ENT Oncology Practice Questions

Q: Recurrent or residual cancer of the nasopharynx after supervoltage radiotherapy is treated by which of the following?

All of the above. **Explanation:** The primary treatment for Nasopharyngeal Carcinoma (NPC) is **Radiotherapy (RT)** because the tumor is highly radiosensitive and the anatomical location makes primary surgical access difficult. However, managing **recurrent or residual disease** after full-course supervoltage radiotherapy is challenging because the area has already received its maximum tolerance dose of radiation. **Why "All of the above" is correct:** When external beam radiation fails, a multi-modal salvage approach is required: 1. **Intracavitary Radioactive Implants (Brachytherapy):** This allows for a high dose of radiation to be delivered directly to the tumor site while sparing the surrounding healthy tissues that were previously irradiated. Gold grains or Iridium-192 are commonly used. 2. **Surgery (Nasopharyngectomy):** While technically demanding, salvage surgery (via maxillary swing or endoscopic approaches) is indicated for localized resectable recurrences. 3. **Cryotherapy:** This is a palliative or adjunct option used to destroy localized residual tumor cells using extreme cold, especially in patients who are not candidates for major surgery. **Clinical Pearls for NEET-PG:** * **Primary Treatment of Choice:** Radiotherapy (specifically IMRT) is the gold standard for NPC. * **EBV Association:** NPC (especially Type 2 and 3) is strongly associated with the **Epstein-Barr Virus**. Monitoring EBV DNA levels is useful for detecting recurrence. * **Fossa of Rosenmüller:** This is the most common site of origin for NPC. * **Trotter’s Triad:** A classic presentation of NPC involving: 1. Conductive deafness (Eustachian tube blockage) 2. Ipsilateral temporoparietal neuralgia (CN V involvement) 3. Palatal paralysis (CN X involvement)

Q: Which of the following conditions is the primary indication for radiotherapy?

Nasopharyngeal Carcinoma T3N1. **Explanation:** **1. Why Nasopharyngeal Carcinoma (NPC) is the Correct Answer:** Nasopharyngeal carcinoma is unique among head and neck cancers because it is **highly radiosensitive**. Due to its anatomical location (deep-seated, close to the skull base and vital structures), surgical access with wide margins is technically difficult and often impossible. Therefore, **Radiotherapy (RT)**, often combined with chemotherapy for advanced stages (T3/T4), is the **primary and definitive treatment** for all stages of NPC, regardless of T or N status. **2. Analysis of Incorrect Options:** * **B, C, and D (Laryngeal Carcinomas):** For T3 lesions of the supraglottis, glottis, and subglottis, the standard of care is typically **Concurrent Chemoradiotherapy (CCRT)** for organ preservation or **Total Laryngectomy** followed by postoperative RT. Unlike NPC, these are not treated with RT alone as the primary modality in T3 stages because surgery remains a viable and often necessary option for advanced laryngeal disease. Specifically, subglottic tumors (Option D) have a poor prognosis and often require aggressive surgical intervention due to early lymphatic spread. **3. Clinical Pearls for NEET-PG:** * **NPC Association:** Strongly linked with **Epstein-Barr Virus (EBV)** and dietary factors (nitrosamines in salted fish). * **Fossa of Rosenmüller:** The most common site of origin for NPC. * **Trotter’s Triad:** Conductive hearing loss (serous otitis media), palatal palsy, and trigeminal neuralgia (ipsilateral) are classic signs of NPC. * **Treatment Rule:** Surgery in NPC is reserved only for residual or recurrent neck nodes (**Neck Dissection**) after the primary tumor is controlled by RT.

Q: What is the causative agent of oropharyngeal carcinoma?

Human papillomavirus (HPV). ### Explanation **Correct Answer: D. Human papillomavirus (HPV)** The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has shifted significantly over the last decade. While tobacco and alcohol were historically the primary risk factors, **Human Papillomavirus (HPV)**, specifically **high-risk strain 16**, is now the leading cause of oropharyngeal cancer (especially involving the palatine tonsils and base of tongue). The underlying mechanism involves the viral oncoproteins **E6 and E7**, which inactivate the host’s tumor suppressor proteins **p53 and Rb**, respectively, leading to malignant transformation. **Why other options are incorrect:** * **Hepatitis B virus (HBV):** Primarily associated with Hepatocellular Carcinoma (HCC); it has no established role in head and neck oncology. * **Cytomegalovirus (CMV):** While a common opportunistic pathogen in immunocompromised patients, it is not considered an oncogenic virus for oropharyngeal cancer. * **Herpes simplex virus (HSV):** Associated with oral lesions (herpetic gingivostomatitis) and encephalitis, but not linked to the pathogenesis of oropharyngeal malignancy. **High-Yield Clinical Pearls for NEET-PG:** * **Site Predilection:** HPV-associated cancers typically occur in the **tonsillar crypts** and **lingual tonsils**. * **Prognosis:** HPV-positive oropharyngeal cancers generally have a **better prognosis** and better response to radiotherapy/chemotherapy compared to HPV-negative (tobacco-related) cancers. * **Surrogate Marker:** **p16 immunohistochemistry (IHC)** is used as a reliable surrogate marker for HPV infection in clinical practice. * **Staging:** Due to the better prognosis, the AJCC 8th Edition has a separate staging system for HPV-mediated (p16+) oropharyngeal cancer.

Q: What is the treatment of choice for T2 carcinoma of the nasopharynx?

Radiotherapy. **Explanation:** **Nasopharyngeal Carcinoma (NPC)** is unique among head and neck cancers due to its anatomical location, strong association with the **Epstein-Barr Virus (EBV)**, and high degree of radiosensitivity. 1. **Why Radiotherapy is the Correct Answer:** The primary treatment for NPC across almost all stages is **Radiotherapy (RT)**. The nasopharynx is surgically inaccessible for wide-margin resections, and the tumor is highly sensitive to radiation. For **T2 lesions** (tumor extending to the soft tissue of the oropharynx or nasal cavity), RT remains the mainstay. While advanced stages (T3, T4, or N+) often require concurrent Chemoradiotherapy (CCRT), RT alone or CCRT is the standard of care. 2. **Why Other Options are Incorrect:** * **Surgery (A & D):** The nasopharynx is located deep in the skull base, surrounded by vital neurovascular structures, making primary surgical resection technically difficult and morbid. Surgery is reserved only for **salvage** in cases of recurrence or persistent localized disease. * **Chemotherapy (C):** NPC is chemosensitive, but chemotherapy is never used as a standalone curative treatment. It is used as an adjunct (neoadjuvant, concurrent, or adjuvant) to radiotherapy to improve survival in locally advanced cases. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** RT is the treatment of choice for Stage I; CCRT is the standard for Stage II to IVB. * **Most Common Site:** Fossa of Rosenmüller. * **Most Common Histology:** Undifferentiated Squamous Cell Carcinoma (WHO Type 3) – this type has the strongest link to EBV and the best prognosis due to high radiosensitivity. * **Clinical Presentation:** Often presents with the **Trotter’s Triad**: (1) Conductive hearing loss (due to Eustachian tube blockage), (2) Ipsilateral facial pain/paresthesia (Trigeminal nerve involvement), and (3) Palatal paralysis.

Question 1

Recurrent or residual cancer of the nasopharynx after supervoltage radiotherapy is treated by which of the following?

Accepted Answer

All of the above

Answer

Intracavitary radioactive implants

Answer

Cryotherapy

Answer

Surgery

Question 2

Which of the following conditions is the primary indication for radiotherapy?

Accepted Answer

Nasopharyngeal Carcinoma T3N1

Answer

Supraglottic Carcinoma T3N0

Answer

Carcinoma of the Glottis T3N0

Answer

Subglottic Carcinoma T3N0

Question 3

What is the causative agent of oropharyngeal carcinoma?

Accepted Answer

Human papillomavirus (HPV)

Answer

Hepatitis B virus (HBV)

Answer

Cytomegalovirus (CMV)

Answer

Herpes simplex virus (HSV)

Question 4

Trismus in oral cancer patients is severe in those treated with which combination of modalities?

Accepted Answer

Surgery and Radiotherapy

Answer

Chemotherapy alone

Answer

Surgery alone

Answer

Not related to treatment

Question 5

What is the treatment of choice for T2 carcinoma of the nasopharynx?

Accepted Answer

Radiotherapy

Answer

Surgery

Answer

Chemotherapy

Answer

Surgery + postoperative radiotherapy

ENT Oncology — MCQs

ENT Oncology — MCQs

On this page

Practice by Chapter

Want unlimited practice?