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Question Bank
- 1Common locations for head and neck cancer
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• nasal cavity • oral cavity • salivary glands • pharynx • larynx - 2What is the cancer subtype with the highest annual incidence?
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Lip and Oral Cavity • M: 264,211 • F: 113502 - 3What is the annual incidence/mortality ratio of males to females for oropharyngeal cancer?
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4.1:1 + 4.6:1 - 4What is the outermost layer of the oral mucosa called?
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stratum corneum - 5Which layer of the oral mucosa is located just below the stratum corneum?
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stratum granulosum, stratum spinosum, stratum basale, BM, connective tissue - 6Where is the proliferation of cells primarily occurring?
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Stratum basale - 7What does the term 'Oropharynx' refer to?
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Posterior 1/3rd of the tongue, Tonsils, Posterior pharyngeal wall - 8What type of carcinoma is associated with HPV?
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HPV-Related Squamous Cell Carcinoma (HPV+ SCC) - 9Risk factors for oropharyngeal cancer?
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• Tobacco use • Alcohol use • Exposure to radiation and chemicals • Vitamin/nutritional deficiencies • HPV Infection • Compromised immune system - 10Oral signs of potentially malignant disorder?
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• erythroplakia • erythroleukoplakia • leukoplakia - 11What is leukoplakia?
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premalignant white patch that cannot be classified as any other disease - 12Types of leukoplakia
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thin, thick, nodular, verrucous - 13What is erythroplakia defined as?
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Red, nonspecific patch or plaque - cant be classified clinically/ pathologically under any other disease - considered a premalignant lesion - 14How does erythroplakia differ from leukoplakia?
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Erythroplakia is less common a higher association with squamous cell carcinoma - 15What type of lesion is erythroleukoplakia?
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mixed red and white lesion - 16Which type of leukoplakia is characterized by a smooth, white appearance?
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Thin, smooth leukoplakia - 17What is dysplasia?
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Abnormal cellular growth and development - 18What are the levels of dysplasia?
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Mild, Moderate, Severe - 19What does dysplasia involve?
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Delay in maturation and differentiation of epithelial cells - 20What is considered as mild dysplasia
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the lower 1/3rd of the lower portion of the epithelium shows abnormal changes - 21What is defined as moderate dysplasia
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the lower 2/3rd of the epithelium exhibits dysplastic changes - 22What is described as severe dysplasia
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Most but not the entire epithelium has dysplastic changes - 23What is carcinoma in-situ?
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altered cells involve the entire epithelium but do not invade the underlying connective tissue - 24What type of cells are primarily affected in squamous cell cancers?
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Stratified squamous epithelium - 25What proteins are encoded by genes that are inactivated in squamous cell cancers?
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• activate proto-oncogenes → oncogenes (cell division) • inactivate tumor suppressor genes → uncontrolled cell division → tumor - 26What is the first step in the HPV infection of oral epithelial cells?
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The viral particles infect the basal cells through an abrasion or wound. - 27Second step of HPV infection of oral epi cells
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The viral genome integrates into the host genome - 283rd step of HPV infection of oral epi cells
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viral E6 and E7 genes from HPV encode for oncoproteins → inhibit host tumor suppressor genes p53 and retinoblastoma - 29Which demographic group is most commonly associated with HPV(+) oropharyngeal cancer?
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• non-smoker • male • younger • caucasian • multiple partners • higher SES • higher education - 30What is a common location for HPV(+) oropharyngeal cancer?
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Tonsil and base of tongue - 31Common presentation of HPV(+) oropharyngeal cancer?
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painless neck mass - 32What are common symptoms of Squamous Cell Carcinoma?
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Numbness or changes in sensation, hoarse voice, pain or difficulty with chewing/swallowing, painless and painful lumps, sores, or discolorations - 33What are signs of precancerous development related to Squamous Cell Carcinoma?
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Leukoplakia, erythroplakia, erythroleukoplakia, abnormal tissue or masses - 34What is the most common malignancy of the oral cavity?
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Conventional Oral Squamous Cell Carcinoma - 35At what age does Conventional Oral Squamous Cell Carcinoma most commonly occur?
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40 years of age and older (male predilection) - 36Most common sites for Conventional Oral Squamous Cell Carcinoma?
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• Lateral and ventral border of the tongue • Floor of the month • Lower lip (vermilion border) - 37Histological features of Squamous Cell Carcinoma?
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– Epithelial islands in connective tissue – Pleomorphic cells, hyperchromatic nuclei – Atypical mitotic figures and keratin pearl formation – Vascular and/or perineural invasion - 38What type of cells are commonly found in Squamous Cell Carcinoma?
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Pleomorphic cells - 39What is one of the characteristics of the nuclei in Squamous Cell Carcinoma?
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Hyperchromatic nuclei - 40What is the medical condition depicted in the images?
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HPV-Related Squamous Cell Carcinoma - 41How many main groups is the superficial ring of nodes arranged into?
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1. jugulo-digastric 2. deep cervical 3. Submandibular 4. Submental 5. jugulo-omohyoid - 42Which lymph node groups usually get metastasis first and are usually tested first?
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Jugulo-digastric and jugulo-omohyoid - 43What level is IA
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Submental Floor of mouth, anterior tongue, mandibular alveolar ridge, and lower lip - 44What level is IB
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Submandibular Submental nodes and facial nodes ( buccal mucosa, nasal mucosa, eyelids, and conjunctiva), upper lip, and marginal areas of the lower lip - 45What is level II
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Deep Cervical-Upper Jugular (JD) Oral cavity, nasopharynx, oropharynx, hypopharynx, larynx, and major salivary glands - 46What is level III
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Deep Cervical-Middle Internal Jugular (JO) Oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx - 47What is level X
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Posterior Skull Group A: Retroauricular (Mastoid) B: Occipital Xa: Retro-auricular skin Xb: Occipital skin - 48What level is VIII
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Parotid Group Orbit, external auditory canal, and parotid gland - 49Where are the Retropharyngeal nodes typically found?
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Buccofacial Group Facial skin, nose, buccal mucosa, maxillary sinus lesions invading the soft tissue of the cheek - 50What is DOI
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Depth of Invasion - 51What is ENE
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extranodal extension (-) = no evidence (+) = positive evidence - 52What does the 'T' stage in TNM staging represent?
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Tumor size and extension into anatomical structure diameter and extension - 53What is N in TMN-Staging
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Lymph node involvement how many groups/locations - 54What does M mean in TMN staging
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M-Metastasis • M0 – no metastasis • M1 – metastasis present - 557th Ed. T-Stage Criteria
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T1: </= 2 T2: 2-4 T3: >4 T4a: moderately advanced; involving extrinsic tongue muscles T4b: very advanced - 567th Ed. N Criteria
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N0: no LN involvment N1: 1 ipsi LN; </= 3 cm N2a: 1 ipsi LN; 3-6 cm N2b: multi ipsi LNs; all </= 6 cm N2c: any bi or ctr LNs; all </= 6 cm N3: any LNs >6 cm - 57Oral Cavity T-Staging
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T0: deleted T1: </= 2 cm, DOI </= 5mm T2: </= 2cm, DOI 5-10 mm OR 2-4cm, DOI </= 10mm T3: >4cm OR DOI >10mm T4a: extrinsic tongue muscle infiltration now deleted - 58Oral Cavity Clinical N-Stage
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N1: 1 ipsi LN; </= 3 cm & ENE (-) N2a: 1 ipsi LN; 3-6 cm & ENE (-) N2b: multi ipsi LNs; all </= 6 cm & ENE (-) N3a: any LNs >6 cm & ENE (-) N3b: any ENE (+), either clinical or radiographic - 59Head/Neck Stage Grouping - Stage 0
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Tis, N0, M0 - 60Head/Neck Stage Grouping - Stage 1
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T1, N0, M0 - 61Head/Neck Stage Grouping - Stage 2
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T2, N0, M0 - 62Untitled question
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• T1, N1, M0 • T2, N1, M0 • T3, N1, M0 • T3, N0, M0 - 63Head/Neck Stage Grouping - Stage IVA
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• T4a, N0, M0 • T4a, N1, M0 • T1, N2, M0 • T2, N2, M0 • T3, N2, M0 • T4a, N2, M0 - 64Head/Neck Stage Grouping - Stage IVB
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• Any T, N3, M • T4b, Any N. M0 • Any T, Any N, M1 - 65Head/Neck Stage Grouping - Stage IVC
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untitled answer - 66Ways of treating Squamous Cell Carcinoma?
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– Surgical excision – Chemotherapy – Radiation – Targeted therapy (Cetuximab) – Immunotherapy ((Pembrolizumab (Keytruda) and nivolumab (Opdivo)) - 67Ways to prevent Squamous Cell Carcinoma?
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– Tobacco cessation – Decrease or eliminate alcohol use – HPV-vaccine – Oral screenings – Education