Test on Head and Neck Squamous Cell Carcinoma

Question 1: PET imaging is generally indicated as a routine study in the evaluation and management of malignant lesions of the lip.

A. Yes

B. No

Explanation: PET imaging is generally not indicated as a routine study in the evaluation and management of malignant lesions of the lip.

Question 2: Which of the following statements about Squamous Cell Carcinoma (SCC) of the oral tongue are accurate based on the provided study materials?

A. SCC of the tongue is the most common intraoral site for primary tumors, with the lateral border of the middle third being the most frequent location.

B. As the primary tumor moves posteriorly in the tongue, its histology often becomes less well-differentiated.

C. Regional metastasis of tongue carcinoma occurs less frequently than other intraoral primary neoplasms.

D. Carcinoma of the base of the tongue has a very high incidence of metastases to both ipsilateral and bilateral cervical nodes.

Explanation: The study materials state that SCC of the tongue exceeds the total incidence of all other intraoral sites, and the most common site is the lateral border of the middle third of the oral tongue, making option 0 correct. It also mentions that as the site of primary tumor moves posteriorly in the tongue, the histology will often change, with oral tongue lesions being well to moderately differentiated while base of tongue carcinomas are usually less well-differentiated, making option 1 correct. The material explicitly states that regional metastasis of tongue carcinoma occurs more frequently than any other intraoral primary neoplasm, so option 2 is incorrect. Finally, it notes that carcinoma of the base of the tongue has a very high incidence of metastases to both ipsilateral and bilateral cervical nodes, making option 3 correct.

Question 3: Is marginal resection indicated when there is gross tumor invasion into bone, as identified on radiographs or clinical exam?

A. Yes

B. No

Explanation: Marginal resection is contraindicated in cases of gross tumor invasion into bone, as identified on radiographs or clinical exam.

Question 4: When managing a patient with no clinical evidence of nodal disease (N0) in oral cavity cancer, which of the following factors should a surgeon consider when deciding between observation and elective treatment?

A. The risk of occult metastasis, which ranges from 20% to 40%.

B. The patient's ability to return for frequent follow-up exams.

C. The size of the primary tumor and its depth of invasion.

D. The presence of previous radiation to the mandible.

Explanation: Factors influencing the decision to observe or electively treat an N0 neck include the potential risk of regional metastasis (20-40% risk of occult metastasis), the size of the primary tumor, the depth of tumor invasion, the grade of the tumor, the location of the primary tumor, a short thick neck, and the patient's ability to return for frequent follow-up exams. Previous radiation to the mandible is a contraindication for marginal resection of the mandible, not a general factor for N0 neck management.

Question 5: During a modified radical neck dissection, Erb's point, where the spinal accessory nerve exits the posterior border of the SCM, is found by tracing the hypoglossal nerve.

A. Yes

B. No

Explanation: The study materials state that Erb's point is found by tracing the great auricular nerve to the point where it exits from the posterior border of the SCM and carefully spreading in the tissue just caudal to it, not by tracing the hypoglossal nerve.