Term Test 1

Question 1

What are the regions of the head and neck

Answer 1

Nasopharynx
Oropharynx
Hypopharynx
Larynx
Oral cavity
Salivary gland thyroid

Question 2

At what vertebral level is the nasopharynx located at

Answer 2

C1

Question 3

At what vertebral level is the oropharynx located at

Answer 3

C2-C3

Question 4

At what vertebral level is the epiglottis located at

Answer 4

C3

Question 5

At what vertebral level is the laryngopharynx located at

Answer 5

C4

Question 6

At what vertebral level are the vocal cords located at

Answer 6

C4

Question 7

What are the salivary glands of the head and neck region

Answer 7

parotid gland
Accessory parotid
Retromolar
Submandibular
Sublingual
Palatine

Question 8

Describe where which each number of lymph nodes in the head and neck region are

Answer 8

1. Submental / subma Ndebele
2. Upper jugular
3. Midjugular region
4. Lower jugular region
5. Posterior triangle
6. Anterior compartment

Question 9

What is the most common histology of head and neck cancer? Why is it the most common

Answer 9

Squamous cell carcinoma (90%)
Squamous cells line the moist surfaces of the head and neck

Question 10

What are the other common head and neck cancer histologies

Answer 10

Nasopharyngeal carcinoma
Mucosal melanoma

Question 11

Where are less common origins of head and neck cancers

Answer 11

Salivary glands
Sinuses
Muscles or nerves of the head and neck

Question 12

What are risk factors of head and neck cancer

Answer 12

Tobacco use
Alcohol abuse
HPV and EPV

Question 13

What are the signs and symptoms specific to a pharynx tumour

Answer 13

Difficult and pain with swallowing

Question 14

What are the signs and symptoms specific to a larynx tumour

Answer 14

Hoarseness or voice change

Question 15

What are the signs and symptoms specific to a nasopharynx tumour

Answer 15

Nasal obstructions or congestion

Question 16

What is the diagnostic work up for head and neck cancers

Answer 16

Medical history and physical examination
Endoscopy
Biopsy (gold standard)
Imaging : CT , MRI , PET , X rays
Ultrasound
HPV (oro) and EPV (Naso) testing

Question 17

When is surgical resection used in head and neck cancers

Answer 17

Localized tumours to achieve clear margins (varies on location and size)

Question 18

When is radiation therapy used in head and neck cancers

Answer 18

Can be used as a primary treatment for difficult to reach tumours or adjuvantly to surgery

Can be palliative and curative

Question 19

When is chemotherapy used in head and neck cancers

Answer 19

Often used with radiation therapy for locally advanced cancers or pre surgery to shrunk tumours

Also used for metastatic cases

Question 20

What are some functional preservation techniques for head and neck cancer

Answer 20

Speech and swallowing
Reconstruction
Minimizing impact on quality of life

Question 21

What is the neoadjuvant therapy used for head and neck cancer

Answer 21

• chemo or radiation to shrink tumours to make them more amendable to surgical removal

Question 22

What is the adjuvant therapy used for head and neck cancer

Answer 22

Postoperative radiation therapy or chemoradiation to eliminate residual microscopic disease and reduce recurrence

Question 23

What are some methods to treating palliatively for head and neck cancers

Answer 23

Chemo and radiation for advanced or recurrent disease or symptom management

Question 24

What are special considerations for simulation for head and neck

Answer 24

Jewelry, glasses, and hearing aids are removed
Remove dentures if metal
Cut eyes out of mask , patient look straight up
Wire lips and surgical scars (scars can drain from sarcoma)

Question 25

Where are the marks on the mask for head and neck cancers for nasopharyngeal and paranasal sinus (anterior mark)

Answer 25

Anterior: midline on chin

Question 26

Where are the marks on the mask for head and neck cancers for oropharynx / hypopharynx (anterior mark)

Answer 26

Anterior midline above larynx

Question 27

Where are the marks on the mask for head and neck cancers for cervical esophagus (anterior mark)

Answer 27

Anterior low on neck

Question 28

Where are the marks on the mask for head and neck cancers for thyroid (anterior mark)

Answer 28

Anterior below larynx

Question 29

Where are the marks on the mask for head and neck cancers for lateral

Answer 29

Mid neck, approximately EAM

Question 30

What is the scanning parameter for standard head and neck

Answer 30

Above frontal sinus to carina

Question 31

What is the scanning parameter for nasopharynx and paranasal sinus

Answer 31

Apex of head to carina

Question 32

What is the scanning parameter for hypopharyngeal cases

Answer 32

Above frontal sinus to 2-3cm below diaphragm

Question 33

What is the scanning parameter for cervical esophageal cases

Answer 33

Above frontal sinus to 2-3cm below diaphragm

Question 34

What is the scanning parameters for thyroid cases

Answer 34

Lower orbital ridge to apex of lung

Question 35

For scanning considerations of the head and neck: ask patient not to _______ during the scan . Assess scan before ______

Answer 35

Swallow Sending patient home

Question 36

For scanning considerations of the head and neck: ensure the ______ is down and flat if _____ block was used If previous _________ include all of ________ in the scan

Answer 36

Tongue Bite Chest irradiation Lungs

Question 37

What is the tolerance for head and neck cancer set ups

Answer 37

5 mm

Question 38

What do we match to in CBCT images for head and neck cancers

Answer 38

Bony anatomy match

Question 39

What images are used for planning for head and neck cancers

Answer 39

CT MRI fusion or PET CT

Question 40

What are the beam arrangements for head and neck cancers

Answer 40

VMAT or IMRT 7-9 beams

Question 41

What is the dose and fractionation of head and neck cancers for : primary tumour and high risk areas

Answer 41

66-70 GY in fractions of. 2 Gy per fx over 6-7 weeks

Question 42

What is the dose and fractionation of head and neck cancers for post operative high risk areas

Answer 42

60-66Gy (positive surgical margins or extracapsular nodal spread)

Question 43

What is the dose and fractionation of head and neck cancers for elective lymphnode irradiation

Answer 43

50-54 Gy in 1.8-3 Gy per fraction

Question 44

What is the dose and fractionation of head and neck cancers for palliative intent

Answer 44

3-50 Gy with hypo fractionated regimens (30/10)

Question 45

What is mucositis? When does it occur? What are the symptoms? And how do you manage it

Answer 45

Inflammation and ulceration of the mucosal lining in the oral cavity, pharynx, and esophagus - 1-2 weeks into treatment - difficultly swallowing, pain, risk of secondary infections - saline or baking soda rinses, topical anesthetics, pain control with systemic analgesics

Question 46

What is xerostomia? When does it occur? What are the symptoms? And how do you manage it

Answer 46

- dry mouth: reduced saliva production due to radiation damage to parotid salivary glands - can start early in treatment and persist long term - difficult swallowing, speaking, and increased risk of dental decay - saliva substitutes or stimulants (pilocarpine) - encourage hydration and oral hygiene

Question 47

What is dysphasia? When does it occur? What are the symptoms? And how do you manage it

Answer 47

- difficulty swallowing , swelling and inflammation of the pharynx and esophagus - worsens as treatment progresses - pain during swallowing, risk of aspiration - modified diet, nutritional support, swallowing therapy exercises

Question 48

What is skin reaction? When does it occur? What are the symptoms? And how do you manage it

Answer 48

- can range from mild to moist desquamation - appears 2-3 weeks into treatment - symptoms: redness, itching, peeling, or open sores in the treatment - topical treatment, gentle skin care

Question 49

What is dysgeusia? When does it occur? What are the symptoms? And how do you manage it

Answer 49

Altered or reduced sense of taste due to damage to taste buds salivary glands Within first few weeks of treatment Symptoms: metallic, bitter, or complete loss of taste Management - advise foods to find tolerable flavours

Question 50

What is hoarseness? When does it occur? What are the symptoms? And how do you manage it

Answer 50

Description: Inflammation of the vocal cords if the larynx is in the radiation field. Onset: Occurs progressively with treatment. Management: • Voice rest and hydration. • Humidification of air.

Question 51

What is fibrosis? When does it occur? What are the symptoms? And how do you manage it

Answer 51

Cause: Radiation-induced scarring in soft tissues, muscles, and skin. Symptoms: • Stiffness or reduced mobility in the neck and jaw (trismus). • Pain or discomfort in the treated area. Management: • Physical therapy and jaw-stretching exercises. • Pain management as needed.

Question 52

What is osteoradiocreosis ORN ? When does it occur? What are the symptoms? And how do you manage it

Answer 52

Cause: Damage to the jawbone (typically the mandible) due to reduced vascularity and tissue healing capacity. Symptoms: • Jaw pain, exposed bone, risk of infection. Management: • Preventive dental care before radiation. • Hyperbaric oxygen therapy in severe cases. • Surgery for advanced ORN.