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Question 1
Common locations for head and neck cancer
• nasal cavity • oral cavity • salivary glands • pharynx • larynx
Question 2
What is the cancer subtype with the highest annual incidence?
Nasopharynx
Larynx
Oropharynx
Lip and Oral Cavity • M: 264,211 • F: 113502
Question 3
What is the annual incidence/mortality ratio of males to females for oropharyngeal cancer?
4.1:1 + 4.6:1
2.1:1
3.1:1
5.1:1
Question 4
What is the outermost layer of the oral mucosa called?
Stratum corneum
Epithelial layer
Connective tissue
stratum corneum
Question 5
Which layer of the oral mucosa is located just below the stratum corneum?
Stratum spinosum
Stratum basale
Stratum corneum
Stratum granulosum
Question 6
Where is the proliferation of cells primarily occurring?
Detaching squame
Stratum spinosum
Stratum corneum
Stratum granulosum
Question 7
What does the term 'Oropharynx' refer to?
Middle 1/3rd of the tongue, Tonsils, Anterior pharyngeal wall
Anterior 1/3rd of the tongue, Tonsils, Posterior pharyngeal wall
Posterior 1/3rd of the tongue, Tonsils, Posterior pharyngeal wall
Posterior 1/3rd of the tongue, Tonsils, Anterior pharyngeal wall
Question 8
What type of carcinoma is associated with HPV?
HPV-Related Basal Cell Carcinoma
HPV-Related Squamous Cell Carcinoma (HPV+ SCC)
HPV-Related Adenocarcinoma
HPV-Related Sarcoma
Question 9
Risk factors for oropharyngeal cancer?
Tobacco use
Coffee consumption
Vitamin/nutritional deficiencies
• Tobacco use • Alcohol use • Exposure to radiation and chemicals • Vitamin/nutritional deficiencies • HPV Infection • Compromised immune system
Question 10
Oral signs of potentially malignant disorder?
Chronic candidiasis
Erythroplakia
Oral submucous fibrosis
• erythroplakia • erythroleukoplakia • leukoplakia
Question 11
What is leukoplakia?
A fungal infection
A type of skin rash
premalignant white patch that cannot be classified as any other disease
A viral infection
Question 12
Types of leukoplakia
A fungal infection
A bacterial infection
A thickened layer of cells
thin, thick, nodular, verrucous
Question 13
What is erythroplakia defined as?
Red, nonspecific patch or plaque - cant be classified clinically/ pathologically under any other disease - considered a premalignant lesion
A type of leukoplakia
A benign skin condition
A common viral infection
Question 14
How does erythroplakia differ from leukoplakia?
Erythroplakia is more common
Erythroplakia is associated with basal cell carcinoma
Leukoplakia is a type of erythroplakia
Erythroplakia is less common a higher association with squamous cell carcinoma
Question 15
What type of lesion is erythroleukoplakia?
A purely red lesion
A purely white lesion
A lesion with blue and white patches
mixed red and white lesion
Question 16
Which type of leukoplakia is characterized by a smooth, white appearance?
Granular, verruciform leukoplakia
Erythroleukoplakia
Thin, smooth leukoplakia
Thick, fissured leukoplakia
Question 17
What is dysplasia?
Normal cellular growth and development
Abnormal cellular growth and development
Cellular death and development
Abnormal cellular division
Question 18
What are the levels of dysplasia?
Mild, Moderate, Critical
Minor, Moderate, Severe
Mild, Moderate, Severe
Minor, Major, Severe
Question 19
What does dysplasia involve?
No effect on cell maturation
Acceleration in maturation and differentiation of epithelial cells
Delay in maturation and differentiation of epithelial cells
Delay in maturation and differentiation of muscle cells
Question 20
What is considered as mild dysplasia
the lower 1/3rd of the lower portion of the epithelium shows abnormal changes
the entire epithelium shows abnormal changes
the middle 1/3rd of the epithelium shows abnormal changes
the upper 1/3rd of the epithelium shows abnormal changes
Question 21
What is defined as moderate dysplasia
the upper 2/3rd of the epithelium exhibits dysplastic changes
the lower 2/3rd of the epithelium exhibits dysplastic changes
the entire epithelium exhibits dysplastic changes
the lower 1/3rd of the epithelium exhibits dysplastic changes
Question 22
What is described as severe dysplasia
the middle 1/3rd of the epithelium has dysplastic changes
the upper 1/3rd of the epithelium has dysplastic changes
the lower 1/3rd of the epithelium has dysplastic changes
Most but not the entire epithelium has dysplastic changes
Question 23
What is carcinoma in-situ?
Epithelial dysplasia
altered cells involve the entire epithelium but do not invade the underlying connective tissue
Basal cell carcinoma
Invasive carcinoma
Question 24
What type of cells are primarily affected in squamous cell cancers?
Basement membrane
Salivary glands
Muscle
Stratified squamous epithelium
Question 25
What proteins are encoded by genes that are inactivated in squamous cell cancers?
RAS
• activate proto-oncogenes → oncogenes (cell division) • inactivate tumor suppressor genes → uncontrolled cell division → tumor
Oncogenes
Epidermal Growth Factor Receptor
Question 26
What is the first step in the HPV infection of oral epithelial cells?
The viral particles infect the basal cells through an abrasion or wound.
Expression of oncoproteins
Uncontrolled cell division
Integration of the viral genome
Question 27
Second step of HPV infection of oral epi cells
Viral particles infect basal cells
Integration into the host genome
Expression of viral RNA
Expression of oncoproteins
Question 28
3rd step of HPV infection of oral epi cells
Inhibiting viral replication
Promoting immune response
viral E6 and E7 genes from HPV encode for oncoproteins → inhibit host tumor suppressor genes p53 and retinoblastoma
Encouraging cell cycle inhibition
Question 29
Which demographic group is most commonly associated with HPV(+) oropharyngeal cancer?
• non-smoker • male • younger • caucasian •
multiple partners
• higher SES • higher education
Younger individuals
More African-Americans
Caucasian
Question 30
What is a common location for HPV(+) oropharyngeal cancer?
Soft palate
Base of tongue
Tonsil and base of tongue
Pharyngeal wall
Question 31
Common presentation of HPV(+) oropharyngeal cancer?
painless neck mass
Sore throat
Otalgia
Dysphagia
Question 32
What are common symptoms of Squamous Cell Carcinoma?
Excessive fatigue and muscle weakness
Numbness or changes in sensation, hoarse voice, pain or difficulty with chewing/swallowing, painless and painful lumps, sores, or discolorations
Severe headaches and blurred vision
Persistent cough and shortness of breath
Question 33
What are signs of precancerous development related to Squamous Cell Carcinoma?
Leukoplakia, erythroplakia, erythroleukoplakia, abnormal tissue or masses
Frequent nosebleeds and sinus infections
Skin rashes and hives
Chronic diarrhea and vomiting
Question 34
What is the most common malignancy of the oral cavity?
Oral Lymphoma
Conventional Oral Squamous Cell Carcinoma
Oral Basal Cell Carcinoma
Oral Melanoma
Question 35
At what age does Conventional Oral Squamous Cell Carcinoma most commonly occur?
20 years of age and younger
40 years of age and older (male predilection)
30 years of age
50 years of age and older
Question 36
Most common sites for Conventional Oral Squamous Cell Carcinoma?
Floor of the mouth
Lateral and ventral border of the tongue
• Lateral and ventral border of the tongue • Floor of the month • Lower lip (vermilion border)
Upper lip
Question 37
Histological features of Squamous Cell Carcinoma?
Muscle fibers in connective tissue
Nerve fibers in connective tissue
– Epithelial islands in connective tissue – Pleomorphic cells, hyperchromatic nuclei – Atypical mitotic figures and keratin pearl formation – Vascular and/or perineural invasion
Adipose tissue in connective tissue
Question 38
What type of cells are commonly found in Squamous Cell Carcinoma?
Cuboidal cells
Pleomorphic cells
Columnar cells
Round cells
Question 39
What is one of the characteristics of the nuclei in Squamous Cell Carcinoma?
Hyperchromatic nuclei
Heterochromatic nuclei
Hypochromatic nuclei
Megachromatic nuclei
Question 40
What is the medical condition depicted in the images?
HPV-Related Squamous Cell Carcinoma
Skin Basal Cell Carcinoma
Cervical Cancer
Laryngeal Papillomatosis
Question 41
How many main groups is the superficial ring of nodes arranged into?
four
1. jugulo-digastric 2. deep cervical 3. Submandibular 4. Submental 5. jugulo-omohyoid
six
three
Question 42
Which lymph node groups usually get metastasis first and are usually tested first?
Jugulo-digastric and jugulo-omohyoid
Question 43
What level is IA
Submental
Floor of mouth, anterior tongue, mandibular alveolar ridge, and lower lip
Question 44
What level is IB
Submandibular
Submental nodes and facial nodes ( buccal mucosa, nasal mucosa, eyelids, and conjunctiva), upper lip, and marginal areas of the lower lip
Question 45
What is level II
Deep Cervical-Upper Jugular
(JD) Oral cavity, nasopharynx, oropharynx, hypopharynx, larynx, and major salivary glands
Question 46
What is level III
Deep Cervical-Middle Internal Jugular
(JO) Oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx
Question 47
What is level X
Posterior Skull Group A: Retroauricular (Mastoid) B: Occipital Xa: Retro-auricular skin Xb: Occipital skin
Question 48
What level is VIII
Level IV: Deep Cervical- Lower Internal Jugular
Level III: Deep Cervical-Middle Internal Jugular
Level IIA: Deep Cervical-Upper Jugular
Parotid Group
Orbit, external auditory canal, and parotid gland
Question 49
Where are the Retropharyngeal nodes typically found?
In the submental region
Near the jugular-diagastric region
Buccofacial Group
Facial skin, nose, buccal mucosa, maxillary sinus lesions invading the soft tissue of the cheek
At the tip of the tongue
Question 50
What is DOI
Depth of Invasion
Question 51
What is ENE
extranodal extension (-) = no evidence (+) = positive evidence
Question 52
What does the 'T' stage in TNM staging represent?
Tumor size and extension into anatomical structure diameter and extension
Tumor grade
Distant metastasis
Metastasis presence
Question 53
What is N in TMN-Staging
5th Ed. (1997)
7th Ed. (2010)
6th Ed. (2002)
9th Ed. (2020)
Question 54
What does M mean in TMN staging
Depth of Infiltration
Depth of Impact
M-Metastasis • M0 – no metastasis • M1 – metastasis present
Diameter of Invasion
Question 55
7th Ed. T-Stage Criteria
T1: </= 2 T2: 2-4 T3: >4 T4a: moderately advanced; involving extrinsic tongue muscles T4b: very advanced
Question 56
7th Ed. N Criteria
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
Question 57
Oral Cavity T-Staging
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
Question 58
Oral Cavity Clinical N-Stage
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
Question 59
Head/Neck Stage Grouping - Stage 0
Tis, N0, M0
Question 60
Head/Neck Stage Grouping - Stage 1
T1, N0, M0
Question 61
Head/Neck Stage Grouping - Stage 2
T2, N0, M0
Question 62
Untitled question
• T1, N1, M0 • T2, N1, M0 • T3, N1, M0 • T3, N0, M0
Question 63
Head/Neck Stage Grouping - Stage IVA
• T4a, N0, M0 • T4a, N1, M0 • T1, N2, M0 • T2, N2, M0 • T3, N2, M0 • T4a, N2, M0
Question 64
Head/Neck Stage Grouping - Stage IVB
• Any T, N3, M • T4b, Any N. M0 • Any T, Any N, M1
Question 65
Head/Neck Stage Grouping - Stage IVC
untitled answer
Question 66
Ways of treating Squamous Cell Carcinoma?
Radiation
Surgical excision
– Surgical excision
– Chemotherapy
– Radiation
– Targeted therapy (Cetuximab) – Immunotherapy ((Pembrolizumab (Keytruda) and nivolumab (Opdivo))
Immunotherapy
Question 67
Ways to prevent Squamous Cell Carcinoma?
Regular exercise
Decrease or eliminate alcohol use
Smoking cessation
HPV-vaccine