Exam 1: Skin + Head & Neck

laryngeal cancer

Disregarding skin malignancies, which cancer is recorded as the most common among all upper aerodigestive tract cancers, including the head and neck? Paranasal sinus carcinoma hypopharyngeal cancer nasopharyngeal cancer laryngeal cancer

Oral Squamous Cell Carcinoma

A 62-year-old African American man has been a smoker since age 18, has contracted HPV, frequently drinks alcohol, and has a poor diet mainly comprised of take-out food. He presents with symptoms like foul breath, red patches in his mouth, numbness in his jaw, and bleeding from the mouth. His doctor orders imaging and a biopsy. Given these lifestyle factors and symptoms, what type of malignancy is most likely? Oral Squamous Cell Carcinoma. Basal Cell Carcinoma. Melanoma. Acute Myeloid Leukemia.

Melanoma

Among various cancers, which cancers incidence rate has increased faster than any other cancer? Lung Cancer Melanoma Breast Cancer Pancreatic Cancer

nasopharynx

Bloody discharge from the nose would be a common symptom of a tumor located in the? oropharynx. nasopharynx. hypopharynx. larynx.

Hypopharynx

Due to the aggressiveness of this site more than 50% of patients present with positive cervical nodes at time of diagnosis. Oral Cavity. Nasal Cavity/Paranasal Sinuses. Hypopharynx. Larynx/

C3

Epiglottis is located at what cervical vertebral body? C1 C2 C3 C4

Skin reactions: apply lotions and medications as directed by a doctor. Avoid sun, wind, hot/cold, etc. Allow the skin to be exposed to air. Dysphagia and esophagitus: eat softer foods and drink lots of water. Pain medication. May require a feeding tube. mucousitis and xerostomia: May require medications. Constantly drink water and hydrate the mouth. Avoid irritants and eat softer, moister foods.

Identify and describe the medical management of three different side effects that may be encountered while treating patients for head and neck cancers and the importance of symptom management in the treatment process.

Supraclavicular LN

If 3D conventional treatment of radiation therapy is used, what is the anterior field including? Mediastinal LN Supraclavicular LN Deep Parotid LN Cervical LN

Direct laryngoscopy is looking directly at the larynx and trachea. Indirect laryngoscopy involves visualizing the vocal cords by means other than obtaining a direct sight.

In a few sentences explain ONE of the following: Indirect laryngoscopy, Direct laryngoscopy.

Surgery and Radiation Therapy

In general head and neck cancer, what curative modalities are the standard of care? Surgery and Chemotherapy. Radiation Therapy and Chemotherapy. Surgery alone. Surgery and Radiation Therapy.

Bolus Lead lined parafin wax liner Mouth Guard, Oral Stint? Led contact lense to protect eye Mask Bite Block Arm pulls-to remove shoulders from lateral portals Could use 10-20° couch kick Dentures in or out Must have dental evaluation & extractions prior to simulation Supine

List 4 positional concerns and/or devices a simulation therapist needs to consider when preparing for a head and neck simulation

Smoking, smokeless tobacco Alcohol Radiation exposure (like dental x-rays) Sun exposure Occupational exposure (nickel refinery, wood dust) Already having had cancer in the area or family history of cancer Genetic factors

List five common etiology factors for head and neck cancers.

1 Deep parotid nodes 2 Submaxillary nodes 3 Buccal nodes 4 Submandibular nodes 5 Submental nodes 6 Supraclavicular nodes 8 Juguloomohyoid node 9 Posterior cervical nodes 10 Deep cervical nodes 11 Jugulodigastric node 12 Subparotid nodes 13 Occipital nodes 14 Retroauricular nodes

Match the number to the appropriate name of the lymph nodes EXCEPT #7

Is difficult to treat safely with radiation given the proximity to critical structures.

Maxillary sinus cancer: Can be resected without significant morbidity. Is difficult to treat safely with radiation given the proximity to critical structures. Is the rarest form of sinus cancer. Is usually diagnosed early.

Direct extension of the primary, including invasion into the subcutaneous tissues Regional lymphatics Distant skin and subcutaneous tissues Lung Liver, bone, and brain

Melanoma can spread to virtually any organ of the body and tend to spread in the following order: Distant skin and subcutaneous tissues Lung Direct extension of the primary, including invasion into the subcutaneous tissues Regional lymphatics Liver, bone, and brain

Men stay indoors and receive occasional intense sun exposure

Men are 3x's more likely to develop basal cell or squamous cell carcinoma for all reasons listed EXCEPT:Men stay indoors and receive occasional intense sun exposure. Men are less aware of changes in their skin. Men are 50% less likely to wear sunscreen. Occupational and recreational sun exposure is traditionally more prevalent in men.

Oropharyngeal Cancer

Mr. Andres, a 67-year-old retired stockbroker with a history of chronic stress, chain smoking, alcohol abuse, and regular consumption of betel nuts during his visits to the Philippines, is presenting with pain in the tonsil/base of tongue area of his mouth and consequent weight loss due to decreased food intake. Considering these factors and symptoms, what is the most likely malignancy? Oropharyngeal Cancer Nasopharyngeal Cancer Basal Cell Carcinoma Thyroid Cancer

I submental and submandibular II upper jugular III middle jugular IV lower jugular V posterior triangle VI anterior compartment

Name the Surgical Lymph Node Regions

Intradermal Nevi

Of the three different types of melanocytic nevi, which one is least likely to transform into melanoma? Junctional nevi Compound nevi Intradermal nevi

Nasal Cavity/Paranasal sinuses

Patients with this type of cancer have a history of long standing sinusitis, nasal obstructions, and bloody discharge are the most common ways this site presents. Nasal Cavity/Paranasal sinuses. Oropharynx. Hypopharynx. Oral Cavity.

Lungs

The most common route of spread for distant metastatic head and neck cancer is: Brain Bone Liver Lung

oral cavity

The retromolar trigone is a structure located within which of the following cavities in the head and neck? nasal cavity oropharynx nasopharynx oral cavity

True

True/False: Basal cell carcinoma rarely metastasize

False

True/False: Fluorouracil (5-FU) topical solution or cream is a viable treatment option for late-stage melanoma cancers.

True

True/False: In general head and neck carcinomas are more common in males.

False

True/False: Individuals who primarily stay indoors but receive occasional, intense sun exposure are at the highest risk of developing non-melanoma cancers.

True

True/False: Melanin protects the skin from UV exposure

True

True/False: Most melanoma's result from a change in a pre-existing nevus.

False

True/False: The skin produces vitamin A and helps enable calcium absorption.

False

True/False: ½ of the body's lymphatic's are located in the head and neck.

True

True/False: The number of melanocytes is about the same for all races but the amount of melanin produced is different.

False

True/False:The sun's rays are more indirect at the equator.

False

Ture/False: Prognosis increases as the affected area progresses backward from the lips to the hypopharynx (excluding larynx)

temperature control, protection, waste removal, sensory, vitamin D production

Two functions of skin are:

It's also known as Mycosis fungoides, associated with the disorder of T-lymphocytes, often resembles eczema or inflammatory conditions, and can be treated with total skin electrons (TSI) for early stages or a combination of chemotherapy and radiation therapy for later stages

What distinguishes Cutaneous T-Cell Lymphoma from other types of skin cancers and disorders? It's also known as Mycosis fungoides, associated with the disorder of T-lymphocytes, often resembles eczema or inflammatory conditions and can be treated with antibiotics and steroids It's also known as Melanoma, associated with the disorder of melanocytes, often resembles a mole and can be treated with just surgery It's also known as Mycosis fungoides, associated with the disorder of B-lymphocytes, often resembles psoriasis and can be treated with immunotherapy and phototherapy It's also known as Mycosis fungoides, associated with the disorder of T-lymphocytes, often resembles eczema or inflammatory conditions, and can be treated with total skin electrons (TSI) for early stages or a combination of chemotherapy and radiation therapy for later stages

It suggests an increased risk of a second primary skin cancer due to repeated exposure to the same carcinogen or a weakened immune system, highlighting that lack of education and inadequate protection can compound this risk

What does the term "multiplicity" imply about the risk factors for secondary primary skin cancers? It implies that the risk of second primary skin cancer is mainly influenced by solitary factors - either prior exposure to carcinogens, or the state of the immune system It designates the multiple roles of diet and lifestyle in the risk of second primary skin cancers, excluding the role of carcinogen exposure or a weakened immune system It refers to the multiplicity of genetic factors solely determining the risk of second primary skin cancers, with no relevance to carcinogen exposure or the immune system state It suggests an increased risk of a second primary skin cancer due to repeated exposure to the same carcinogen or a weakened immune system, highlighting that lack of education and inadequate protection can compound this risk

Moles, hair color, complexion, family history, immunosuppression, age, gender, Xeroderma pigmentosum, and a history of melanomas

What factors are considered to contribute to the etiology of melanoma? Moles, hair color, complexion, family history, immunosuppression, age, gender, Xeroderma pigmentosum, and a history of melanomas Socioeconomic status, geographical location, and smoking history Vitamin D levels, body mass index, and physical activity Previous surgeries, blood type, diet, and stress level

A combination of the tumor's thickness, its site, potential morbidity, and ensuring no tumor involvement down to the fascia

What factors should primarily dictate the determination of surgical margins for melanoma, rather than a standard or solely pathological report? A combination of the tumor's thickness, its site, potential morbidity, and ensuring no tumor involvement down to the fascia. The site of the tumor only. The thickness of the tumor only. The potential morbidity only.

Frequently involves lymph nodes and distant metastasis

What is a common characteristic of Merkel cell carcinoma in terms of metastasis? It rarely involves lymph nodes. Frequently involves lymph nodes and distant metastasis. It primarily metastasizes to the liver. It only metastasizes locally to adjacent tissues.

60-70%

What is the approximate percentage of patients with head and neck cancer who present with cervical and jugulodigastric lymph node involvement? 10-20% 50-60% 60-70% 30-40&

A = Asymmetry B = Border C = Color D = Diameter

What is the correct interpretation of the ABCD rules in the clinical presentation of melanoma?

Squamous cell carcinoma

What is the most common histologic type of head and neck cancer? Transitional cell carcinoma. Renal cell carcinoma. Adenocarcinoma. Squamous cell carcinoma.

Hoarseness Sore Throat

What is the most common presenting symptom of larynx cancer (choose the top two)? Persistent Cough Hoarseness Difficulty Breathing Sore Throat

70Gy

What is the standard of care total radiation therapy dose for general head and neck cancers. 70Gy 60Gy 80Gy 72Gy

Surgery

What is the standard treatment for melanoma? Surgery Radiation Therapy Chemotherapy Hormone Therapy

90% of skin cancers are preventable with an increase in protection from the sun. Various forms of protection include sunscreen, wearing long sleeve shirts and long pants, and avoiding prolonged exposure to the sun.

What percentage of skin cancer is preventable one? Provide one way YOU can help prevent skin cancer.

People who consume large amounts of both alcohol and tobacco have the highest risk of these cancers, with the risks being about 35 times higher for heavy smokers and drinkers than for those who never smoke or drink.

What statement best describes the relationship between the consumption of tobacco and alcohol and the risk of developing cancers in the head and neck? People who consume large amounts of both alcohol and tobacco are at a slightly increased risk of these cancers. The risk is only about twice as high for heavy smokers and drinkers compared to those who never smoke or drink. Only heavy tobacco use, not alcohol consumption, increases the risk of these cancers, with the risk being six times higher for cigarette smokers than non-smokers. People who consume large amounts of both alcohol and tobacco have the highest risk of these cancers, with the risks being about 35 times higher for heavy smokers and drinkers than for those who never smoke or drink. There is no significant correlation between the consumption of large amounts of both alcohol and tobacco and the risk of developing these cancers.

True Vocal Cords

What structure of the neck is also known as the glottis? Nasal Turbinates Vestibular Folds True Vocal Cords False Vocal Cords

The treatment pictured is most likely electron therapy. This would likely be squamous cell carcinoma becasue it is on the skin and is in an area affected by constant sun exposure. The marks on the skin show the treatment area. The material below the ear is a bolus used to reduce chondritus and other acute side effects and the white material above the ear is parafin wax, used to reduce skin reactions and homogenize the dose. These devices are used for immobilization, reproducibility, and reduction of acute side affects.

What type of treatment is pictured? Pathology and explain your rationale as to why you chose that one? Photon or electron? What are the skin marks on the patients' ear in figure A used for? What is the material on top and below the ear? What effect does each of them have on the treatment and why is it necessary for this particular set up?

It is employed for treating tumors that are difficult to surgically remove, located in cosmetically significant areas like the face, or are recurrent. Also, when the treatment plan, cost, and available equipment allow for it

When is radiation therapy most commonly considered as a treatment option for non-melanoma cancers like Basal Cell Carcinoma and Squamous Cell Carcinoma? It is primarily used when the tumors are in visible areas and the treatment cost is not a concern The decision to use radiation therapy is only determined by the availability of the equipment Radiation therapy is solely based on physician's preference without considering the tumor's characteristics and patient's circumstances It is employed for treating tumors that are difficult to surgically remove, located in cosmetically significant areas like the face, or are recurrent. Also, when the treatment plan, cost, and available equipment allow for it

legs

Where is the most common site for melanoma on women? arms trunk legs face

UVB

Which UV light, damages DNA, repair systems, as well as impairs T-cell function? UVA UVB UVC UVD

Scaly, crusty, and slightly elevated lesions, potentially with a cutaneous horn, commonly found on sun-exposed skin such as the arms and the head and neck region

Which choice describes the common characteristics and typical locations of squamous cell carcinoma? Scaly, crusty, and slightly elevated lesions, potentially with a cutaneous horn, commonly found on sun-exposed skin such as the arms and the head and neck region Smooth, red, slightly indented lesions, commonly found on sun-exposed skin such as the arms and the head and neck region Scaly, crusty, and slightly elevated lesions, often with a cutaneous horn, predominantly found on the torso and legs Irregular, bumpy lesions, usually found in areas not exposed to the sun

Bowen's Disease

Which clinical presentation pathology for non-melanoma skin cancers are associated with pink and brown papules covered with a thickened, horny layer? Actinic Keratosis Arsenical Keratosis Bowen's Disease Keratoacanthoma

Maintenance of physiologic function, eradication of disease, preservation of social cosmesis, the patient's age and general health condition, and the patient's desires

Which factors are primary considerations in the treatment of head and neck cancers? The patient's socioeconomic status, eradication of disease, and potential short-term side effects of treatment The patient's diet, desk job versus field work, and eradication of disease The patient's height and weight, eradication of disease, and potential long-term healthcare costs Maintenance of physiologic function, eradication of disease, preservation of social cosmesis, the patient's age and general health condition, and the patient's desires

Superficial spreading

Which is the most common pathology subtype of melanoma? Superficial spreading. Nodular. Lentigo Maligna. Acral Lentiginous.

Cervical and jugulodigastric lymph nodes

Which is the most common sites of metastatic lymphatic spread in head and neck cancers? Cervical and jugulodigastric lymph nodes. Deep and subparotid lymph nodes. Submandibular and submental lymph nodes. Mediastinal lymph nodes.

Exposure to radiation, genetics, Xeroderma pigmentosum, Basal Cell Nevus Syndrome, and pitting of palms or soles

Which of the following best describes the risk factors for basal cell carcinoma? Physical activity levels, dietary habits, and personal hygiene practices. Exposure to extreme cold, genetics, and cysts in the jaw bones. Socioeconomic status, high protein intake, and aging. Exposure to radiation, genetics, Xeroderma pigmentosum, Basal Cell Nevus Syndrome, and pitting of palms or soles.

Increased use of sunscreen

Which of the following factors is NOT mentioned as a contributing factor to the rise in melanoma incidence rates? Healthy tan being popular. Increased use of sunscreen. Clothing trends showing more skin. Depletion of the ozone.

Parapharynx

Which of the following is not a division of the pharynx? Parapharynx oropharynx Hypopharynx Nasopharynx

Lymphatics may be labeled by groups, chains, or levels

Which of the following is true regarding the lymphatics of the head and neck? Submental nodes are inferior to the angle of the mandible. Cervical nodes are superficial only. Retropharyngeal node is the only sentinel node in the head and neck. Lymphatics may be labeled by groups, chains, or levels.

They are smooth, red, with milky lumps, a pearly border, multiple telangiectasis and 80% are found in the head and neck region

Which of the following statements best describes the common characteristics and statistics of basal cell carcinomas? They are rough, red, with milky lumps, a dark border, and are mostly found in the lower extremities They are irregular and pigmented, frequently occurring on the hands and feet They are bumpy, blue, and creamy with a jagged border and are mostly found on the torso They are smooth, red, with milky lumps, a pearly border, multiple telangiectasis and 80% are found in the head and neck region

Formation of cataracts.

Which potential chronic side effect is associated with the treatment of paranasal sinuses with radiation therapy? Heightened allergy sensitivity. Development of type 2 diabetes. Formation of cataracts. Rapid weight loss.

Excessive sun exposure, radiation, HPV infection, weakened immune system, rare genetic disorders, history of precancerous or cancerous skin lesions, chronic inflammatory conditions, areas with chronic drainage, and smoking

Which set best describes the factors that significantly increases the risk of developing squamous cell carcinoma? Excessive coffee intake, frequent use of cosmetic products, chronic lack of sleep, and history of epilepsy Habitual use of high SPF sunscreen, limited consumption of red meat, moderate alcohol intake, and a history of type 2 diabetes, and exposure to hydrocarbons derived from coal and petroleum Living near the equator, genetically inherited blonde hair, regular use of commercial moisturizers, and frequent intake of vitamin C supplements Excessive sun exposure, radiation, HPV infection, weakened immune system, rare genetic disorders, history of precancerous or cancerous skin lesions, chronic inflammatory conditions, areas with chronic drainage, and smoking

stratum basale

Which skin layer is also called the basal layer and is the home to melanocytes? stratum basale stratum spinosum stratum granulosum stratum corneum stratum lucidum

stratum corneum

Which skin layer, also known as the horny layer, is found at the skin surface and consists of dead flat squamous cells? stratum basale stratum spinosum stratum granulosum stratum corneum stratum lucidum

SCCs are more likely to metastasize than Basal Cell Carcinomas, particularly in the case of larger tumors (>1cm), those in areas of chronic inflammation or scar tissue, and in those among immunosuppressed patients

Which statement accurately describes the major features of Squamous Cell Carcinoma (SCC)? SCCs metastasize more frequently than melanomas, commonly involving the heart and kidneys SCC metastasizes less frequently than Basal Cell Carcinomas, and tumors smaller than 1 cm in size rarely metastasize. B. Regardless of their size, SCCs have an equal likelihood of metastasizing, and only involve regional lymph nodes Regardless of their size, SCCs have an equal likelihood of metastasizing, and only involve regional lymph nodes SCCs are more likely to metastasize than Basal Cell Carcinomas, particularly in the case of larger tumors (>1cm), those in areas of chronic inflammation or scar tissue, and in those among immunosuppressed patients

Moh's Surgery

Which surgical method is characterized by the removal of a tumor in layers, where each layer is examined under a microscope until clear margins are achieved, specifically to treat aggressive, rapidly growing carcinomas? Laser Surgery Reconstructive Surgery Cryosurgery Moh's Surgery

Continuous sore throat and hoarseness

Which symptoms primarily indicate the possible presence of laryngeal cancer? Persistent joint pain and loss of appetite. Continuous sore throat and hoarseness. Rapid weight loss and chronic fatigue. Consistent headaches and difficulty breathing.

Nasopharyngeal Carcinoma.

Which type of head and neck cancer often features cells containing parts of the Epstein Barr Virus (EBV), with most patients showing evidence of this infection in their blood? Oral Squamous Cell Carcinoma. Laryngeal Cancer. Nasopharyngeal Carcinoma. Hypopharyngeal Carcinoma