Head And Neck Cancer, Tumors Of The Lung

Front 1

Which of the following is FALSE about head and neck carcinoma demographics?
A. head and neck carcinoma accounts for approximately 5.6% of all new cancers
B. the gender ratio is 5:1 male to female but an increasing percentage of women are being affected
C. head and neck cancer is generally considered a dz of the 5th and 6th decade of life though it does occur at younger ages due to HPV
D. all are true

Back 1

D. all are true

Front 2

Head and neck cancer is generally considered a dz of the 5th and 6th decade of life though it does occur at younger ages due to what as an increasing cause of head and neck cancer?

Back 2

HPV infection

Front 3

True or False:
Head and neck cancer is primarily a dz of cigarette and alcohol consumption. In fact, a synergistic effect seems to exist between alcohol and tobacco with regards to carcinogenesis.

Back 3

True

Front 4

What strains of HPV are identified as particularly premalignant and can yield malignant lesions?

A. HPV 6
B. HPV 8
C. HPV 11
D. HPV 16
E. HPV 18

Back 4

D. HPV 16
E. HPV 18

Front 5

What are other risk factors for head and neck cancers besides cigarettes, alcohol, smokeless tobacco, and HPV? (5)

Back 5

- prolonged exposure to sunlight (--> squamous cell carcinoma of the lip)
- syphilis (can play a part in oral carcinoma)
- poor oral hygeine (--> oral cavity cancer)
- dietary deficiencies
- environmental carcinogens like sulfa, petroleum products and epoxy resins

Front 6

Ciliated pseudostratified columnar epithelium lines the respiratory tract with the exception of the vocal cords, which are covered by non-keratinizing squamous epithelium. The reminder of the upper aerodigestive tract, including the pharynx is also covered by non-keratinizing squamous epithelium. Premalignant lesions demonstrate what three changes?

Back 6

-hyperkeratosis
- hyperplasia
- dysplasia

Front 7

How are neck and head cancers staged? (With what system?)

Back 7

TNM system: T signifies tumor size, N status of the neck lymph nodes, M the presence or absence of distant metastatic dz. The staging specifics itself, though, changes by site of cancer.

note: once a regional lymph node is involved, the survival rate drops by 50%

Front 8

Once a regional lymph node is involved with a head and neck cancer, the survival rate drops by ______%.

Back 8

50%

Front 9

The more the _______________, the better the prognosis of the head and neck cancer. (2)
A. tumor differentiation
B. desmoplastic reaction
C. eosinophilic infiltration of the tumor
D. perineural and vascular invasion at the tumor site
E. HPV positivity

Back 9

C. eosinophilic infiltration of the tumor - presumes the host has a greater response to tumor than otherwise
E. HPV positivity - HPV related tumors are more responsive to chemoradiation therapy

Front 10

Describe each of the following parameters of head and neck cancer prognosis and state whether its presence indicates a better or worse prognosis if found.

A. desmoplastic reaction
B. eosinophilic infiltration
C. HPV positivity
D. perineural invasion
E. vascular invasion

Back 10

A. desmoplastic reaction: diffuse inflammatory and fibrous tissue infiltration at the tumor site --> worse prognosis
B. eosinophilic infiltration: eosinophils at tumor site presumes that there si a greater host response to tumor --> better prognosis
C. HPV positivity: HPV related tumors are responsive than non-HPV tumors to chemoradiation therapy --> better prognosis
D. perineural invasion: is associated with more extensive local and regional dz --> worse prognosis
E. vascular invasion: important step in metastasis --> worse prognosis

Front 11

When should a smoker be examined for laryngeal carcinoma? (What presenting symptom?)

Back 11

Vocal changes lasting more than two weeks.

Front 12

Difficulty swallowing may be the initial presentation of what type of tumor whereas non-healing oral ulcers are suspicious for what?

laryngeal carcinoma, hypopharyngeal lesion, pharyngeal or hypopharyngeal tumor, oral carcinoma

Back 12

Difficulty swallowing = pharyngeal or hypopharyngeal tumor

non-healing oral ulcers = oral carcinoma

Front 13

Metastatic dz in the head and neck tend to occur in a predictable and systematic fashion. _________ have a tendency to metastasize earlier than __________ with approximately 35% lymph node involvement at initial presentation.

A. laryngeal carcinomas, oral carcinomas
B. oral carcinomas, laryngeal carcinomas

Back 13

B. oral carcinomas, laryngeal carcinomas

Front 14

What are diagnostic evaluation approaches for head and neck cancers? (hint: keep in mind where distant metastasis often manifests - 4 places)

Back 14

- Panendoscopy and biopsy : to evaluate extent of tumor and exclude any secondary lesions. Also, HPV status is determined by tumor biopsy
- The four places metastasis is likely to go are: lungs, liver, bone and brain. so, get chest xray, do liver function tests and/or CT of abdomen, bone scans, and PET scans. Note that PET scans only pick up tumors > 1 cm in size.

Front 15

In general, it is NOT recommended to use chemotherapy as a sole treatment for head and neck _________. But, in general induction chemo can serve as an indicator of tumor favorability for chemo therapy and consequently, organ preservation.

A. squamous cell carcinoma
B. small cell carcinoma
C. adenocarcinoma
D. bronchioloalveolar carcinoma
E. bronchial carcinoid tumor

Back 15

head and neck
A. squamous cell carcinoma

Front 16

What are the top 4 leading cancer deaths for
A. men
B. women

Back 16

A. men: lung, prostate, colon. pancreas
B. women: lung, breast, colon, pancreas

Front 17

True or False:
For many cancers there are many new cases per year than there are deaths per year. Lung cancer is one major exception to this as almost the same number of patients die each year that are diagnosed.

Back 17

TRUE

Front 18

Cigarette smoking accounts for ___% of lung cancer cases.

Back 18

87%

Front 19

Besides exposure to smoke, what are other potential causes of lung cancer? (~7)

Back 19

- arsenic
- benzene
- many other chemicals
- radon
- asbestos
- air pollution
- occupational radiation exposure

Front 20

What are the tumor types and subtypes and what is the most common?

Back 20

Small cell (16%) and NON-small cell (84%).

Of the non-small cell, there are
squamous (30%)
adenocarcinoma (30-35%)
large cell (10%)
mixed

Others: carcinoid, adenocystic carcinoma, mucoepidermoid, mesothelioma

These two categories are important because being small cell versus non-small cell effects treatment.

Front 21

Within the non-small cell category of lung cancers, what two are most common and which is most commonly diagnosed?

Back 21

Of the non-small cell lung cancers,
squamous cell carcinoma and adenocarcinoma are the two most common and adenocarcinoma is now being the most commonly diagnosed.

Front 22

Most people are asymptomatic with their lung cancer until late in the disease process when what types of symptoms occur? (7)

Back 22

any of the following: cough, dyspnea, hemoptosyis, wheezing, pneumonia, chest pain

If tumor has spread to other areas in the chest, then can resul tin hoarseness or diaphragm paralysis. Pleural effusion or pericardial effusion often result sin dyspnea. Can also cause obstruction of blood vessels.

If metastasis to brain has occurred, can result in HA, imbalance, seizures or other symptoms.

Additionally, common nonspecific symptoms include weight loss, fever and anorexia.

Front 23

In ____________, 10% of patients have metastatic lesions to the brain at the time of diagnosis. This can result in HA, imbalance, seizures or other symptoms.
A. non-small cell carcinoma
B. small cell carcinoma

Back 23

B. small cell carcinoma

Front 24

What are some physical findings you might find with a lung tumor?

Back 24

clubbing of finger nailbed, acanthosis nigricans, erythema multiforme, **enlarged lymph nodes** (esp in neck or supraclavicular area)

some paraneoplastic syndromes (secondary effects of lung cancer) can include: hypercalcemia (non-small cell), ACTH (small cell), SIADH causing hyponatremia (small cell). Neurologic paraneoplastic syndromes --> peripheral neuropathy, myopathy, Eaton-Lambert syndrome, dementia.

Front 25

Some paraneoplastic syndromes (secondary effects of lung cancer) can include: _________(non-small cell), _________ causing _______ and _______ causing ________ (both by small cell). Neurologic paraneoplastic syndromes --> peripheral neuropathy, myopathy, Eaton-Lambert syndrome, dementia.

Back 25

some paraneoplastic syndromes (secondary effects of lung cancer) can include: hypercalcemia (non-small cell), ACTH (small cell), SIADH causing hyponatremia (small cell). Neurologic paraneoplastic syndromes --> peripheral neuropathy, myopathy, Eaton-Lambert syndrome, dementia.

Front 26

Which lung cancers are generally more centrally located? Which are more peripherally located usually?
A. non-small cell carcinoma: squamous cell
B. non-small cell carcinoma: adenocarcinoma
C. non-small cell carcinoma: large cell carcinoma
D. small cell carcinoma

Back 26

CENTRAL (the "s" ones)
A. non-small cell carcinoma: squamous cell
D. small cell carcinoma

PERIPHERAL
B. non-small cell carcinoma: adenocarcinoma
C. non-small cell carcinoma: large cell carcinoma

note: all of em can occur centrally and peripherally, these are just more frequent here

Front 27

True or False:
Screening high risk patients with chest radiographs and sptum cytology has never been proven to reduce mortality.

Back 27

TRUE

Som studies screening patients with chest CT scans have shown earlier detection of lung cancer but with questionable mortality benefit.
US Preventive Services Task Force has a neutral stance regarding screening with sputum cytology, CT scan or CXR.

Front 28

Lung cancer staging occurs via the TNM system. Tumor size (T1-T4), lymph node involvement (N0-N3), and presenc eof metastatic dz (M0-M1). The major distinction to know is when surgery is indicated and when it is NOT. When?

Back 28

NO SURGERY, just chemo/radiation/research/palliative care: Stage IIIB and Stage IV

SURGERY: Stage I, II and sometimes IIIA

Presence of any tumor outside chest wall is consiered metastatic and thus Stage IV (inoperable). Lymph nodes positive for tumor on opposite side of chest as primary tumor are considered N3 and are thus Stage IIIB inoperable too. Stage IV is also present i f tumor cells are in a pericardial or pleural effusion.

NOTE: in the case of small cell lung cancer, a simpler different staging is used. Treatment option is between chemo/radiation with only rare cases of surgical resection

Front 29

Which has longest median survival?
A. Untreated stage IIIB or IV nonsmall cell lung cancer
B. Chemo treated stage IIIB or IV nonsmall cell lung cancer
C. Untreated extensive small cell cancer
D. Treated small cell cancer

Back 29

D. Treated small cell cancer 18 MONTHS

C. Untreated extensive small cell cancer 9 MONTHS
B. Chemo treated stage IIIB or IV nonsmall cell lung cancer 8 MONTHS
A. Untreated stage IIIB or IV nonsmall cell lung cancer 4-5 MONTHS

Front 30

Which lung carcinoma has the characteristics described:
keritin pearls, strong association with smoking, most central, can cavitate, can be associated with hypercalcemia

A. squamous cell carcinoma
B. adenocarcinoma
C. Bronchoalveolar carcinoma
D. Large cell undifferentiated carcioma
E. small cell carcinoma

Back 30

A. squamous cell carcinoma

Front 31

Which lung carcinoma has the characteristics described:
gland formation and/or mucin production, most common type in women and non-smokers, mostly in peripheral lung

A. squamous cell carcinoma
B. adenocarcinoma
C. Bronchoalveolar carcinoma
D. Large cell undifferentiated carcioma
E. small cell carcinoma

Back 31

B. adenocarcinoma

Front 32

Which lung carcinoma has the characteristics described:
subtype of another category, these tumor cells grow "in situ" along alveolar septa and alveolar architecture is maintained. May be associated with abundant mucus production

A. squamous cell carcinoma
B. adenocarcinoma
C. Bronchoalveolar carcinoma
D. Large cell undifferentiated carcioma
E. small cell carcinoma

Back 32

C. Bronchoalveolar carcinoma

Front 33

Which lung carcinoma has the characteristics described:
high nuclear/cytpolasmic ratio "oat cell", strong association wtih smoking, mostly central, is a neuroendocrine tumor

A. squamous cell carcinoma
B. adenocarcinoma
C. Bronchoalveolar carcinoma
D. Large cell undifferentiated carcioma
E. small cell carcinoma

Back 33

E. small cell carcinoma

Front 34

Which lung carcinoma has the characteristics described:
no obvious histologic differentiation, not small cell, may be central or peripheral

A. squamous cell carcinoma
B. adenocarcinoma
C. Bronchoalveolar carcinoma
D. Large cell undifferentiated carcioma
E. small cell carcinoma

Back 34

D. Large cell undifferentiated carcioma

Front 35

What is superior vena cava syndrome with regards to tumors of the lung?

Back 35

It is when there is compression of SVC by a tumor and venous congestion occurs, dusky cyanosis of head/neck/upper extremities.

Front 36

What is Pancoast's tumor? (Carcinoma in lung apex w/ invasion of.....)

Back 36

Carcinoma in lung apex w/ invasion of sympathetic ganglia, brachial plexus.

Sx: Horner's syndrome, arm pain