Head and Neck Cancer FRCR CO2A Flashcards

Question

why is mouth bite used during RT simulation

Answer 1

to reduce dose to adjacent normal structures

Answer 2

To treat glottic caner when Antr commisure is involved To treat skin, if involved

Answer 3

identify extent of scar, done with aid of a lead wire, can be visualised on planning CT scan

Answer 4

Chin should be in normal position shoulders should be kept as low as possible

Answer 5

1. Delineate GTV: Primary and nodes, help from diagnostic imaging and C/E findings, coregistration of diagnostic images 2. Delineate the CTV1 (GTV + 1 cm isotropic expansion in all directions, adjacent high risk regions and whole involved nodal level(s) in neck, crop out nature tissue barriers like bone, air and fascia, include the entire involved nodal levels , may be extended to include adjacent high risk regions eg parapharyngeal spaces and remaining oropharynx/larynx etc 3. Delineate elective CTV2 4. Delineate OARs 5. Create PTV and PRV

Answer 6

Giving margin (3 to 5 mm) to OAR

Answer 7

1. Recreate preoperative primary and nodal GTV: with the aid of coregistration of diagnostic scans, edit GTV based on post op changes, 1 to 1.5 cm isotropic margin in all directions to create CTVp and CTVn from GTVn, extend CTV to include all pathologically involved nodal levels and include sermas and other post op changes (CTV1) 2. CTV2: uninvolved nodal levels in dissected neck and other at risk nodal levels

Answer 8

setting objectives / constraints and order of priorities

Answer 9

an objective is a parameter desired to be met where compromise may be an option while constraint is a parameter that must be met, compromise is not an option

Answer 10

Serial organs, Dmax cannot exceed a predetermined level even to achieve PTV coverage

Answer 11

1. Serial Oragans Dmax 2. PTV coverage 3. Objectives for dose to the parallel structures

Answer 12

V99%>90% V95%>95% V50% 100% V5% < 105% V2% < 107 %

Answer 13

1. Avoid Sun Exposure, wet shaving and perfumed soap and toileratires 2. Twice daily applicaiton of skin moisturizers to the H&N Cancer region 3. maintaining oral hygiene by using regular mouth wash 3 to 4 times/day 4. AVoid smoking, alcohol and certain foods like citrus, spicy, hot and hard food 5. Avoid Chlorhexidine mouth wash, instead do with 1 cup of warm water + 1/2 tsf salt + 1/2 tsf baking Soda

Answer 14

S/Es within 90 days of Treatment: Acute, thereafter Chronic

Answer 15

1. Xerostomia 2. Swallowing dysfunction 3. Trismus 4. Subcut fibrosis 5. ORN

Answer 16

it inhibits the regrowth of the mucosa

Answer 17

CRT improved survival by 6.5% at 5 years compared to RT alone

Answer 18

DCF (docetaxel, Cisplatin, 5 FU) in Neoadjuvant setting

Answer 19

Improved outcomes but higher acute toxicity, 12% neutropenic sepsis other s/e: mucositis, esophagitis, nausea and anorexia

Answer 20

High Dose Cisplatin @ 100 mg/m2 on D1, D22

Answer 21

40 mg/m2 weekly for 6 weeks, Carboplatin AUC 5 on D1 and D22 or weekly at AUC 1.5 to 2

Answer 22

Conflicting results an italian study by Ghi et al 2014 showed sequential therapy improved 3 year survival 58% vs 46%

Answer 23

1. inoperable locoregionaly recurrent disease 2. distant metastatic disease or 3. combination of both

Answer 24

Pembrolizumab/platinum (cisplatin or carboplatin)/5-FU Pembrolizumab (for tumors that express PD-L1 with CPS ≥1)c | Subsequent Line Nivolumabd (if disease progression on or after platinum ## Footnote * Pembrolizumab40-42 (if disease progression on or after platinum therapy) (category 1)

Answer 25

* Nivolumab (if disease progression on or after platinum therapy) (category 1) * Pembrolizumab (if disease progression on or after platinum therapy) (category 1)

Answer 26

Cisplatin * Carboplatin * Paclitaxel * Docetaxe * 5-FU45 Methotrexate progression on or after platinum therapy) (category 2B) * Cetuximab * Capecitabine5

Answer 27

response rate single agent: 10 to 15 % combination: 25 to 30 % but increased incidence of toxicity

Answer 28

Rx of choice: Surgery (WLE and with/without reconstruction and Neck dissection depending on the subsite of oral cavity. Node negative: Prophylactic Neck dissection (U/L for lateralized tumors and B/L for midline tumors) for FOM and Tongue while observation for other subsites

Answer 29

Pts not willing for surgery or not able to go for surgery due to comorbidities

Answer 30

for FOM and Tongue

Answer 31

with electrons (9-15 MeV) or KV X rays (170-300 KV)

Answer 32

1. determine depth of tumor 2. Add 1 cm for microscopic disease and 5 mm for penumbra 3. use internal shielding (lead in wax) (general rule - energy/2 in mm of lead) 4. use mouth bite 5. custom made end plate cut out to shape the field 6. use a bolus of 5 to 10 mm thickness to ensure surface is covered

Answer 33

More than 4 cm, and/or invasion of adjacent structures (extrinsic tongue muscles, bone) and/or regional LN involvement

Answer 34

Combined Approach (Sx and RT) high risk of locoregional Recurrence

Answer 35

ECS + Margin + <1 mm

Answer 36

1. Buccal mucosa 2. Alveolus 3. RMT 4. lateral border of oral tongue 5. Lateralized FOM

Answer 37

when tumor crosses the midline

Answer 38

St I: 71.5% St II: 57.9% St III: 44.5% St IV: 31.9%

Answer 39

Supr: Floor of sphenoid sinus and clavus Infr: caudal edge of C1 or nasal aspect of soft palate Antr: junction with nasal choanae Postr: PPW Lateral: Lat pharyngeal wall and medial border of parapharyngeal space

Answer 40

Retropharyngeal nodes: 1st echelon Then to Level II and upper V nodes

Answer 41

lateral wall of roof of NPx

Answer 42

I/L palpable LAD (60-90%) BL LAD (50%)

Answer 43

1. EBV and Nitrosamines (present in salt cured fish and meat and released during the cooking Process) 2. Genetic predisposition and heavy alcohol intake

Answer 44

1. Painless Neck Lump, the posterior triangle 2. U/L otitis media, conductive deafness and tinnitus 3. nasal obstruction, epistaxis 4. sore throat 5. Cranial Nerver dysfunction (II-VI or XI-XII)

Answer 45

Sq Cell Carcinoma, 3 types, type I keratinizing (west and 20% of NPC), type II non keratinizing (a/w EBV, 30% of NPx), type III (poorly differentiated) other histologies: Adenocarcinoma, Lymphoma (T Cell)

Answer 46

RT with/without ChT

Answer 47

IMRT for all patients due to close proximity of vital organs

Answer 48

limited to Dx and salvage neck dissection for recurrent or persistent + nodes after CRT

Answer 49

Radical RT alone

Answer 50

Concurrent ChemoRadiotherapy due to higher incidence of distant failure with RT

Answer 51

NACT often 2 cycles with PF followed by ChemoRT with cisplatin (100 mg/m2 3 weekly for 3 doses)

Answer 52

70 Gy/ 35 # to CTV1 59.4 Gy/ 35# to CTV2 54 Gy/ 35# to CTV3 CTV1 includes GTV + 1 cm and whole NPx and all involved LNs

Answer 53

post: B/L Retropharyngeal Nodes Antr: postr third nasal cavity, postr ethmoid and postr third maxillary antrum antrly LaterallY: B/L parapharyngal spaces, pterygoid plates and /or pterygoid muscles Supr: skull base and floor of sphenoid sinus suprly including b/l foramen ovale, carotid canal and foramen spinosum, clivus and petrous tips

Answer 54

1. upper 1/2 of sphenoid sinus 2. infraorbital fissure, orbital apex and supraorbital fissure 3. uninvolved nodal levels (level Ib-Va, Vb, the retrostyloid space and the SCF)

Answer 55

at least 70 Gy

Answer 56

St I: 71.5% St II: 64.2% St III: 62.2 % St IV: 38.4 %

Answer 57

90 % at 2 to 5 years

Answer 58

HPV 16 smoking Alcohol

Answer 59

1. MC subsite: tonsil and tongue base 2. early T stage and advanced N stage with LNs that are cystic in nature

Answer 60

extends from Plate to the hyoid supr: jxn of hard and soft palate Infr: the vallecula/hyoid antr: circumvallate papillae postr: the postr pharyngeal wall lat: lateral pharyngeal wall

Answer 61

Tonsils Tongue Base Valleculae Soft palate postr pharyngeal wall

Answer 62

1. Level II nodes: 1st echelon

Answer 63

1. difficulty in swallowing and odynophagia 2. referred otalgia 3. Trismus 4. Impaired Tongue movement and altered speech

Answer 64

Sq Cell Carc AC Small Cell Carc Lymphoma Mucosal Melanoma

Answer 65

Tonsillar fossa

Answer 66

Tonsullar tumor involving adjacent tongue/soft palate by > 1 cm or arising from midline, tongue base/soft palate/PPW/vallecula

Answer 67

Sx (TLM or TORS) with SND(I/L or B/L)

Answer 68

CRT or RT with concomitant Cetuximab (where chemo is contraindicated) or RT alone or Induction Chemo f/b RT/CRT

Answer 69

after age 70

Answer 70

Higher chances of metastatic 1. T4 2. N2c/N3

Answer 71

Stage of disease HPV status Smoking Hx

Answer 72

82.4% for HPV + compared to 57.1 % for HPV - 3 year OS 93% in HPV + with a low smoking Hx

Answer 73

Pyriform sinus PPW Post Cricoid region

Answer 74

Level II to V and RPLNs (PFS) Level II, III and RPLN (PPW) Levels III, V and paratracheal (post cricoid)

Answer 75

medially and suprly by The AEF antrosuperirly by the pharyngoepiglottic fold Laterally by superior edge of thyroid cartilage Inferiorly: the apex opens into the esophagus 65 to 75% Cancers here

Answer 76

tip of epiglottis to the infr border of cricoid 10 - 20 % cancer pts | cricopharyngeus mucle and pharngeal constrictor muscles form the PPW

Answer 77

Postr surface of arytenoids to the inferior border of the cricoid cartilage, 5 to 10 % of cancers | cricopharyngeus muscle

Answer 78

Smoking Alcohol IRon and Vitamin defy asbestos exposure wood and coal dust

Answer 79

Odynophagia Wt loss referred otalgia, hemoptysis difficulty in breathing painless neck swelling

Answer 80

Elective Rx of B/L Neck for all stages, even in clinically node negative neck due to high incidence of occult LN Mets (30 to 50%)

Answer 81

surgery either TLM or TORS open surgical procedures not recommended

Answer 82

Total laryngectomy partial or total pharyngectomy permanent tracheostomy b/l neck dissection and reconstruction

Answer 83

1 cm isotropic margin except supr and infr (2 cm)

Answer 84

GTV and margin whole hypopharynx (tip of epiglottis to bottom of cricoid or lower as dictated by tumor), parapharyngeal space on I/L side with gross disesase involving the space

Answer 85

Glottis Supraglottis and Subglottis

Answer 86

Glottic cancer

Answer 87

supraglottic larynx

Answer 88

Arytenoids, AEF, Epiglottis, False cords

Answer 89

Vocal Cords antr commisure postr comissure

Answer 90

below the vocal cords to the bottom of the cricoid

Answer 91

Hoarseness of voice Sore throat, Odynophagia Difficulty swallowing painless neck swelling

Answer 92

Tranoral laser resection in supraglottic and glottic cancers SND considered in N0 patients but not for glottic cancer due to the low risk of nodal mets

Answer 93

Recurrent /persistent disease following RT

Answer 94

Total Laryngectomy and B/L Neck Dissection

Answer 95

Primary RT is an alternative Rx option for early stage disease at all subsites and is Rx of Choice in patients with poor access to surgery

Answer 96

RAdical RT

Answer 97

classified into two groups 1. with no extra laryngeal extension with useful laryngeal function 2. with gross cartilage destruction and/or extra laryngeal disease or with poor function

Answer 98

Total Laryngectomy and Neck dissection and Adj. RT or CRT

Answer 99

CRT (larynx preservation) NACT f/b CRT (large volume disease) RT (over 70 yrs or not fit) RT and Cetuximab (C/I for Chemo)

Answer 100

If antr commissure is involved

Answer 101

Maxilla (70%) Nasal Cavity (lateral wall) Ethmoid sinuses (10%) Tumors of frontal and sphenoid are rare

Answer 102

Supr: floor of the orbit Infr: alveolar process of maxilla medial wall: the nasal cavity antr wall: antr wall of maxilla postr wall: pterygoid and pterygopalatin fossa

Answer 103

line connecting medial canthus to angle of mandible (imaginery line) divides maxilla into antroinferior and posterosuperior region

Answer 104

AntroInfr a/w earlier presentation and good prognosis and reverse is true for postr superior

Answer 105

Retropharyngeal LNs, level I and II, early stage: < 5%, advanced stage: 10 to 15%

Answer 106

leather, textile, wood dust and nickel dust air pollution, tobacco, virus

Answer 107

Nickel dust; Squmaous cell carcinoma Wood Dust: Adenocarcinoma

Answer 108

Early disease: Asymptomatic present at a later stage, with symptoms related to invasion of adjacent structures Symptoms include: 1. nasal obstrn 2. anosmia, nasal discharge, epistaxis 3. Facial/cheek swelling 4. Eye symptoms: diplopia, watering of eyes, proptosis 5. Pain in face numbness, 6. loosening of teeth, non healing ulcer in the oral cavity

Answer 109

Squamous cell Carcinoma (50%), Mucosal Melanoma, olfactory esthesioneuroblastoma, Adenoid cystic carcioma

Answer 110

Surgery for early stage Sx followed by adjuvant RT for locally advanced

Answer 111

for clinically node negative and advanced stage disease

Answer 112

RT with/without Chemo

Answer 113

GTV + 1 cm the whole maxillary antrum, b/l ethmoid sinuses and I/L nasal cavity pterygopalatine fossa and masticator space in maxillary sinus tumors sphenoid sinus when the ethmoid sinus is involved Entire orbit when there is gross orbital fat involvement

Answer 114

Pleomorphic adenomas and Warthin's tumor

Answer 115

70% parotid 10 % submandibular glands < 1% in sublingual glands

Answer 116

superficial lobe

Answer 117

Preauricular and intraparotid nodes

Answer 118

Lingual nerve, marginal branch of facial nerve, and the hypoglossal nerve causing tongue weakness

Answer 119

Benign: Pleomorphic Adenoma Malignant: MEC, Adenoid Cystic Carcinoma, Adenocarcinoma, malignant mixed tumors and Acinic cell carcinomas

Answer 120

high incidence of PNI

Answer 121

Surgery involves superficial parotidectomy or total parotidectomy for tumors arising in the parotid glands, facial nerve is preserved where possible

Answer 122

1. Node involvement 2. locally advanced tumors (> 4 cm, T3/T4 disease) 3. High grade tumors like undifferentiated carcinoma and high grade MED, AdenoCarc, malignant mixed tumors

Answer 123

As an alternative in pt's with locally advanced, inoperable or where surgery could not be done Post op Setting: 1. close or + resection margins 2. residual disease 3. + nodes 4. High Grade Histology, MEC, Adenoid Cystic Carcinoma, High grade Adenocarcinoma, malignant mixed tumors except T1 tumors with clear margins 5. Tumors > 4 cm, T3/T4 tumors, bone and nerve involvment, skin involved, PNI, Close proximity to facial nerve where nerve is involved

Answer 124

Positive or close margins

Answer 125

Most of the metastasis from below the clavicle

Answer 126

1. History 2. C/E 3. Flexible Endoscopy 4. EUA: to look at postnasal space, tongue base, hypopharynx, and take biopsies from there 5. USG Neck and FNAC 6. CT Neck and Chest 7. MRI craniofacial region 9. PET for patients for radical Rx when other Ivestigations failed to reveal a primary site PET identifies 25% fo patients

Answer 127

HPV P26 and EBV

Answer 128

MRND followed by post op RT depending on histologic findings or CRT or RT alone

Answer 129

varies widely most oncologists do total mucosal irradiation

Answer 130

20 Gy/ 10#

Answer 131

single lateral field angled 5 degree away from lens or with 1/2 beam blocking or antr field with central axis blocking

Answer 132

15 Gy in 5 fractions, visual acquity is improved or stabilised in 66% of patients at 12 month follow upw

Answer 133

elderly patients, choroidal vessels prolferation causing subretinal H'ge and retinal detachment leading cause of blindness in developed countries

Answer 134

Autoimmune response, activated T cells invade the orbit and stimulate the production of Glycosaminoglycan in fibroblasts

Answer 135

Around 6% ## Footnote This statistic highlights the prevalence of head and neck cancers in the global context.

Answer 136

2–3:1 ## Footnote This indicates that head and neck cancers are more common in men than women.

Answer 137

40–70 years ## Footnote This age range shows the demographic most susceptible to squamous cell carcinomas.

Answer 138

Far East ## Footnote This indicates a regional variation in the incidence of specific types of head and neck cancers.

Answer 139

Tobacco ## Footnote More than 90% of patients with head and neck SCC have a history of tobacco use.

Answer 140

Increased alcohol consumption is associated with increased risk ## Footnote Alcohol has a synergistic effect with tobacco in the development of SCCs.

Answer 141

Human papilloma virus (HPV) ## Footnote Approximately 90% of these specimens are positive for HPV-16, particularly associated with oropharyngeal SCC.

Answer 142

Epstein–Barr virus (EBV) ## Footnote Plasma levels of EBV DNA before treatment and after radiotherapy correlate with outcomes and survival.

Answer 143

Lower socioeconomic status ## Footnote This highlights the impact of socioeconomic conditions on health outcomes.

Answer 144

A mixture of tobacco, slaked lime, and areca nut, popular in India and parts of South East Asia ## Footnote It is associated with oral submucous fibrosis and leukoplakia, increasing the risk of oral carcinoma.

Answer 145

* Asbestos (larynx) * Wood dusts (nasal cavity, nasal sinuses, nasopharynx, larynx) * Nickel (maxillary sinus) * Pesticides (larynx) ## Footnote These occupational exposures can significantly increase the risk of developing head and neck malignancies.

Answer 146

UV exposure ## Footnote This highlights the environmental factors that contribute to the risk of skin cancers.

Answer 147

Increases the risk of subsequent head and neck malignancies ## Footnote This underlines the importance of monitoring patients with a history of radiation therapy.

Answer 148

Squamous metaplasia → Dysplasia → Carcinoma-in-situ → Invasive squamous cell carcinoma ## Footnote This stepwise progression illustrates the development of SCC from non-cancerous changes to invasive cancer.

Answer 149

90% ## Footnote This statistic emphasizes the predominance of SCC among head and neck malignancies.

Answer 150

* Inactivating tumor suppressor genes * Activating oncogenes ## Footnote These alterations disrupt the regulation of cell proliferation, contributing to cancer development.

Answer 151

WHO classification ## Footnote This classification helps in the categorization and understanding of different types of head and neck cancers.

Answer 152

Head and neck

Answer 153

Anatomical levels of neck nodes and typical regional lymphatic drainage for head and neck subsites

Answer 154

Relatively predictable for different tumour subsites

Answer 155

* Primary site * Size of primary tumour

Answer 156

The primary site and size of the primary tumour

Answer 157

* Squamous cell carcinoma and variants * Nasopharyngeal carcinoma * Salivary gland tumours – acinic cell carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma * Adenocarcinoma * Lymphoma * Small cell carcinoma * Carcinoid * Sarcoma * Metastasis

Answer 158

* IA – Submental * IB – Submandibular * II – Upper deep cervical * III – Middle deep cervical * IV – Lower deep cervical * VA – Posterior triangle * VB – Supraclavicular * VI – Anterior compartment

Answer 159

Symptoms depend on the site of the tumour

Answer 160

* Duration and intensity of symptoms * Age * Socioeconomic status * Tobacco and alcohol use * Co-morbid conditions * History of previous malignancy or pre-malignancy

Answer 161

* Smoking-related illness * Respiratory disease * Cardiac disease * Diabetes * Liver disease * Peripheral vascular disease * Immunodeficiency * Poor nutrition

Answer 162

The whole oral cavity and teeth

Answer 163

Flexible fibreoptic nasoendoscopy or indirect laryngoscopy

Answer 164

Enlarged lymph nodes or thyroid masses

Answer 165

An occult primary

Answer 166

* Base of tongue * Tonsil * Nasopharynx * Piriform fossae

Answer 167

* to establish a histological diagnosis * to stage the disease * to exclude synchronous tumours of the upper aerodigestive tract * determine fitness for radical treatments ## Footnote None

Answer 168

* Fine needle aspiration/core biopsy * Examination under anaesthesia (EUA) with panendoscopy ## Footnote EUA is often used to obtain biopsies to establish a histological diagnosis and to clinically stage the tumour.

Answer 169

* Ultrasound examination of the neck * CT of the head and neck region * MRI of the head and neck region * 18FDG PET-CT ## Footnote MRI is superior for assessing soft tissue infiltration, cartilage invasion, and perineural spread.

Answer 170

* MRI is superior for soft tissue infiltration, cartilage invasion, and perineural spread * CT is useful for assessing bone involvement and is better tolerated by patients with swallowing difficulties due to faster acquisition speed ## Footnote CT chest or chest X-ray may be needed to rule out pulmonary metastases.

Answer 171

* Primary tumour size and/or extent * Regional lymph node metastasis * Distant metastatic spread ## Footnote TNM stands for Tumor, Node, Metastasis.

Answer 172

A multidisciplinary approach ## Footnote All patients require assessment of performance status, dentition, swallowing, and nutrition.

Answer 173

To minimize late side effects of radical radiotherapy such as dental caries and osteoradionecrosis ## Footnote Maintaining adequate nutrition is also a challenge in these patients.

Answer 174

Swallowing and language therapy (SALT) assessment ## Footnote Patients are encouraged to stop smoking and minimize alcohol intake during radiotherapy.

Answer 175

* Surgery * Radiotherapy ## Footnote The choice of treatment is based on the location of the tumour and anticipated morbidity.

Answer 176

* 85–95% for T1 lesions * 70–85% for T2 lesions ## Footnote Treatment of the neck should be considered in addition to the treatment of the primary site.

Answer 177

In node negative head and neck cancers with a >15–20% risk of occult cervical node metastasis ## Footnote This includes all cancers except <2 cm lesions in the oral cavity and T1 glottic cancers.

Answer 178

* Neck dissection * Neck irradiation ## Footnote The level(s) of nodes to be treated depends on the primary site of the tumour and T stage.

Answer 179

Combined modality treatment ## Footnote Treatment decisions are based on chances of local control and outcome.

Answer 180

* Surgery followed by postoperative radiotherapy * Chemoradiotherapy

Answer 181

T1N0M0 tumor of ≤2 cm

Answer 182

T2N0M0 tumor of >2–4 cm

Answer 183

* T3N0M0 tumor of >4 cm * T1–3N1M0 ipsilateral single node ≤3 cm

Answer 184

* T4N0–1M0 involving adjacent structures * Any T N2M0 ipsilateral single node >3–6 cm * Any T N3M0 nodes >6 cm * Any T, any N, M1 (distant metastasis)

Answer 185

* T4a (resectable) * T4b (unresectable)

Answer 186

80.5 Gy in 70 fractions over 7 weeks using two 1.15 Gy fractions per day

Answer 187

Failed to improve local control in locally advanced head and neck cancer

Answer 188

Results in an absolute 5-year survival improvement of approximately 10% compared with radiotherapy alone

Answer 189

Two randomized studies showed differing benefit, making its role unclear

Answer 190

Evolving role in reducing radiation dose to critical structures and modifying side effects

Answer 191

May be used for some early tumors and small volume tumor recurrences within previously irradiated sites

Answer 192

Controversial; large meta-analysis showed no significant benefit

Answer 193

30–40% with median survival around 6 months

Answer 194

Cisplatin/5-FU combinations

Answer 195

Addition of cetuximab to cisplatin and 5-FU improves overall survival compared to chemotherapy alone in metastatic/recurrent setting

Answer 196

Over 80% of head and neck SCC tumors overexpress EGFR, associated with poor prognosis

Answer 197

* Improves 3-year local control (41% vs. 34%) * Improves overall survival (55% vs. 45%)

Answer 198

In patients with locally advanced head and neck cancer with good performance status when platinum-based chemoradiation is contraindicated

Answer 199

Input from clinical nurse specialists, speech and language therapists, dietitians, physiotherapists, occupational therapists, dental surgeons, dental hygienists, and prosthetic specialists ## Footnote A multi-disciplinary approach ensures comprehensive care addressing various aspects of patient recovery.

Answer 200

Positive resection margins, extracapsular spread ## Footnote Major risk factors significantly increase the likelihood of recurrence.

Answer 201

* Close resection margins (<5 mm) * 2 or more involved nodes * Invasion of soft tissues * More than one lymph node level involved * Multifocal primary * Involved node >3 cm in diameter * Perineural invasion * Vascular invasion * Poorly differentiated * T3 or T4 disease ## Footnote Minor risk factors can also contribute to the risk of recurrence but are less significant than major factors.

Answer 202

High risk of recurrence: one major or two minor risk factors; Intermediate risk: one minor risk factor ## Footnote Understanding these associations helps in patient management and treatment planning.

Answer 203

* Oral cavity primary site * Presence of carcinoma-in-situ or dysplasia at the resection margin * Uncertain surgical or pathological findings ## Footnote These factors have minimal impact on recurrence risk compared to major and minor factors.

Answer 204

All patients supine with the head in neutral position, except for specific cancers ## Footnote Proper positioning is crucial for effective treatment and minimizing damage to healthy tissues.

Answer 205

Immobilization ## Footnote A customized shell ensures that the patient remains in a stable position throughout treatment.

Answer 206

GTV – all radiologically visible tumour ## Footnote GTV is critical for accurately targeting the treatment area.

Answer 207

CTV – includes GTV with a margin; PTV – accounts for setup error ## Footnote CTV and PTV are essential for defining treatment areas and ensuring adequate radiation delivery.

Answer 208

44 Gy in 2 Gy per fraction ## Footnote This dose is administered with a lateral parallel opposed beam to target the primary tumour and upper neck nodes.

Answer 209

Indicated if there is skin involvement, close superficial margin, primary electron treatments, or postoperative tracheostome site ## Footnote Bolus helps enhance dose delivery to superficial tissues.

Answer 210

* Salvage surgery * Radiotherapy * Palliative chemotherapy * Best supportive care ## Footnote Treatment choices depend on the initial treatment and patient condition.

Answer 211

* Cisplatin 100 mg/m2 IV 3-weekly on days 1, 22, and 43 (if GFR >50 ml/min) * Cisplatin 40 mg/m2 IV weekly for 6 courses (if GFR <55 and >40 substitute with carboplatin AUC 5) ## Footnote This regimen is based on clinical trial protocols for postoperative chemoradiotherapy.

Answer 212

400 mg/m2 IV followed by weekly doses of 250 mg/m2 for 2–8 weeks ## Footnote Cetuximab is used as an alternative treatment in specific patient scenarios.

Answer 213

* Docetaxel 75 mg/m2 IV day 1 * Cisplatin 100 mg/m2 day 2 * 5-Fluorouracil 1000 mg/m2/day days 1–4 ## Footnote This regimen is administered over a cycle duration of 3 weeks with a maximum of 3 courses.

Answer 214

Around 50% ## Footnote Prognosis is adversely affected by cervical node involvement.

Answer 215

Ninety percent ## Footnote A second primary tumour is the leading cause of death in patients successfully treated for early head and neck cancers.

Answer 216

Basal cell carcinoma and squamous cell carcinoma ## Footnote Managed similarly to skin cancers.

Answer 217

Malignant melanoma ## Footnote Behaves similarly to melanoma elsewhere.

Answer 218

Exenteration of the eye, with adjuvant radiotherapy with or without chemotherapy ## Footnote Lacrimal gland tumours are treated with complete surgical excision if possible.

Answer 219

Aggressive surgical approach ## Footnote High risk of local recurrence.

Answer 220

Around 10% ## Footnote For early disease, the survival rate is 80%.

Answer 221

Squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, melanoma, olfactory neuroblastoma, undifferentiated carcinoma ## Footnote 50% arise from the maxillary sinus.

Answer 222

Epistaxis and nasal obstruction ## Footnote Other symptoms depend on the site of origin.

Answer 223

CT scan and MRI ## Footnote MRI is particularly beneficial for assessing skull base and orbital involvement.

Answer 224

Total surgical excision followed by postoperative radiotherapy ## Footnote Node dissection is needed for clinically involved lymph nodes.

Answer 225

Around 30–50% ## Footnote Survival rates depend on the stage and type of tumour.

Answer 226

Mucoepidermoid carcinoma ## Footnote Other types include adenoid cystic carcinoma and adenocarcinoma.

Answer 227

Painless swelling ## Footnote Pain and nerve palsies can occur in malignant lesions.

Answer 228

Concurrent chemoradiotherapy ## Footnote The target volume encompasses both the primary tumour site and the bilateral neck nodes.

Answer 229

Epstein–Barr virus infection ## Footnote Other factors include genetic predisposition and dietary habits.

Answer 230

70% ## Footnote Other symptoms depend on local tumour spread.

Answer 231

Around 80% 5-year survival ## Footnote Stage IV disease has a survival rate of about 30%.

Answer 232

Lip, anterior two-thirds of tongue, buccal mucosa, floor of mouth, gingival, retromolar trigone, hard palate ## Footnote 90% of cancers are squamous cell carcinoma.

Answer 233

White or red patch that can progress to an ulcerative lesion ## Footnote Other features may include difficulty in eating and ill-fitting dentures.

Answer 234

Surgery or radiotherapy ## Footnote Choice depends on anticipated cosmetic outcome and local expertise.

Answer 235

90–100% cure rates ## Footnote Survival rates vary depending on the site and presence of lymph node involvement.

Answer 236

Squamous cell carcinoma and non-Hodgkin lymphoma ## Footnote The majority of tumours are squamous cell carcinoma (85%).

Answer 237

Painful swallowing ## Footnote Other features include sore throat and referred ear ache.

Answer 238

>80% ## Footnote This indicates a high success rate for treatment at early stages.

Answer 239

The anatomical divisions are: * pyriform ossa * postcricoid * posterior pharyngeal wall ## Footnote These divisions are critical for understanding the location and spread of hypopharyngeal cancers.

Answer 240

More than 95% are epithelial, predominantly SCC (squamous cell carcinoma).

Answer 241

The most frequent site is pyriform ossa (60%), followed by postcricoid (30%) and posterior pharyngeal wall (10%).

Answer 242

Overall prognosis is generally poor, with a 5-year survival of 15–65%.

Answer 243

Common presenting features include: * progressive dysphagia * odynophagia * hoarseness * neck mass

Answer 244

The most common site of metastasis is lung (80%), followed by liver and bone.

Answer 245

Management typically involves total pharyngolaryngectomy with reconstruction, which is associated with significant morbidity.

Answer 246

Chemoradiotherapy (with or without neoadjuvant chemotherapy) improves chances of laryngeal preservation.

Answer 247

90% of laryngeal cancers are SCC (squamous cell carcinoma).

Answer 248

The anatomical divisions are: * glottis * supraglottis * subglottis

Answer 249

Hoarseness of Voice

Answer 250

Hoarseness is the most common presentation.

Answer 251

Early stage disease is generally managed with either surgery or radiotherapy.

Answer 252

Voice rehabilitation is an essential component of treatment.

Answer 253

Options include: * voice prosthesis * esophageal speech * electrolarynx

Answer 254

Glottic cancers have local control rates of: * 90% for T1 * 75% for T2 * 60% for selected T3 tumours.

Answer 255

Uncommon tumors include: * adenoid cystic carcinoma * sarcomas * paragangliomas

Answer 256

Adenoid cystic carcinoma is characterized by perineural invasion and late recurrences, including lung metastasis.

Answer 257

Surgery followed by radiotherapy is the treatment of choice.

Answer 258

Sarcomas are treated with surgical excision followed by postoperative radiotherapy if high grade or with close/positive margins.

Answer 259

The most frequent sites are the carotid body and jugulo-tympanic region.

Answer 260

Surgery is the treatment of choice, with radiotherapy as an option for patients who decline surgery.

Head and Neck Cancer FRCR CO2A Flashcards

(290 cards)