DEN 7208 Thats Not a Leukoplakia in Your Mom's Mouth

Squamous cell carcinoma is the most common malignancy of the coral cavity. What are the most frequent sites?

A. Tongue

B. Buccal mucosa

C. Floor of the mouth

D. A and C

E. All of the above

D. A and C

● Remember that the floor of the mouth up to the lateral sides of the tongue are non-keratinzed, prime spots for cancers to develop keratinized lesions.

Involvement of which nodes when diagnosing a cancer give an ominous prognosis?

A. Nodes I - II

B. Nodes II - III

C. Nodes III - IV

D. Nodes IV - V

D. Nodes IV - V

● The deep lower nodes are IV through VI. IV through V consist of the thryroid and pretracheal which always have apoor prognosis.

What is the most common site of metastasis by all tumors?

A. Ipsilateral level II nodes

B. Contralateral level II nodes

C. Ipsilateral level III nodes

D. Contralateral level III nodes

A. Ipsilateral level II nodes

● Level II nodes are upper jugular lymph nodes. Herschaft highlights this as the spaghetti bowl of lymph nodes. Level III are just middle jugular lymph nodes

Tumors of the oral cavity anterior to the circumvalate papillae most frequently metastasize to these nodes:

A. Level I

B. Level II

C. Level III

D. Level IV

E. Level V

B. Level II

● Keep in mind that the base of the tongue is posterior to the circumvalate papillae. Level III is not as involved. Level 4 and 5 are seldom involved.

Tumors of the oropharynx most commonly spread to________ nodes, and have a higher level of metastasis to ______ compared to oral cancers.

A. Level I - Level II

B. Level II - Level IV

C. Level II - Level V

D. Level III - Level V

C. Level II - Level V

● Level II is the most common across the board. As you get behind the circumvalate papillae, level 5 is critical because it is the nodes of the thyroid.

Early T1 or T2 lesions of alveolar ridge can be managed successfully with

A. Surgery alone

B. Radiation alone

C. Radiation and then surgery

D. Surgery and then radiation.

A. Surgery alone

● The idea is that lesions of the alveolar ridge invade the tooth socket, making radiation less feasible

In early and late disease of the floor of the mouth, how can you treat it respectively?

A. Surgery alone - surgery and radiation

B. Radiation alone - surgery and radiation

C. Surgery and radiation - surgery or radiation alone

D. Surgery or radiation alone - surgery and radiation

D. Surgery or radiation alone - surgery and radiation

● Advanced takes the more aggressive approach

In treating cancers of the tongue, what form of radiotherapy is used where a radioactive source is placed next to the area of treatment?

A. Endocurietherapy

B. Teletherapy

C. Brachytherapy

D. A and C

E. All of the above

D. A and C

● Brachytherapy (brachys meaning "short distance") and endocurietherapy are the same thing. This is also used to treat localized prostate cancer. Teletherapy uses an external beam

A tonsil cancer that is in stage III or stage IV can be effectively treated by which of the following methods?

A. Radiation alone

B. Radiation for 6 weeks followed by surgical resection

C. Surgical resection followed in 6 weeks by radiation

D. Surgery alone

C. Surgical resection followed in 6 weeks by radiation

● If it is in sage one, radiation is recommended for tonsil as opposed to the alveolar ridge which is surgery.

Selective neck dissection involves removal of which of the following?

A. Nodal groups I to V

B. Sternocleidomastoid muscle

C. Internal jugular vein

D. A and C

E. All of the above

A. Nodal groups I to V

● Selective (unlike radical) works to preserve the sternocleidomastoid, spinal accessory nerve, and internal jugular vein

Radical neck dissection involves removal of which of the following?

A. Nodal groups I to V

B. Sternocleidomastoid muscle

C. Internal jugular vein

D. A and C

E. All of the above

E. All of the above

● It additionally removes the spinal accessory nerve

Removal of the spinal accessory nerve affects which of the following muscles?

A. Destablization of scapula

B. Denervation of trapezius

C. Shoulder Syndrome

D. A and C

E. All of the above

E. All of the above

● This affects tilting / rotation of the head and the scapula for shoulder elevation

Which of the following is FALSE regarding P-gp (ABCB1)

A. Confers a multidrug resistance pheonotype to cancer cells

B. It is a transmembrane influx pump that responds to chemotherapeutic agents

C. Radioactive Verapamil (calcium channel blocker) can be used to measure P-gp function

D. P-gp (ABCB1) works to move chemotherapeutic agents such as Etoposide and Doxorubicin across the cell membrane.

B. It is a transmembrane influx pump that responds to chemotherapeutic agents

● P-gp (ABCB1) is an EFFLUX pump that gets chemotherapeutic agents out of the cell. Research is being done toinhibit this function to enhance the effects of chemotherapy.

Which strategy of chemotherapy is used after surgery to reduce the recurrence of additional surgery?

A. Combined modality chemotherapy

B. Combination chemotherapy

C. Neoadjuvant chemotherapy

D. Adjuvant chemotherapy

E. Palliative chemotherapy

D. Adjuvant chemotherapy

● Also useful in killing cancerous cells that have spread to other parts of the body. This is different from neo which is using chemotherapy to reduce the size of the tumor to make surgery easier.

Which strategy of chemotherapy uses drugs with other cancer treatments such as radiation and surgery. This is how most cancers are treated today

A. Combine modality chemotherapy

B. Combination chemotherapy

C. Neoadjuvant chemotherapy

D. Adjuvant chemotherapy

E. Palliative chemotherapy

A. Combine modality chemotherapy

● This is using everything at once in hopes of killing the cancer. This differs from combination where each treatment has a different mechanism to create a complete treatment

Walter from "Breaking Bad" underwent chemotherapy which ended up reducing the size of his lung tumor. This allowed for successful surgery later one. What strategy of chemotherapy was this?

A. Combine modality chemotherapy

B. Combination chemotherapy

C. Neoadjuvant chemotherapy

D. Adjuvant chemotherapy

E. Palliative chemotherapy

C. Neoadjuvant chemotherapy

● In the event that prognosis is poor, palliative is used just to prolong life.

All chemotherapeutic drugs work the same way by affecting which of the following?

A. Cell division

B. DNA synthesis

C. DNA function

D. B and C

E. All of the above

E. All of the above

● All encompassing definition - DNA synthesis and function is cell division.

Cisplatin, Carboplatin, and Oxaliplatin are what kind of chemotherapeutic drugs?

A. Alkylating agents

B. Antimetabolites

C. Plant alkaloids

D. Antitumor antibiotics

E. Anthracyclines

A. Alkylating agents

● Alkylating agents add an alkyl group (carbon and hydrogens such as methane) to make electronegative groups in cells. Alkylated DNA cannot uncoil or divide properly, this is how mustard gas works.

What are the most widely used cytostatics due to their ability to prevent purine or pyrimidine from being incorporated into DNA during "S" phase of the cell cycle?

A. Alkylating agents

B. Antimetabolites

C. Plant alkaloids

D. Antitumor antibiotics

E. Anthracyclines

B. Antimetabolites

● Anti-metabolites are broken down into three analogs: pyrimidine analog, purine analog, and folic acid analog.

What chemotherapeutic agent affects RNA synthesis through impairing function of folic acids?

A. Carboplatin

B. Azathioprine

C. Gemcitabine

D. Methotrexate

E. Thioguanine

D. Methotrexate

● Carboplatin is an alkylating agent. Gemcitabine is a pyramidine analog anti-metabolite. Thioguanine is a purine analg anti-metabolite

Which anti-metabolites are purine analog drugs?

A. Thioguanine

B. Mercaptopurine

C. Azathioprine

D. A and B

E. All of the above

E. All of the above

● He highlighted all three of these in lecture. Methotrexate is folic acid analog. The three pyrimidine analogs are ARAC, 5-Fluorouracil, and gemcitabine.

Of the anti-metabolites, what is the main immunosuppressive cytotoxic substance?

A. Methotrexate

B. Gemcitabine

C. Azathrioprine

D. Mercatopurine

E. Thioguanine

C. Azathrioprine

● Successfully suppresses autoimmunity, widely used in transplantations to control rejection reactions

What cytostatics blocks cell division by preventing microtubule function?

A. Alkylating agents

B. Antimetabolites

C. Plant alkaloids

D. Antitumor antibiotics

E. Anthracyclines

C. Plant alkaloids

● Microtubules are vital for cell division. Examples include vinca alkaloids and taxanes.

What chemotherapeutic agent binds to tubulin to inhibits its assembly into microtubules?

A. Paclitaxel

B. Vinblastine

C. Thioguanine

D. Fuorouracil

E. Carboplatin

B. Vinblastine

● The vinca alkaloids are responsible for this mechanism. This includes Vincristine, Vinblatine, Vinorelbine, and Vindesine

What chemotherapeutic agent binds to polymerized tubulin to stabilize microtubules?

A. Vinorelbine

B. Gemcitabine

C. Thioguanine

D. Methorexate

E. Docetaxel

E. Docetaxel

● Taxanes are responsible for binding to polymerized microtubules to prevent separation of chromosomes. Another example is Paclitaxel. The synthetic form of Paclitaxel is just docetaxel.

What plant alkaloid is obtained from American Mayapple and prevents the cell from entering G1 phase?

A. Thioguanine

B. Mercaptopurine

C. Fluorouracil

D. Etoposide

D. Etoposide

● This is derived from Podophyllotoxin which comes from the American Mayapple. Another form is called teniposide.

Which of the following enzymes maintain the topology of DNA by SPECIFICALLY relieving torsional strain on DNA helix to allow for transcription.

A. Topoisomerase I

B. Topoisomerase II

C. Topoisomerase III

D. A and B

E. All of the above

D. A and B

● These are the only two discussed. They MAINTAIN THE TOPOLOGY OF DNA.

What type of topoisomerase uses ATP to break DNA and what drug chemotherapeutic drug acts as its inhibitor?

A. Topoisomerase I - Tropotecan

B. Topoisomerasae I - Irinotecan

C. Topoisomerase II - Etoposide

D. Topoisomerase II - Irinotecan

C. Topoisomerase II - Etoposide

Which of the following is NOT a Type I topoisomerase inhibitor?

A. Etoposide

B. Etoposide phosphate

C. Teniposide

D. A and B

E. All of the above

E. All of the above

● These are all examples of Type II inhibitors. The examples of Type I topoisomerase inhibitors are campthothecins: Irinotecan and Topotecan.

What antitumor antibiotic is used in kidney transplantations?

A. Dactinomycin

B. Daunomycin

C. Dexamethasone

D. Docetaxel

E. Doxorubicin

A. Dactinomycin

● Most important immunosuppressant from this group of antitumor antibiotics. Daunomycin is the trade name of the first anthracycline discovered - daunorubicin. Doxorubicin is the improved form of daunorubicin. Docetaxel is a taxane

What class of chemotherapeutic agents is the most effective against more types of cancer than any other chemotherapy agent?

A. Alkylating agents

B. Anthracyclines

C. Plant alkaloids

D. Antitumor antibiotics

E. Antimetabolites

B. Anthracyclines

● Used to treat a wide range of cancers - leukemias, lymphomas, breast, uterine, ovarian, and lung.

Which of the following is produced naturally by Streptomyces peucetius?

A. Daunorubicin

B. Daunomycin

C. Doxorubicin

D. Adriamycin

E. All of the above

E. All of the above

● This is just the progression of anthracyclin. The first one discovered was daunorubicin. Its trade name ended up being Daunomycin. Doxorubicin was developed shortly after and went by the trade name Adriamycin.

When reviewing a patient's medical history, she admits to having a non-Hodgkin's lymphoma and knows that she has taken monoclonal antibodies, but she can't remember the name of the drugs. What chemotherapeutics are used in her case?

A. Rituximab

B. Rituxan

C. Mabthera

D. A and B

E. All of the above

E. All of the above

● These are all different names for the same drug

An oncologist decides to treat a cancer by preventing the overexpression of the HER2 receptor of a breast cell carcinoma. Which type of drug and drug name respectively would be the most effective?

A. Anthracycline - Daunorubicin

B. Anthracycline - Adriamycin

C. Monoclonal antibodies - Transtuzumab

D. Monoclonal antibodies - Cetuximab

C. Monoclonal antibodies - Transtuzumab

● Anything that has to do with receptors is a monoclonal antibody. Trastuzumab is also called Herceptin.

A patient is taking Cetuximab to treat colorectal cancer. This drug primarily works on what part of the cell?

A. Epidermal growth factor receptor

B. RAS oncogene

C. TFG-β Pathway

D. Platelet derived growth factor receptor

E. Fibroblast growth factor receptor

A. Epidermal growth factor receptor

● The rest are just distracters and have no relevance

What monoclonal antibody indirectly attacks tumor cells by blocking angiogenesis?

A. Cetuximab

B. Bevacizumab

C. Rituximab

D. A and B

E. All of the above

B. Bevacizumab

● Also called Avastin, this is the one exception to monoclonal antibodies.

A patient with pre-existing vertigo is seeking chemotherapy for ovarian cancer. Anthracyclines have proven to be the most effective in this case. What chemotherapeutic drug can be used in conjunction with anthracyclines to alleviate her specific adverse affects even though it may not have any effect on the cancer?

A. Herceptin

B. Etoposide

C. Adriamycin

D. Dexamethasone

D. Dexamethasone

● This is a layered question. You have to know that while anthracyclines are the most effective, they cause severe nausea and vomiting, hence the existing vertigo. Dexamethasone is a steroid (hormonal therapy) that causes regression of lymph node malignancies (not ovarian) but is also antiemetic. You would have to know that antiemetic means anti-nausea.

A patient undergoing hormone therapy to treat a breast cancer is probably using which drug correctly matched with its action?

A. Finasteride - inhibiting production

B. Aromatase inhbitiors - inhibiting action

C. Taxol - inhibiting production

D. Tamoxifen - inhibiting action

D. Tamoxifen - inhibiting action

● Finasteride is for prostate cancer. Aromatase inhibitors inhibit production. Taxol is the original name of Paclitaxel, which is a taxane

When treating a large, poorly vascularized tumor with a chemotherapeutic drug, it didn't work at all. This is probably because the drug you used targeted which phase of the cell cyle?

A. G0

B. G1 🡪 S

C. S

D. S 🡪 G2

E. M

C. S

● The idea is that most cytolytics are dependent on rapidly diving cells (S phase), so slow growing tumors can often escape therapy.

Which of the following is FALSE concerning Linerar Energy Transfer (LET) of ionizing radiation?

A. LET is higher for alpha particles than for beta particles

B. Gamma rays penetrate the deepest, interacting with the most molecules per unit distance

C. LET is less for X-rays compared to alpha particles

D. Linear energy transfer is expressed as energy loss per unit of distance traveled.

B. Gamma rays penetrate the deepest, interacting with the most molecules per unit distance

● Gamma rays and x-rays penetrate the deepest, but interact with relatively few molecules per units distance.

What tissue has a high turnover rate and is very susceptible to radiation?

A. GI mucosa

B. Endothelium

C. Liver

D. A and B

E. All of the above

A. GI mucosa

● Other cells with a high turnover rate are bone marrow and lymphoid tissue

Why are rapidly growing, slightly hypoxic tumors not as affected by radiation therapy?

A. Hypoxic indicates that the tumor is to dense for standard radiotherapy

B. Too many free radicals are generated that interfere with adjuvant chemotherapy

C. There is a lack of superoxide to damage the cell

D. The peripheral vasculature when subjected to damage will form a protective incapsulation

C. There is a lack of superoxide to damage the cell

● This is called the oxygen effect. Radiant energy reacts with molecular oxygen to generate free radicals (superoxide) to damage the malignant tissue.

At low doses of radiation, which of the following can occur?

A. Increased expression of protoncogenes

B. Induce cytokines like TNF

C. Activate TP53 to induce apoptosis

D. A and B

E. All of the above

E. All of the above

● It has both cancer causing and inhibiting effects.

When extremely high dose levels of radiant energy are used, what is the marker of cell death?

A. Cytoplasmic swelling

B. Nuclear pyknosis

C. Mitochondrial distortion

D. Degeneration of endoplasmic reticulum

E. Plasma membrane breaks

B. Nuclear pyknosis

● The rest are just a variety of cytoplasmic changes induced by radiant energy.

What type of cells is resistant to radiotherapy?

A. Erythrocytes

B. Neutrophils

C. Platelets

D. Basophils

E. Mast cells

A. Erythrocytes

● Anemia will results regardless due to the bone marrow damage.

When a pathologist is examining post-irradiation tissues for possible persistent tumor cells, what cellular characteristic generates a similarity between radiation-injured cells and cancer cells?

A. Cellular pleomorphism

B. Giant cell formation

C. Conformational changes in nuclei, and mitotic figures

D. A and C

E. All of the above

E. All of the above

● These three characteristics are called the "Histologic Constellation".

Prolonged exposure of low-dose radiation such as radon commonly causes which of the following?

A. Squamous cell carcinoma

B. Lymphosarcoma

C. Bronchogenic carcinoma

D. Osteosarcoma

E. Myeloma

C. Bronchogenic carcinoma

● Remember radon is a common indoor air pollutant.

Radon acts as what form of ionizing radiation?

A. Alpha particle +

B. Beta particle -/+

C. Neutron

D. Heavy ion

A. Alpha particle +

● Does not accumulate in tissues (doesn't get past the lungs) because it penetrates poorly.

What is the 2nd leading cause of lung cancer?

A. Beryllium

B. Coal / Carbon

C. Asbestos

D. Radon

D. Radon

● Specifically caused by two radon decay byproducts

At 100 to 300 rad, acute radiation syndrome can occur. What syndrome has been identified with this?

A. Hematopoietic

B. Gastrointestinal

C. Cerebral

D. A and B

E. All of the above

E. All of the above

● This results in anemia, nausea and vomiting, diarrhea, convulsions, and drowsiness.

When measuring the dose of ionizing radiation, which of the following is true?

A. 1 gray = 1 joule per 1 kilogram of absorber

B. 1 gray = 1 joule per 10 kilogram of absorber

C. 1 gray = 10 joule per 1 kilogram of absorber

D. 1 gray = 5 joule per 1 kilogram of absorber

A. 1 gray = 1 joule per 1 kilogram of absorber

● 1 gray also equals 100 rads (old terminology) and 1 centrigray (cGY) = 1 rad.

What form of treatment in cancer usually results in hair loss?

A. Proton Beam Therapy

B. Brachytherapy

C. Stereostaic Radiosurgery

D. None of the above

D. None of the above

● These are all forms of radiation therapy. Radiation does not cause hair loss, chemotherapy does.

Timing of dental procedures before therapy is critical. When do extractions and surgical procedures need to be performed prior to chemotherapy and radiation therapy respectively.

A. Extractions = 2-3 weeks before any therapy. Surgery = 1 week before CT, 3 weeks before RT

B. Extractions = 1-2 weeks before any therapy. Surgery = 2 weeks before CT, 3 weeks before RT

C. Extractions = 2-3 weeks before any therapy. Surgery = 1 week before CT, 2 weeks before RT

D. Extractions = 1-2 weeks before any therapy. Surgery = 3 weeks before CT, 4 weeks before RT

A. Extractions = 2-3 weeks before any therapy. Surgery = 1 week before CT, 3 weeks before RT

● With surgery, eliminate sharp bone edges, obtain primary closure, and avoid hemostatic packing

In providing preventative dental care before therapy, what is essential for patients receiving radiation therapy to the head or neck?

A. Chlorohexadiene rinses

B. Fluoride supplementation

C. Flossing

D. Avoiding acidic foods

B. Fluoride supplementation

● While preventative care encompasses oral hygiene, diet, avoidance of tobacco/alcohol, fluoride supplementation, and CHX rinses, fluoride supplementation was critical to this type of patient.

When the goals of dental treatment are to treat infection and symptoms and avoid invasive surgical procedures, this is reserved for:

A. Dental care before therapy

B. Dental care during therapy

C. Dental care after therapy

D. None of the above

B. Dental care during therapy

● This is reserved for acute infection.

Oral complications are common in 75% of what kind of patients?

E. Brachytherapy

F. External beam therapy

G. Chemotherapy

H. Bone marrow transplant

H. Bone marrow transplant

● Specifically caused by two radon decay byproducts

Which of the following complications of antineoplastic therapy are present in both chemotherapy and radiation therapy?

A. Mucositis

B. Hyposalivation

C. Hemorrhage

D. A and B

E. All of the above

D. A and B

● All three are characteristic of chemotherapy

A patient of yours is in the middle of her chemotherapy treatment. She is complaining of what sounds like mucositis. Where in the mouth would you expect to find this?

A. Hard palate

B. Alveolar mucosa

C. Dorsum of the tongue

D. Buccal mucosa

D. Buccal mucosa

● It occurs wherever this is non-keratinzed mucosa (lateral/ventral tongue, soft palate, FOM). Although buccal mucosa is parakeratinzed, she has it listed.

Petechiae and ecchymosis are clinical features of what kind of antineoplastic therapy complication?

A. Mucositis

B. Hemorrhage

C. Dermatitis

D. Xerostomia

B. Hemorrhage

● Specifically caused by two radon decay byproducts

Erythema is a clinical feature of what kind of antineoplasic therapy complication?

A. Mucositis

B. Hemorrhage

C. Dermatitis

D. Xerostomia

C. Dermatitis

● This is only present on the skin in radiation portals

What is the most radiosensitive salivary gland?

A. Submandibular

B. Parotid

C. Sublingual

D. Salivary glands of the hard and soft palate

B. Parotid

● Commonly the cause of xerostomia in radiation therapy.

Radiographs of a patient undergoing treatment for her breast cancer display apple-core radiolucencies at the CEJ. This is characteristic of what antineoplastic therapy complication?

A. Mucositis

B. Hemorrhage

C. Xerostomia

D. Osteoradionecrosis

C. Xerostomia

● Specifically caused by two radon decay byproducts