Head & Neck Oncology

Topics in this chapter

• Head and Neck Anatomy
• Oral and Oropharyngeal Cancers
• Nasopharyngeal Carcinoma and EBV
• Laryngeal Cancer and Surgery
• Salivary Gland Tumors
• Neck Nodes, Staging and Unknown Primary

Practice questions

1. Question 1Q-B9DB38

   A 55-year-old chronic smoker and heavy drinker presents with a 4-month history of progressive hoarseness. Laryngoscopy reveals a 1 cm exophytic lesion limited to the middle third of the left true vocal cord, which has normal mobility. What is the most appropriate initial management strategy for this patient?

   1. A.Total laryngectomy with bilateral selective neck dissection
   2. B.Concurrent chemoradiotherapy
   3. C.Transoral laser microsurgery (TLM) or definitive radiation therapy
   4. D.Induction chemotherapy followed by partial laryngectomy
   See the answer and solution
2. Question 2Q-437E13

   A 60-year-old man presents with a painless, hard, non-tender swelling in the upper neck at the anterior border of the sternocleidomastoid muscle, at the level of the carotid bifurcation. Biopsy reveals a well-differentiated squamous cell carcinoma metastatic to a lymph node, but the primary site is not immediately identifiable on physical examination. What is the most appropriate next step in localization of the primary tumor?

   1. A.Blind tonsillectomy and random mucosal biopsies of the nasopharynx and hypopharynx
   2. B.PET-CT scan followed by examination under anesthesia (EUA) with targeted biopsies and HPV/p16 testing
   3. C.Immediate radical neck dissection followed by observation
   4. D.Palliative radiotherapy to the entire head and neck axis
   See the answer and solution
3. Question 3Q-D1DB5A

   Which of the following spaces of the neck is bounded superiorly by the skull base and inferiorly by the clavicle/mediastinum, and contains the carotid artery, internal jugular vein, vagus nerve, and sympathetic chain, making it a critical conduit for the spread of head and neck cancer?

   1. A.Retropharyngeal space
   2. B.Carotid space
   3. C.Submandibular space
   4. D.Danger space
   See the answer and solution
4. Question 4Q-A2F40A

   A 45-year-old male with a history of betel nut chewing presents with restricted mouth opening (trismus) and a firm, white, non-scrapable mucosal plaque on the buccal mucosa. Histopathology reveals epithelial dysplasia with subepithelial fibrosis. What is the most definitive diagnosis?

   1. A.Oral hairy leukoplakia
   2. B.Oral submucous fibrosis with leukoplakia
   3. C.Actinic cheilitis
   4. D.Squamous cell papilloma
   See the answer and solution
5. Question 5Q-E96A62

   During a modified radical neck dissection, a surgeon preserves the spinal accessory nerve, the internal jugular vein, and which of the following structures to classify it as a Type I modified radical neck dissection?

   1. A.Sternocleidomastoid muscle
   2. B.External jugular vein
   3. C.Hypoglossal nerve
   4. D.Omohyoid muscle
   See the answer and solution