ENT ENT Head and Neck Oncology 2 — Questions and Answers
Question 1: Why does HPV-positive oropharyngeal squamous cell carcinoma carry a better prognosis than HPV-negative disease?
- It is always diagnosed at Stage I
- It responds significantly better to radiation and chemotherapy (Correct answer)
- It has a lower mitotic rate
- It never metastasizes to cervical lymph nodes
Correct answer: It responds significantly better to radiation and chemotherapy
HPV-positive oropharyngeal SCC demonstrates markedly improved locoregional control and overall survival due to enhanced sensitivity to concurrent chemoradiation compared to HPV-negative tumors.
Question 2: Which cervical lymph node level contains the jugulodigastric node, the most commonly involved node in oropharyngeal and oral cavity cancers?
- Level I
- Level II (Correct answer)
- Level III
- Level IV
Correct answer: Level II
The jugulodigastric node resides at Level II (upper jugular group) near the junction of the posterior belly of the digastric and internal jugular vein, and is frequently the first node involved in upper aerodigestive tract cancers.
Question 3: Thyroid cancer arising from calcitonin-secreting parafollicular C cells is classified as:
- Papillary thyroid carcinoma
- Follicular thyroid carcinoma
- Medullary thyroid carcinoma (Correct answer)
- Anaplastic thyroid carcinoma
Correct answer: Medullary thyroid carcinoma
Medullary thyroid carcinoma arises from parafollicular C cells that secrete calcitonin, and may be sporadic or hereditary (associated with MEN2A/MEN2B syndromes).
Question 4: Which imaging technique is most sensitive for detecting distant metastases in head and neck cancer staging?
- CT chest with contrast
- MRI with gadolinium
- PET-CT scan (Correct answer)
- Technetium bone scan
Correct answer: PET-CT scan
18F-FDG PET-CT is the most sensitive modality for detecting distant metastases and occult regional nodal disease in head and neck cancer staging, combining metabolic activity with anatomic localization.
Question 5: In the AJCC 8th edition TNM staging, lymph node metastasis with clinical extranodal extension (ENE) is classified as:
- N1
- N2b
- N3b (Correct answer)
- M1
Correct answer: N3b
Per AJCC 8th edition, clinical extranodal extension in cervical lymph node metastases automatically qualifies as N3b regardless of the number or size of involved nodes.
Question 6: The Delphian (prelaryngeal/precricoid) lymph node, when positive, indicates which finding in thyroid or laryngeal cancer?
- Distant metastasis
- High-risk extrathyroidal or extralaryngeal extension (Correct answer)
- Perineural invasion
- Mucosal skip lesion
Correct answer: High-risk extrathyroidal or extralaryngeal extension
A positive Delphian node, situated anterior to the cricothyroid membrane over the thyroid isthmus, signals high-risk extrathyroidal or extralaryngeal extension and carries a poor prognosis.
ENT ENT Head and Neck Oncology 2
Why does HPV-positive oropharyngeal squamous cell carcinoma carry a better prognosis than HPV-negative disease?