Oral Cavity Cancer Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Oral Cavity Cancer. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Oral Cavity Cancer Indian Medical PG Question 1: N3a TNM staging of head and neck tumors (AJCC 8th edition) shows:
- A. Metastasis in a lymph node >6 cm (Correct Answer)
- B. Metastasis in lymph nodes >2 cm
- C. Metastasis in lymph nodes >5 cm
- D. None of the options
Oral Cavity Cancer Explanation: ***Metastasis in a lymph node >6 cm***
- **N3a disease** in head and neck cancer staging (AJCC 8th edition) specifically refers to metastasis in a single lymph node larger than 6 cm in greatest dimension **without extranodal extension (ENE)**.
- This applies to oral cavity, oropharynx (HPV-negative), hypopharynx, and larynx cancers.
- **Note:** N3 staging also includes **N3b** (metastasis in any node with clinically overt ENE), but this question specifically asks about N3a criteria.
*Metastasis in lymph nodes >2 cm*
- Lymph nodes in the 2-3 cm range typically fall within **N1 or N2a categories**, depending on laterality and number of involved nodes.
- **N3a disease** requires a single lymph node to exceed 6 cm in greatest dimension without ENE.
*Metastasis in lymph nodes >5 cm*
- A lymph node between 3-6 cm is usually classified as **N2 disease** (N2a if single ipsilateral ≤6 cm, N2b if multiple ipsilateral ≤6 cm, N2c if bilateral or contralateral ≤6 cm).
- To be classified as **N3a**, the lymph node must be **>6 cm** without extranodal extension.
*None of the options*
- This option is incorrect because the first option accurately describes the size criterion for **N3a TNM staging** in head and neck tumors according to AJCC 8th edition guidelines.
- While N3 staging has two subcategories (N3a and N3b), the size criterion of >6 cm correctly defines N3a disease.
Oral Cavity Cancer Indian Medical PG Question 2: Which of the following is the most significant premalignant condition of the oral cavity?
- A. Fordyce spots
- B. Median rhomboid glossitis
- C. Erythema multiforme
- D. Erythroplakia (Correct Answer)
Oral Cavity Cancer Explanation: **Erythroplakia**
- Erythroplakia is characterized by a **red patch** on the mucous membrane that cannot be attributed to any other pathology.
- It has a significantly higher rate of **malignant transformation** (up to 50%) compared to other oral premalignant conditions.
*Fordyce spots*
- These are **ectopic sebaceous glands** appearing as small, painless, yellowish-white papules on the oral mucosa, particularly the buccal mucosa and lips.
- Fordyce spots are **normal anatomical variations** and have no malignant potential.
*Median rhomboid glossitis*
- This is a **chronic fungal infection** (Candida albicans) of the tongue, presenting as a reddish, rhomboid-shaped area in the midline of the dorsal tongue.
- It is a **benign inflammatory condition** and is not considered premalignant.
*Erythema multiforme*
- Erythema multiforme is an **acute, inflammatory mucocutaneous disorder** triggered by infections (e.g., herpes simplex virus) or drugs.
- It typically presents with **target lesions** on the skin and erosions/ulcers in the oral cavity but is not associated with an increased risk of malignancy.
Oral Cavity Cancer Indian Medical PG Question 3: Which of the following is not a premalignant condition for oral cancer?
- A. Leukoplakia
- B. Erythroplakia
- C. Systemic Sclerosis (Correct Answer)
- D. Oral submucous fibrosis
Oral Cavity Cancer Explanation: ***Systemic Sclerosis***
- Systemic sclerosis is primarily an **autoimmune disease** affecting connective tissue and does not have a direct association with the development of oral cancer.
- Although oral manifestations can occur, systemic sclerosis is **not classified** as a premalignant condition for oral malignancies.
*Leukoplakia*
- Leukoplakia is characterized by **white patches** in the oral cavity and is considered a potentially **premalignant** lesion [1].
- It has a known association with the development of **squamous cell carcinoma** in the oral region [1].
*Erythroplakia*
- Erythroplakia presents as **red lesions** in the oral cavity and has a higher risk of **malignant transformation** compared to leukoplakia.
- It is regarded as a significant **premalignant condition** for oral cancer.
*Oral submucous fibrosis*
- This condition involves **fibrosis** of the oral mucosa and is recognized as a **premalignant condition** due to its association with increased cancer risk.
- It often develops in individuals with a history of **betel quid** or areca nut use, contributing to cancer risk in the oral cavity [2].
**References:**
[1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 344-345.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 738-739.
Oral Cavity Cancer Indian Medical PG Question 4: Carcinoma tongue less than 2 cm is treated by -
- A. Excision and Radiotherapy
- B. Excision (Correct Answer)
- C. Chemotherapy
- D. Radiotherapy
Oral Cavity Cancer Explanation: ***Excision***
- **Early-stage oral tongue carcinoma** (T1, less than 2 cm) is primarily treated with **surgical excision** due to its high cure rates.
- The goal is complete removal with **clear margins**, which is often curative for small lesions.
*Excision and Radiotherapy*
- While excision is appropriate, **adjuvant radiotherapy** is typically reserved for larger tumors, those with **positive margins**, **lymph node involvement**, or **perineural/vascular invasion**.
- For very small tumors (<2 cm) with clear margins and no high-risk features, radiotherapy is often **overtreatment** and adds unnecessary side effects.
*Chemotherapy*
- **Chemotherapy** is generally used in more advanced stages of oral tongue carcinoma, either as neoadjuvant therapy, concurrent with radiotherapy, or for metastatic disease.
- It is **not a primary treatment** for early-stage localized disease due to its systemic toxicity and limited role in local control compared to surgery.
*Radiotherapy*
- **Radiotherapy alone** can be used as a primary treatment for oral tongue carcinoma, especially in patients who are **unfit for surgery** or refuse surgery.
- However, for small lesions, **surgery typically offers better local control** and avoids the long-term side effects of radiation, such as xerostomia and osteoradionecrosis.
Oral Cavity Cancer Indian Medical PG Question 5: A patient presents with a cheek cancer of 2.5 cm size, which is close to and involves the alveolus, and is associated with a single mobile cervical lymph node of 6 cm size. What is the TNM staging?
- A. T3 N2
- B. T4 N2 (Correct Answer)
- C. T3 N3
- D. T4 N3
Oral Cavity Cancer Explanation: ***T4 N2***
- The primary tumor involving the **alveolus (cortical bone invasion)** is classified as **T4a** regardless of size according to AJCC TNM staging for oral cavity cancers.
- A single mobile ipsilateral cervical lymph node of **6 cm** is classified as **N2a** (single ipsilateral node, 3-6 cm in greatest dimension).
- Therefore, the correct staging is **T4 N2**.
*T3 N2*
- **T3 classification is incorrect** as alveolar involvement (cortical bone invasion) automatically upgrades the tumor to T4a.
- While N2 is correct for a single 6 cm node, the T-stage is underestimated.
*T4 N3*
- While **T4 is correct** due to alveolar bone involvement, **N3 is incorrect**.
- **N3a requires lymph nodes >6 cm** (greater than 6 cm), not equal to 6 cm.
- A single 6 cm node falls within the N2a category (3-6 cm range).
*T3 N3*
- **Both T3 and N3 are incorrect** for this presentation.
- Alveolar involvement mandates T4 staging, and a 6 cm node is N2a, not N3.
Oral Cavity Cancer Indian Medical PG Question 6: Treatment of resectable T4N0M0 stage of head and neck carcinoma is?
- A. Radiotherapy alone
- B. Surgery and Radiotherapy (Correct Answer)
- C. Chemoradiation
- D. Surgery alone
Oral Cavity Cancer Explanation: ***Surgery and Radiotherapy***
- For **resectable T4N0M0 head and neck carcinoma**, the standard treatment is **surgical resection** of the primary tumor followed by **adjuvant radiotherapy**.
- This approach achieves optimal **local control** for advanced primary tumors without nodal involvement.
- **Adjuvant radiotherapy** is essential for T4 tumors due to high risk of microscopic residual disease and local recurrence.
- Surgery allows for complete tumor removal with negative margins, while radiotherapy addresses subclinical disease.
*Radiotherapy alone*
- Radiotherapy alone is **insufficient as monotherapy** for T4 tumors due to the large tumor burden and extensive local invasion.
- Single modality radiation cannot reliably achieve adequate tumor control for advanced primary lesions.
- Generally reserved for early-stage disease or patients unfit for surgery.
*Chemoradiation*
- **Definitive chemoradiation** is an alternative for **unresectable T4 tumors** or when organ preservation is desired (e.g., laryngeal cancer).
- For **resectable** T4N0M0 disease, surgery with adjuvant RT is preferred as it provides better local control and allows pathological staging.
- Chemoradiation may be used postoperatively if high-risk features are found (positive margins, perineural invasion, extranodal extension).
- In this **N0 case with resectable tumor**, upfront surgery is the preferred initial approach.
*Surgery alone*
- While surgical resection is crucial for T4 tumors, **surgery alone is inadequate** due to high risk of locoregional recurrence.
- T4 classification indicates extensive local invasion, necessitating **adjuvant radiotherapy** to eradicate microscopic disease.
- Combined modality treatment (surgery + RT) significantly improves local control and survival compared to surgery alone.
Oral Cavity Cancer Indian Medical PG Question 7: True about tongue cancer:
- A. Slurring of speech is a common complaint
- B. MC site is on Lateral margin (Correct Answer)
- C. Cervical lymph node metastasis is universally present
- D. Most common type is adenocarcinoma
Oral Cavity Cancer Explanation: ***MC site is on Lateral margin***
- The **lateral border** of the tongue is the most common site for squamous cell carcinoma (SCC) of the tongue due to chronic irritation and exposure to carcinogens.
- This anatomical location makes it susceptible to tumor development due to constant friction and potential for trauma.
*Slurring of speech is a common complaint*
- While speech can be affected by advanced tongue cancer, **dysarthria** (slurring of speech) is not typically an early or primary complaint.
- Early symptoms often include a **painless lesion**, ulcer, or lump on the tongue.
*Cervical lymph node metastasis is universally present*
- While **cervical lymph node metastasis** is common in tongue cancer, its presence is not universal at diagnosis.
- The incidence of metastasis varies depending on tumor size, depth of invasion, and location, ranging from 30% to 50% in early stages.
*Most common type is adenocarcinoma*
- The vast majority of tongue cancers, over 90%, are **squamous cell carcinomas (SCCs)**, arising from the epithelial cells.
- **Adenocarcinoma** is a rare type of tongue cancer, originating from glandular tissue, and is not the most common histological type.
Oral Cavity Cancer Indian Medical PG Question 8: Which cancers can cause referred otalgia (referred pain in the ear)? Select the most comprehensive answer.
- A. Cancer of the pharynx
- B. Cancer of the oral cavity
- C. Cancer of the pharynx, oral cavity, and larynx (Correct Answer)
- D. Cancer of the larynx
Oral Cavity Cancer Explanation: ***Cancer of the pharynx, oral cavity, and larynx***
- Cancers in these locations can cause **referred otalgia** due to shared innervation of the ear by cranial nerves that also supply these areas.
- Specifically, the **glossopharyngeal nerve (IX)**, **vagus nerve (X)**, and **trigeminal nerve (V3)** are involved in both sensation from these head and neck regions and the ear.
*Cancer of the pharynx*
- While pharyngeal cancer can cause **referred otalgia** through cranial nerves IX and X, it is not the most comprehensive answer as other sites are also involved.
- This option exclusively mentions the pharynx, missing other important anatomical locations that can also refer pain to the ear.
*Cancer of the oral cavity*
- Cancer here can cause **referred otalgia**, primarily through the **trigeminal nerve (V3)**, which innervates parts of the oral cavity and the ear.
- However, similar to pharyngeal cancer, this option is not comprehensive as it omits other regions related to referred ear pain.
*Cancer of the larynx*
- Laryngeal cancer can cause **referred otalgia** via the **vagus nerve (X)**, specifically its superior laryngeal branch.
- This option is also incomplete as it does not include cancers of the pharynx or oral cavity, which are equally important causes of referred ear pain.
Oral Cavity Cancer Indian Medical PG Question 9: Tongue fixation in a patient with carcinoma tongue is staged as
- A. T1
- B. T2
- C. T3
- D. T4 (Correct Answer)
Oral Cavity Cancer Explanation: ***T4***
- **Tongue fixation** in carcinoma of the tongue indicates advanced local disease classified as **T4a stage** according to AJCC TNM staging.
- This finding suggests invasion of **extrinsic tongue muscles**, which causes loss of tongue mobility and represents moderately advanced local disease.
- T4a tumors invade through cortical bone, involve the inferior alveolar nerve, floor of mouth, or skin of face, or in the case of tongue, involve deep extrinsic muscles causing fixation.
*T1*
- **T1 tumors** are small lesions measuring **≤2 cm** in greatest dimension with **depth of invasion (DOI) ≤5 mm**.
- They are superficial without invasion of deep structures or causing any functional impairment like tongue fixation.
*T2*
- **T2 tumors** measure **≤2 cm with DOI >5 mm and ≤10 mm**, OR **>2 cm but ≤4 cm with DOI ≤10 mm**.
- While larger than T1, they do not involve deep extrinsic muscles or cause tongue fixation.
*T3*
- **T3 tumors** are defined as tumors **>4 cm** OR **any tumor with DOI >10 mm**.
- Although T3 indicates larger tumor size and deeper invasion, **tongue fixation** specifically indicates T4a stage due to involvement of extrinsic tongue musculature.
Oral Cavity Cancer Indian Medical PG Question 10: Which of the following is not a cause of oropharyngeal carcinoma?
- A. Occupational exposure to hydrochloric acid (Correct Answer)
- B. Smoking
- C. Human Papilloma Virus infection
- D. Occupational exposure to isopropyl oil
Oral Cavity Cancer Explanation: **Explanation:**
The primary risk factors for oropharyngeal carcinoma (OPC) are lifestyle-related and viral, rather than chemical or industrial.
**1. Why Option A is the Correct Answer:**
Occupational exposure to **hydrochloric acid (HCl)** is primarily associated with dental erosion and irritation of the upper respiratory tract, but it is **not** a recognized carcinogen for the oropharynx. In contrast, exposure to strong inorganic acid mists (like sulfuric acid) is linked specifically to **laryngeal cancer**, not oropharyngeal cancer.
**2. Analysis of Other Options:**
* **Smoking (Option B):** Tobacco use is a classic risk factor. Carcinogens like nitrosamines and polycyclic aromatic hydrocarbons cause field cancerization, leading to squamous cell carcinoma (SCC) of the entire aerodigestive tract.
* **Human Papilloma Virus (Option C):** HPV (specifically **Type 16**) is now the leading cause of oropharyngeal cancer globally, especially involving the palatine tonsils and base of tongue. HPV-positive tumors have a better prognosis than tobacco-related ones.
* **Isopropyl Oil (Option D):** Occupational exposure to the manufacture of isopropyl alcohol (specifically the "strong acid process" involving isopropyl oil) is a documented risk factor for cancers of the **paranasal sinuses and the oropharynx**.
**Clinical Pearls for NEET-PG:**
* **Most Common Site:** The **palatine tonsil** is the most common site for oropharyngeal SCC.
* **HPV Marker:** **p16** immunohistochemistry is used as a surrogate marker for HPV-associated oropharyngeal cancer.
* **Plummer-Vinson Syndrome:** Associated with post-cricoid (hypopharyngeal) carcinoma, not primarily oropharyngeal.
* **Diet:** Deficiencies in Vitamin A and C are also implicated in the development of oral and pharyngeal malignancies.
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