumor antigens

A

MAGE is seen in 71 °/o; others include mutated CASP-8, SCCAg, cytokeratin fragment I 9.

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138
Q

What clinical factors increase the risk of radiation injury

A

Male gender, extremes of age, higher doses and fractions, comorbidities.

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139
Q

What is the most common type of skin sarcoma

A

Malignant fibrous histiocytoma.

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140
Q

Which salivary gland tumor contains both benign and malignant cells

A

Malignant lymphoepithelioma.

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141
Q

Which salivary gland tumor is more common in Eskimos

A

Malignant oncocytoma.

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142
Q

Where in the head and neck are osteogenic sarcomas most commonly found

A

Mandible.

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143
Q

Which bone in the head and neck is most commonly affected by ORN

A

Mandible; it has a relatively tenuous blood supply, and it is stress-bearing.

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144
Q

Which branch of the facial nerve is most commonly paretic after parotidectomy

A

Marginal mandibular.

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145
Q

Which nasal masses should not be biopsied in the clinic

A

Masses in children or adolescents and masses suspicious for angiofibroma… some also recommend delaying biopsy of any nasal mass until after imaging has been obtained.

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146
Q

Where is it most commonly found in the head and neck

A

Maxilla.

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147
Q

What are the most common locations of sino nasal SCCA

A

Maxillary sinus, followed by the nasal cavity, then ethmoid sinuses.

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148
Q

What is the role of ascertaining EBV titers in patients with NPC

A

May be a valuable screening tool in high-risk populations and can help establish the diagnosis of NPC in the patient with an unknown primary. In patients with type I disease, EBV titers are not elevated and have no prognostic significance.

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149
Q

How do you test for multiple myeloma in these patients

A

Measure serum M-protein and urine Bence Jones protein; bone survey; bone marrow biopsy.

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150
Q

How do you test for multiple myeloma in these patients

A

Measure serum M-protein and urine Bence Jones protein; bone survey; bone marrow biopsy.

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151
Q

What is the most common presentation of a parapharyngeal space tumor

A

Medial displacement of the lateral oropharyngeal wall or as a palpable mass beneath the angle of the mandible.

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152
Q

What is the gold standard of treatment for inverting papillomas

A

Medial maxillectomy via lateral rhinotomy.

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153
Q

What are the four basic surgical procedures used to resect tumors of the mid face

A

Medial maxillectomy, suprastructure maxillectomy, infrastructure maxillectomy, and radical maxillectomy.

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154
Q

What are the four basic surgical procedures used to resect tumors of the mid face

A

Medial maxillectomy, suprastructure maxillectomy, infrastructure maxillectomy, and radical maxillectomy.

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155
Q

What structures are found in the prestyloid compartment of the parapharyngeal space

A

Medial pterygoid muscle, fat, lymphatics, minor nerves and vessels.

156
Q

What cells are melanomas comprised of

A

Melanocytes, which are derived from neural crest cells.

157
Q

Which adnexal skin carcinoma arises from a pluripotential basal cell within or around the hair cells

A

Merkel cell carcinoma.

158
Q

What factor is most related to the chance of recurrence for inverting papilloma

A

Method of removal.

159
Q

In which areas of the world is the incidence of esophageal cancer highest

A

Middle East, southern and eastern Africa, and northern China.

160
Q

What is the most common site of a malignant salivary gland neoplasm

A

Minor salivary glands (60%; of these, 40% occur on the palate).

161
Q

In patients who undergo resection of inverting papilloma via lateral rhinotomy/medial maxillectomy, what is the most important factor related to risk for recurrence

A

Mitotic index.

162
Q

How does melanoma of the nose differ from cutaneous melanoma

A

More aggressive with a worse prognosis and an unpredictable course… local recurrence is the most common cause of failure.

163
Q

How do these tumors differ clinically from carotid body tumors

A

More common in females, less likely to secrete catecholamines or metastasize, and are more radiosensitive.

164
Q

What are the indications for MOHS surgery

A

Morpheaform BCC, recurrent BCC, and BCC in cosmetically-sensitive locations.

165
Q

Which of these commonly resembles a scar

A

Morpheaform.

166
Q

What is the histologic appearance of pleomorphic adenoma

A

Morphologically diverse with mucoid, chondroid, osseous, and myxoid elements.

167
Q

Which of these is most common in North America? Least common

A

Most common is type lll (70%); least common is type II (10%).

168
Q

What are the clinical features of salivary duct carcinomas

A

Most commonly involve the parotid gland and present as an asymptomatic mass; higher incidence in males; distant metastases are the most common cause of death.

169
Q

What is the most common malignant tumor of the parotid gland in adults

A

Mucoepidermoid carcinoma.

170
Q

Which salivary gland tumor is more common in women with a history of breast cancer

A

Mucoepidermoid carcinoma.

171
Q

What are the 2 most common malignant tumors of the parotid gland in children younger than 12

A

Mucoepidermoid is the most common, followed by acinic cell.

172
Q

What is the most common salivary gland malignancy following radiation

A

Mucoepidermoid.

173
Q

What are the layers of the posterior pharyngeal wall, from superficial to deep

A

Mucosa, constrictor muscles, longus colli, retropharyngeal space, prevertebral fascia.

174
Q

What are the 3 most common malignant bone tumors of the paranasal sinuses

A

Multiple myeloma, osteogenic sarcoma, chondrosarcoma.

175
Q

What are the indications for postoperative radiation after neck dissection

A

Multiple nodes or extracapsular spread.

176
Q

What are the indications for postoperative radiation therapy

A

Multiple nodes, extracapsular spread, positive/inadequate margins, or node > 3 em.

177
Q

How does metastatic disease to the lungs normally present

A

Multiple small lesions less than 3 mm that are difficult to detect on x-ray.

178
Q

What can be done to prevent functional dysphagia due to neuromuscular incoordination

A

Myotomy of the jejunal musculature.

179
Q

What is the most common presenting symptom of sinonasal neoplasms

A

Nasal obstruction (50%).

180
Q

Where is melanoma most commonly found in the nose and paranasal sinuses

A

Nasal septum.

181
Q

What is the mortality rate for stomal recurrence

A

Nearly 100%.

182
Q

T/F: Almost all cases of ORN are secondary to overlying soft tissue

A

necrosis. True.

183
Q

What are the histologic features of glomus tumors

A

Nests of chief cells with neurosecretory granules, surrounded by fibrovascular stroma and sustentacular cells that are S-1 00 positive. Chief cells are positive on immunohistochemistry for chromogranin, synaptophysin and neuron-specific enolase neurofilaments.

184
Q

Which type of radiation therapy does adenoid cystic carcinoma respond best to

A

Neutron beam.

185
Q

Which substances are thought to predispose to sinonasal neoplasms

A

Nickel, chromium, isopropyl oils, volatile hydrocarbons, organic fibers from wood, shoe, and textile refineries.

186
Q

Which of these is classically associated with SCCA

A

Nickel.

187
Q

What was the outcome of this study

A

No significant difference in survival among the three arms.

188
Q

What is the role of induction chemotherapy

A

No survival advantage has been proven.

189
Q

If a marginal mandibulectomy is performed and the bony margin is positive, does one irradiate the remaining bone

A

No, as bone is relatively hypoxic and cannot generate many free radicals with XRT; the patient should be taken back to the OR for mandibulectomy.

190
Q

Are elective neck dissections warranted in patients with sino nasal SCCA

A

No, as the incidence of occult cervical metastases is 10%.

191
Q

What are the 5 main types of BCC

A

Nodular, cystic, superficial multicentric, morpheaform, keratotic.

192
Q

Which of these is most common

A

Nodular.

193
Q

What is the most common type of lymphoma of the nose and paranasal sinuses

A

Non-Hodgkin’s.

194
Q

What is the pathophysiology of fibrous dysplasia

A

Normal medullary bone is replaced by collagen, fibroblasts, and osteoid.

195
Q

What is the primary limitation of the gastric pull-up

A

Obtaining enough length to achieve a tension-free closure.

196
Q

When embolized preoperatively, communication between the external and internal carotid circulation may occur through which vessel

A

Occipital artery.

197
Q

Which mandibular tumor or cyst produces white, keratin-containing fluid

A

Odontogenic keratocyst.

198
Q

How does it appear on MRI

A

On T-1 weighted MRI, mildly hyperintense to hypointense with mild to moderate enhancement; on T-2 weighted MRl, markedly homogenous and hypointense (ground glass appearance).

199
Q

What are the advantages of transoral laser resection of early supraglottic cancer

A

Oncologically sound, no tracheostomy or feeding tube is usually necessary, early discharge, rapid resumption of deglutition, more cost effective.

200
Q

What percentage of incompletely excised basal cell cancers will recur

A

One-third.

201
Q

What are five adjunctive procedures to the above dissections

A

Orbital exenteration, infratemporal fossa dissection, craniotomy, contralateral maxillectomy, rhinectomy.

202
Q

What are five adjunctive procedures to the above dissections

A

Orbital exenteration, infratemporal fossa dissection, craniotomy, contralateral maxillectomy, rhinectomy.

203
Q

What structures are preserved with an infrastructure maxillectomy that would be resected with a total maxillectomy

A

Orbital floor and sometimes the infraorbital nerve.

204
Q

What are the poor prognostic factors for SNUC tumors

A

Orbital involvement and neck metastases; tumors in the paranasal sinuses have a worse prognosis than those arising in the nasal cavity.

205
Q

What are the characteristics of skeletal metastases

A

Osteolytic lesions most frequently found in the lumbosacral spine and ribs.

206
Q

What are the complications from radiation overdosage in the treatment of NPC

A

Osteoradionecrosis, brain necrosis, transverse myelitis, hearing loss, hypopituitarism, hypothyroidism, optic neuritis.

207
Q

What can cause postoperative pneumocephalus

A

Overly aggressive drainage of CSF via a lumbar drain or ball-valve action of the flaps used to reconstruct the skull base.

208
Q

What are the two most common tumor suppressor genes under investigation for treatment of head and neck cancers

A

p53 and p 16.

209
Q

Where is adenoid cystic carcinoma of the head and neck most commonly found

A

Palate, followed by major salivary glands, then paranasal sinuses.

210
Q

What is the most common manifestation of acute injury to the peripheral nervous system

A

Paraesthesias.

211
Q

What is the primary site of lymphatic drainage from subglottic tumors

A

Paratracheal nodes.

212
Q

What is the least common site of a malignant salivary gland neoplasm

A

Parotid gland (32°/o).

213
Q

What is the most common site of a salivary gland neoplasm

A

Parotid gland (73°/o).

214
Q

Which salivary gland has the best prognosis for malignant tumors

A

Parotid gland.

215
Q

What procedure is performed for resection of these lesions

A

Partial laryngopharyngectomy.

216
Q

What is the supraglottic swallow

A

Patient inhales, takes food into mouth, performs Valsalva to close the glottis, coughs to clear debris from the glottis, swallows, and then exhales.

217
Q

What is the most common tumor of the parotid gland

A

Pleomorphic adenoma in adults, hemangioma in children.

218
Q

What is the most common tumor of the parapharyngeal space

A

Pleomorphic adenoma.

219
Q

What can happen if the free jejunal graft is too long

A

Pooling of secretions and dysphagia.

220
Q

What is the primary problem of using concomitant chemotherapy

A

Poor patient tolerance requiring treatment breaks; split-course radiation therapy has been shown to result in decreased survival compared with continuous course radiotherapy.

221
Q

What are the contraindications to craniofacial resection

A

Poor surgical candidate, presence of multiple distant metastases, invasion of the prevertebral fascia, cavernous sinus (by a high-grade tumor), carotid artery (in a high-risk patient), or bilateral optic nerves/optic chiasm.

222
Q

What are the histopathologic features of synovial sarcoma of the head and neck

A

Poorly differentiated, high grade malignant neoplasms arising from pluripotential mesenchymal cells; biphasic cellular pattern containing spindle cells and epithelioid cells; microcalcifications in 30 - 60%; the existence of monophasic forms, containing either spindle or epithelioid cells, is controversial.

223
Q

What are other significant prognostic factors for supraglottic tumors

A

Positive surgical wound washings, nearness of neoplastic involvement to the margins of surgical resection, stomal recurrence after laryngectomy, regional and distant metastases.

224
Q

In which of these sites is cancer more common in females

A

Postcricoid area.

225
Q

Which site of the hypopharynx drains bilaterally into levels IV and VI

A

Postcricoid area.

226
Q

In patients with Plummer-Vinson syndrome, where is SCCA of the esophagus most likely to occur

A

Post-cricoid area.

227
Q

What area of the sinonasal tract is better visualized with endoscopy as opposed to medial maxillectomy

A

Posterior ethmoid cells, particularly those lateral to the sphenoid sinus and around the optic nerve.

228
Q

What can be done to improve the results of salvage neck dissection

A

Postoperative brachytherapy via hollow tubes placed at the time of surgery.

229
Q

Which compartment are neurogenic tumors most likely to arise in

A

Poststyloid compartment.

230
Q

What is the treatment for SNUC

A

Preoperative chemoradiation, followed by surgical resection for those tumors without distant metastases or extensive intracranial involvement.

231
Q

When must the facial nerve be sacrificed during parotidectomy

A

Preoperative facial nerve weakness or paralysis; adenoid cystic carcinoma abutting the nerve; malignant tumor infiltrating the nerve.

232
Q

According to Levine et al, what treatment protocol has improved both functional and survival outcome for sinonasal malignancies

A

Preoperative radiation (50Gy) +/chemotherapy (Cytoxan, vincristine) followed by craniofacial resection.

233
Q

What are the contraindications to surgical resection

A

Presence of distant metastases; involvement of prevertebral fascia, trachea, or carotid arteries.

234
Q

What is the primary advantage of the midline mandibular osteotomy for resection of oropharyngeal tumors compared to the lateral mandibulotomy

A

Preservation of the inferior alveolar and lingual nerves.

235
Q

Parapharyngeal tumors arising from the deep lobe of the parotid will involve which compartment

A

Prestyloid compartment.

236
Q

What are the reconstructive options after partial pharyngectomy

A

Primary closure (if 3 or more em of tissue is available), skin graft, SCM flap, radial forearm free flap or deltopectoral flap with a de-epithelialized pedicle.

237
Q

What are the reconstructive options after total laryngectomy and partial pharyngectomy

A

Primary closure if more than 40% of the pharyngeal circumference is left in situ, regional flap (pectoralis major, deltopectoral), radial forearm free flap, gastric patch, free jejunal patch, tongue base rotation flap.

238
Q

What are the differences between primary and secondary subglottic tumors

A

Primary tumors are less common, usually present with stridor or dyspnea and at a more advanced stage, and have a worse survival time than secondary tumors.

239
Q

What features of hypopharyngeal tumors distinguish them from other head and neck tumors

A

Propensity for early submucosal spread and skip lesions.

240
Q

What structure in the hypopharynx marks the location of the cricoarytenoid joint

A

Pyriform apex.

241
Q

What are the most common and least common sites of tumor involvement in the hypopharynx

A

Pyriform sinus is the most common site (75%); postcricoid area is the least common site (3-4%).

242
Q

What are the 3 subsites of the hypopharynx

A

Pyriform sinus, postcricoid area, and posterior pharyngeal wall.

243
Q

What is the primary treatment modality for nasopharyngeal cancer

A

Radiation therapy to the nasopharynx (66-70 Gy) and neck (60 Gy).

244
Q

What is the primary modality of treatment for extramedullary plasmacytomas

A

Radiation.

245
Q

What is the primary modality of treatment for extramedullary plasmacytomas

A

Radiation.

246
Q

What is the recommended treatment for neck disease after radiation therapy

A

Radical neck dissection.

247
Q

What are the three most common odontogenic cysts

A

Radicular cyst (65%), odontogenic keratocyst, dentigerous cyst.

248
Q

How is isotretinoin effective in the treatment of SCCA of the head and neck

A

Reduces the incidence of second primary tumors.

249
Q

What are the most common presenting symptoms in patients with tumor of the retromolar trigone (RMT)

A

Referred otalgia and trismus.

250
Q

What are the most common complications of gastric pull-up

A

Regurgitation, cervical dysphagia, stricture, anastomotic leak.

251
Q

What are the treatment options for recurrent/persistent NPC at the primary site

A

Reirradiation with larger therapeutic dose than initial treatment; stereotactic radiotherapy; brachytherapy with split palate implantation of radioactive gold surgical resection.

252
Q

What are 5 major approaches of gene transfer, and which is most common

A

Replacement of mutated tumor suppressor genes, introduction of toxic/suicide genes, immunomodulation (most common), delivery of antisense nucleotides, and cytolytic viral therapy.

253
Q

Which nodal groups does nasopharyngeal cancer spread to

A

Retropharyngeal nodes of Rouviere, jugulodigastric nodes, spinal accessory chain.

254
Q

What space does the parapharyngeal space communicate with dorsally

A

Retropharyngeal space.

255
Q

What is the blood supply to the gastric pull-up

A

Right gastroepiploic and right gastric arteries.

256
Q

How do RT failures differ from surgical failures in site of recurrence

A

RT failures often occur in the center of areas that were grossly involved with cancer initially; surgical failures often occur at the periphery of the original tumor.

257
Q

Which sinonasal neoplasms remodel rather than erode bone

A

Sarcomas, minor salivary gland carcinomas, hemangiopericytomas, extramedullary plasmacytomas, large cell lymphomas, and olfactory neuroblastomas.

258
Q

Which sinonasal neoplasms remodel rather than erode bone

A

Sarcomas, minor salivary gland carcinomas, hemangiopericytomas, extramedullary plasmacytomas, large cell lymphomas, and olfactory neuroblastomas.

259
Q

What are the indications for a prophylactic neck dissection

A

SCC A > 4 em with deep invasion arising on the cheek, upper neck, or scalp.

260
Q

What is the most common malignant sinonasal neoplasm

A

SCCA, comprising 80% of malignant sinonasal neoplasms.

261
Q

Cancer of the cervical esophagus is usually what type

A

SCCA.

262
Q

Why are patients prone to aspiration after supraglottic laryngectomy

A

Secondary to loss of epiglottis and closure of false cords, to decrease in laryngeal elevation and loss of afferent stimulation to the vocal cords with tracheostomy, and to decrease in sensation from loss of superior laryngeal nerves during tumor resection.

263
Q

What are the characteristics of an ideal oncolytic virus

A

Selective for infection and lysis of cancer cells; stimulates a potent antitumor response with limited local/systemic toxicity.

264
Q

What effects does RT have on the ears

A

Serous OM; possibly SNHL, although this controversial.

265
Q

What is its significance

A

Serves as a pathway for tumor extension into the thyroid cartilage.

266
Q

What does continuous facial nerve monitoring during parotidectomy prevent

A

Short-term paresis.

267
Q

What impact does hyperfractionated therapy have on locoregional control and survival rates compared to conventional therapy

A

Significantly higher locoregional control and survival rates.

268
Q

What is a SNUC

A

Sinonasal undifferentiated carcinoma… a very aggressive small cell sinonasal tumor.

269
Q

Which has a steeper dose-response curve: small well-vascularized tumors or bulky tumors

A

Small well-vascularized tumors.

270
Q

How does chondrosarcoma of the mandible appear radiographically

A

Soft tissue mass with amorphous “popcorn” calcifications.

271
Q

Which of these is the least common

A

Spindle-pleomorphic.

272
Q

What is the classic finding on arteriogram of carotid body tumors

A

Splaying of the carotid bifurcation by a well-defined tumor blush (“lyre sign”).

273
Q

What is Bowen’s disease

A

Squamous cell carcinoma-in-situ of the skin.

274
Q

What is the most important prognostic factor for malignant salivary gland neoplasms

A

Stage.

275
Q

What is the function of IL-2

A

Stimulates T and NK cells.

276
Q

Compared to supraglottic and glottic tumors, subglottic tumors are at a much higher risk for developing what

A

Stomal recurrence.

277
Q

What are the 5 layers of the epidermis from deep to superficial

A

Stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum

278
Q

Why is the clinically negative neck treated

A

Studies have shown improved local control and disease-free survival for prophylactic irradiation of the cJinicalJy negative neck in patients with NPC.

279
Q

What are the incisions used for the midface degloving approach

A

Sublabial; intercartilaginous; complete transfixion.

280
Q

What is the least common site of a salivary gland neoplasm

A

Submandibular gland (I 1 %).

281
Q

Which salivary gland has the worst prognosis for malignant tumors

A

Submandibular gland.

282
Q

How does osteosarcoma of the mandible appear radiographically

A

Sunburst appearance, radiating periosteal new bone.

283
Q

Which of these is more commonly found on the extremities or trunk

A

Superficial multicentric.

284
Q

What are the 4 types of melanoma

A

Superficial spreading, lentigo maligna, acral lentiginous, and nodular sclerosing.

285
Q

Which is the most common

A

Superficial spreading.

286
Q

Which has the best prognosis

A

Superficial spreading.

287
Q

What is the blood supply to the jejunum

A

Superior mesenteric arterial arcade.

288
Q

What are the boundaries of the pyriform fossa

A

Superiorly, the inferior margin of the hyoid; anteriorly, the junction of the anterior and posterior halves of the thyroid cartilage; posteriorly, the posterior edge of the thyroid cartilage; apex, the cricoarytenoid joint.

289
Q

Which type of laryngeal cancer is mostly likely to metastasize distally

A

Supraglottic.

290
Q

What is the most direct approach for resection of all other posterior pharyngeal wall tumors

A

Suprahyoid.

291
Q

What is the optimal treatment for osteosarcoma of the head and neck

A

Surgery and radiation therapy.

292
Q

What is the role of concomitant chemotherapy

A

Survival advantage has been found using cisplatinum and 5-tlourouracil.

293
Q

What is the stage of a transglottic tumor without vocal cord fixation, cartilage invasion, or extension beyond the larynx

A

T2.

294
Q

What are 2 important techniques to prevent postoperative fistula formation

A

Tension-free closure and perioperative antibiotics.

295
Q

What are “carpet carcinomas”

A

Term used by Kleinsasser to describe laryngeal carcinomas with diffuse mucosal spread and limited submucosal infiltration.

296
Q

What were the results from the EORTC 22851 study comparing accelerated split-course XRT to conventional XRT

A

The accelerated course resulted in significantly higher late side effects without significant locoregional control or survival advantage.

297
Q

What feature distinguishes low-grade from high-grade mucoepidermoid carcinoma

A

The amount of mucin in the tumor.

298
Q

What are the advantages of postoperative RT

A

The anatomic extent of the tumor can be determined surgically, making it easier to define the treatment portals required; a greater dose can be given postoperatively than preoperatively; the total dose to be given can be determined on the basis of residual tumor burden after surgery; surgical resection is easier and healing is better in non-irradiated tissue.

299
Q

What structure courses through the foramen ovale

A

The mandibular nerve (V3 ).

300
Q

What is the anterolateral surgical approach to the nasopharynx

A

The maxillary antrum attached to an anterior cheek flap is developed as an osteocutaneous flap and swung laterally.

301
Q

Which factors determine the probability of local control with RT

A

The number of malignant cells and the proportion of hypoxic cells.

302
Q

What can be done for a large discrepancy between the circumference of the pharyngeal stoma and the jejunal segment

A

The proximal jejunum can be opened longitudinally along its antimesenteric border or a redundant piece of jejunum can be inserted into the proximal segment to widen the lumen.

303
Q

What conclusions can be made based on meta-analysis of these studies

A

The surgical patients had slightly higher (but not significant) survival advantage (6%). Among patients receiving chemotherapy, 58% were able to keep their larynx. Better outcomes were seen in patients with hypopharyngeal cancer who underwent chemotherapy than in those with laryngeal cancer.

304
Q

What was the first published randomized trial for organ preservation

A

The VA trial for SCC A of the larynx.

305
Q

How does one differentiate between a benign and a malignant paraganglioma

A

There are no clear histologic characteristics of malignancy; malignant lesions are defined by the presence of metastases.

306
Q

What problems may result from insertion at this location

A

This location is associated with chronic B-cell leukemias and integration into both copies of chromosome 19 may lead to cell death.

307
Q

What were the results from the RTOG 9003 study evaluating accelerated treatments with concomitant boost

A

This protocol resulted in significantly higher locoregional control and survival rates with somewhat higher rate of late side effects compared to conventional XRT.

308
Q

What is the arterial supply to the cervical esophagus

A

Thyroid branch of the thyrocervical trunk.

309
Q

What is the difference between hemilaryngectomy and vertical partial laryngectomy (VPL)

A

Thyroid perichondrium is preserved in VPL and excised in hemilaryngectomy.

310
Q

Why is the superior limb placed 1 em inferior to the mandible

A

To hide the scar in the shadow of the mandible.

311
Q

Why should the inferior turbinate be removed during resection of a sinonasal tumor

A

To prevent interference with a palatal prosthesis.

312
Q

What are the risk factors for developing esophageal cancer

A

Tobacco, alcohol, achalasia, Plummer-Vinson syndrome, prior head and neck cancer, tylosis, Barrett’s disease.

313
Q

What is the treatment of choice for primary subglottic cancer

A

Total laryngectomy, bilateral neck dissection, near total thyroidectomy, paratracheal node dissection and postoperative radiation to the superior mediastinum and stoma; if the anterior cervical esophageal wall is involved, then laryngopharyngectomy with cervical esophagectomy instead of total laryngectomy.

314
Q

What is the treatment of choice for metastatic cutaneous SCCA to the parotid

A

Total parotidectomy with preservation of VII (unless invaded by tumor) and postoperative radiation therapy to the parotid area and ipsilateral neck.

315
Q

What is the best surgical approach for removal of parapharyngeal tumors

A

Transcerv i cal.

316
Q

What effects does RT have on the brain or spinal cord

A

Transient radiation myelopathy, transverse myelitis.

317
Q

What is the primary blood supply to the skin flaps raised in a neck dissection

A

Transverse cervical artery and facial artery.

318
Q

T /F: The dose of radiation necessary to kill hypoxic cells is 2.5 - 3.0 times greater than that required to kill well-oxygenated cells.

A

True, as free radical formation requires oxygen.

319
Q

T/F: Embryologically, the supraglottis (SG) and glottis are separate entities

A

True.

320
Q

T/F: CT scan of the larynx underestimates the stage of laryngeal cancer

A

True.

321
Q

T/F: Once invasion of the laryngeal framework occurs, the ossified portions of cartilage have the least resistance to tumor spread

A

True.

322
Q

T/F: Any laryngeal tumor with vocal cord fixation is at least stage T3

A

True.

323
Q

T/F: No correlation with distant spread has been found with the age, sex, or general clinical condition of the host

A

True.

324
Q

T/F: Stage I lesions of the supraglottis can be controlled equally well with radiotherapy or surgery

A

True.

325
Q

T/F: Extension of a tumor in the pyriform sinus below the plane of the laryngeal ventricle is an absolute contraindication to supraglottic laryngectomy

A

True.

326
Q

T/F: Chemosensitive tumors are usually radiosensitive

A

True.

327
Q

T/F: It takes the same amount of radiation to reduce a cell population from 100 to 10 cells as it does to reduce it from 10 billion to 1 billion cells

A

True.

328
Q

T/F: The cells responsible for acute radiation injuries are rapidly cycling

A

True.

329
Q

T/F: Surgery is more effective in salvaging RT failures than RT is in salvaging surgical failures

A

True.

330
Q

T/F: Disease-free, but not overall, survival is improved in patients with early oral tongue cancer who undergo elective neck dissection

A

True.

331
Q

T/F: Neck dissections removed in continuity with the tumor specimen are associated with a significantly higher incidence of survival than those removed separate from the tumor

A

True.

332
Q

T/F: The involvement of the medial (as opposed to lateral) wall of the pyriform sinus significantly increases the likelihood of bilateral cervical metastasis

A

True.

333
Q

T/F: Due to the high incidence of cervical metastases, treatment of the neck is necessary in all patients with hypopharyngeal cancer

A

True.

334
Q

T/F: Superficial lesions of the posterior pharyngeal wall can be resected endoscopically with a laser and left to mucosalize by secondary intention

A

True.

335
Q

T/F: Due to shrinkage, at least 8 - 10 mm of in-situ margin must be taken to achieve a 5 mm pathologically clear margin for tumors of the oral cavity

A

True.

336
Q

T/F: There is a much lower risk of distant metastases with osteosarcoma of the head and neck than that of the long bones

A

True.

337
Q

T/F: A patient with T3N2aMO SCCA of the BOT has a complete response to external-beam RT both at the primary site and the neck. A planned neck dissection should be done to increase the rate of regional control

A

True.

338
Q

T /F: Adnexal carcinomas of the skin are very aggressive and have a poor prognosis.

A

True.

339
Q

Reconstruction should be delayed after excision of Merkel cell carcinoma until permanent section results are back.

A

True.

340
Q

T/F: Squamous cell carcinoma (SCCA) arising in sun-exposed areas tend to behave less aggressively than those arising de novo

A

True.

341
Q

T/F: Women with melanoma have a better prognosis than men regardless of tumor depth

A

True.

342
Q

T/F: The presence of unilateral compared with bilateral nodal disease in patients with NPC has no prognostic significance

A

True.

343
Q

T/F: Smoking by itself is not a significant etiologic factor for sinonasal tumors

A

True.

344
Q

T/F: Hypopharyngeal cancer has the worst prognosis of all head and neck cancers

A

True; 70°/o of patients present with advanced disease (stage III and IV) and the 5-year disease-specific survival is only 33%.

345
Q

T /F: RT should not be delayed in the presence of a fistula, open wound, or bony exposure.

A

True; as long as the carotid artery is not exposed, radiation treatments should never be delayed.

346
Q

What is the role of the MHC (major histocompatability complex) in the development of head and neck cancer

A

Tumor cells can escape early detection by the patient’s immune system via decreased expression of class I MHC antigens.

347
Q

What is the primary contraindication to nasopharyngectomy

A

Tumor involvement of the cavernous sinus or cranial nerves.

348
Q

What are the two most important factors predicting lymph node metastasis in laryngeal cancer

A

Tumor size and location.

349
Q

What are the most important prognostic factors in patients with osteosarcoma

A

Tumor size, grade, and surgical margin status.

350
Q

What factors increase the likelihood of regional metastasis of SCCA

A

Tumors arising on the ear, diameter >2 em or >4 mm thickness, poorly differentiated histology, and recurrent tumors.

351
Q

What is the significance of tumor size on the incidence of complications with resection

A

Tumors larger than 5 em are associated with a significantly higher rate of complications with removal (67°/o for tumors >5 em vs 15% for tumors

352
Q

How does the behavior of pyriform sinus tumors differ from postcricoid and posterior pharyngeal wall tumors

A

Tumors of the pyriform sinus tend to infiltrate deeply at early stages~ those of the postcricoid area and posterior pharyngeal wall tend to remain superficial until achieving an advanced stage.

353
Q

What factors increase the likelihood of recurrence for SCCA

A

Tumors on the midface, diameter >2 em or thickness >4 mm, perineural invasion, or regional metastases.

354
Q

What are the classifications of nasopharyngeal cancer designated by the WHO

A

Type 1: well-differentiated, keratinizing SCCA. Type II: poorly differentiated, nonkeratinizing SCCA. Type Ill: lymphoepithelioma or undifferentiated.

355
Q

What are the 2 primary cells of paragangliomas

A

Type I granule-storing chief cells and type II Schwann-like sustentacular cells arranged in a cluster called a Zellballen.

356
Q

What are the three types of ORN

A

Type I occurs soon after radiation therapy; Type II occurs long after radiation therapy and is induced by trauma; Type III occurs long after radiation therapy and occurs spontaneously.

357
Q

Which of these is not associated with positive EBV titers

A

Type I.

358
Q

Which of these is characterized by syncytia (fused multinuclear giant cells)

A

Type Ill.

359
Q

What factor, other than tumor thickness, influences regional metastasis in melanoma

A

Ulceration.

360
Q

Which kind of supraglottic cancers are more likely to extend inferiorly to the anterior commissure or ventricle… ulcerative or exophytic

A

Ulcerative lesions.

361
Q

What is the significance of positive margins after laryngeal surgery

A

Unclear; no correlation exists between recurrence rate and the type of involved margin (gross, close, intraepithelial). Some advocate careful followup instead of further treatment.

362
Q

What can be said of the presence of level V cervical metastases from SCCA of the upper aerodigestive tract

A

Uncommon (7%), and if present, most likely to occur in the presence of level IV metastases.

363
Q

In what region of the world is Plummer-Vinson syndrome most common

A

United Kingdom and Scandinavia… rare in the US.

364
Q

What are the advantages of planned preoperative RT

A

Unresectable tumors may be made resectable; the extent of surgical resection may be diminished; the treatment portals preoperatively are usually smaller than those used postoperatively; microscopic disease is more radiosensitive preoperatively due to better blood supply; the viability of tumor cells that may be disseminated by surgical manipulation is diminished.

365
Q

What percentage of sinonasal tumors can be attributed to occupational exposures

A

Up to 44%.

366
Q

What % of patients treated with 50 - 60 Gy of RT to the head and neck complain of ageusia

A

Up to 50°/o.

367
Q

What are the 3 major randomized studies on organ preservation as treatment for laryngeal cancer

A

VA, GETTEC, EORTC.

368
Q

How can one differentiate a vagal paraganglioma from a carotid body tumor

A

Vagal paragangliomas displace the internal carotid anteriorly and medially.

369
Q

What anatomic structure serves as a natural barrier to the inferior extension of supraglottic cancers

A

Ventricle (embryologic development is completely separate from the false cord).

370
Q

Which of these is more common in the oral mucosa

A

Verrucous

371
Q

What is Ackerman’s tumor

A

Verrucous carcinoma, thought to be less radiosensitive and less likely to metastasize than SCCA.

372
Q

What is Ackerman’s tumor

A

Verrucous carcinoma, thought to be less radiosensitive and less likely to metastasize than SCCA.

373
Q

When is XRT considered in lieu of surgery for treatment of carotid body tumors

A

Very large tumors, recurrent tumors, or poor surgical candidates.

374
Q

What are the 2 main categories of gene delivery agents

A

Viral and nonviral/physical.

375
Q

What are the contraindications to supraglottic laryngectomy

A

Vocal cord fixation, extension to apex of pyriform sinus, bilateral arytenoid involvement, extensive involvement of BOT, involvement of the anterior commissure, invasion of the thyroid cartilage, invasion into the interarytenoid space.

376
Q

What is Broyles’ tendon

A

Vocalis muscle tendon that inserts into the thyroid cartilage.

377
Q

Which benign parotid gland tumors are recognized by a high concentration of mitochondria on electron microscopy

A

Warthin’s tumor and oncocytoma.

378
Q

How does cemento-ossifying fibroma appear radiographically

A

Well-circumscribed lesion with a dense core and lucent rim; the core enlarges and rim diminishes with maturation.

379
Q

What are the recommended indications for elective neck dissection by the National Cancer Comprehensive Network

A

When expected incidence of microscopic or subclinical disease surpass 20% (though many use 25% or 30% as the criteria).

380
Q

What is the primary mode of treatment

A

Wide surgical excision and postoperative radiation therapy.

381
Q

What significance do these features have on treatment

A

Wide surgical margins (4-6 em inferior to gross, 2-3 em superior to gross) and wide radiation therapy ports are necessary.

382
Q

What are the disadvantages of planned preoperative RT

A

Wound healing is more difficult, and the dose that can be safely delivered preoperatively is less than that which can be given postoperatively.

383
Q

What are some other genetic disorders that are associated with a high risk of cutaneous malignancies

A

Xeroderma pigmentosum, albinism, epidermodysplastic verruciformis, epidermolysis bullosa dystrophica, and dyskeratosis congenital

384
Q

Which cranial nerve is most commonly damaged by RT to the head and neck

A

XII.

385
Q

'our patient has a mucoepidermoid carcinoma of the parotid gland. Histologic evaluation of the biopsy specimen reveals a scant amount of mucin. There is no clinical evidence of regional metastasis. Do you treat the neck

A

Yes.

386
Q

Should the NO neck be treated in patients with Merkel cell carcinoma

A

Yes.

ENT Specialties MAIN (17 decks)

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