Devita, Hellman, and Rosenberg's Cancer

LWBK1006-17 LWW-Govindan-Review December 7, 2011 21:14

196 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 17.5. A 56-year-old man presents to his primary care physician with a 3-month

history of right ear pain and two masses on the right side of his neck.

On examination, he is found to have a 3-cm right tonsil mass and two

separate right-sided lymph nodes below the sternocleidomastoid. One

lymph node is 2 cm, and the other is 1 cm in diameter. He has a fine-needle

aspiration (FNA) of one of the neck lymph nodes, and it is consistent with

a squamous cell carcinoma. A neck and chest computed tomography (CT)

shows no additional lymphadenopathy or distant metastasis. What is the

stage of his disease?

A. Stage II

B. Stage III

C. Stage IVA

D. Stage IVC

Question 17.6. Which of the following statements is TRUE?

A. Only classic radical neck dissections should be performed for the

management of SCCHN.

B. Complications from neck dissections include hematoma; seroma;

lymphedema; wound infections and dehiscence; damage to the VII,

X, XI, and XII cranial nerves; carotid exposure; and carotid rupture.

C. In a surgically treated tumor without radiographic evidence of lymph

node metastasis, an elective neck dissection should only be performed

if the risk of occult metastasis to the neck is greater than 50%.

D. For patients who have had a neck dissection for SCCHN, there is no

benefit from postoperative radiation.

Question 17.7. Which of the following statements is TRUE?

A. The combination of cisplatin and 5FU has been clearly shown to

improve survival over single-agent methotrexate in the treatment of

metastatic SCCHN.

B. Cetuximab has no activity in metastatic or recurrent SCCHN.

C. The combination of cisplatin and 5FU has a higher response rate than

single-agent methotrexate in the treatment of metastatic SCCHN.

D. Higher doses of chemotherapy have led to improved survival.

Question 17.8. A 66-year-old man presents to his otolaryngologist with a 4-cm left floor

of mouth squamous cell cancer. He has a left-sided 3-cm lymph node

felt on examination and seen on CT. Magnetic resonance imaging (MRI)

shows that the primary tumor is invading into the mandible. He has

no evidence of distant metastasis on CT of his chest. What is the most

appropriate primary therapy for this patient?

A. Surgery

B. Radiation

C. Chemoradiation