Oral Cancers — MCQs
All of the following are true about carcinoma of the hard palate except:
The most common site for squamous cell carcinoma in oral cavity is -
What is the most appropriate treatment after resection of lateral border of tongue carcinoma with high-risk features (positive margins, perineural invasion)?
What is the most significant factor associated with the causation of head and neck carcinoma?
All are premalignant conditions of oral cavity except:
N3a TNM staging of head and neck tumors (AJCC 8th edition) shows:
A 59-year-old woman has discomfort in the posterior part of her tongue. A biopsy confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior third of the tongue?
Which cancers can cause referred otalgia (referred pain in the ear)? Select the most comprehensive answer.
Tongue fixation in a patient with carcinoma tongue is staged as
Which of the following statements are true? 1. Due to increasing mammography there occurs over diagnosis of breast carcinoma 2. Colon cancer screening is done by digital rectal examination 3. Oral cancer screening is done by visual inspection 4. Cervix cancer screening is done by a pap smear
Oral Cancers Indian Medical PG Practice Questions and MCQs
Question 1: All of the following are true about carcinoma of the hard palate except:
- A. Lymphatic metastasis is uncommon
- B. Larger tumors require maxillectomy
- C. Associated with reverse smoking
- D. Most cancers are poorly differentiated and of ulcerative variety (Correct Answer)
Explanation: ***Most cancers are poorly differentiated and of ulcerative variety*** - The majority of **hard palate carcinomas** are well to moderately differentiated squamous cell carcinomas, rather than poorly differentiated. - While some may ulcerate, the presentation is not predominantly of an **ulcerative variety**; they can also present as exophytic or endophytic masses. *Lymphatic metastasis is uncommon* - **Lymphatic metastasis** to regional lymph nodes (submandibular and deep cervical) is indeed uncommon in early-stage hard palate cancers due to the relatively dense bony barrier. - However, as the tumor size increases or if there is extensive soft tissue involvement, the risk of **nodal metastasis** significantly rises. *Larger tumors require maxillectomy* - For larger or deeply invasive carcinomas of the hard palate, **maxillectomy** (surgical removal of part or all of the maxilla) is often necessary to achieve adequate surgical margins. - This extensive surgical approach is crucial for local disease control and to prevent recurrence, especially when the tumor extends into the bone or adjacent structures. *Associated with reverse smoking* - **Reverse smoking**, a practice where the lit end of a cigarette is placed inside the mouth, generates higher heat and carcinogen exposure to the palate. - This habit is strongly linked to an increased incidence of **squamous cell carcinoma** of the hard palate, particularly in certain geographic regions.
Question 2: The most common site for squamous cell carcinoma in oral cavity is -
- A. Floor of mouth
- B. Buccal mucosa
- C. Tongue (Correct Answer)
- D. Upper and lower alveolus
Explanation: ***Tongue*** - The **lateral borders** and **ventral surface** of the tongue are the most common sites for squamous cell carcinoma (SCC) in the oral cavity. - This area is exposed to carcinogens present in tobacco and alcohol, making it highly susceptible to malignant transformation. *Floor of mouth* - While the floor of the mouth is a common site for oral SCC, it ranks **second** to the tongue in incidence. - Carcinomas here can be particularly aggressive due to early involvement of adjacent structures like the **mandible** and **submandibular gland**. *Buccal mucosa* - The buccal mucosa is a less common site for SCC compared to the tongue and floor of the mouth, although its incidence can be higher in regions with prevalent **smokeless tobacco** use. - Lesions here often present as **white patches (leukoplakia)** or **red patches (erythroplakia)**. *Upper and lower alveolus* - SCC of the alveolar ridges is relatively **uncommon** and typically associated with chronic irritation from ill-fitting dentures or poor oral hygiene. - These cancers can involve the underlying **bone** early in their progression.
Question 3: What is the most appropriate treatment after resection of lateral border of tongue carcinoma with high-risk features (positive margins, perineural invasion)?
- A. Systemic chemotherapy
- B. Adjuvant radiotherapy (Correct Answer)
- C. Surgical neck dissection
- D. Postoperative observation
Explanation: ***Adjuvant radiotherapy*** - **Adjuvant radiotherapy** is the **standard of care** after surgical resection of **oral tongue squamous cell carcinoma** with **high-risk features** such as: - **Positive or close margins** (<5 mm) - **Perineural invasion (PNI)** - **Lymphovascular invasion (LVI)** - **Deep tumor invasion** (>4 mm depth) - **Advanced T stage** (T3-T4) - These features significantly **increase the risk of local recurrence**, and adjuvant radiotherapy improves **locoregional control** and **overall survival**. - The **tongue** has rich lymphatic drainage making it prone to both local recurrence and regional metastasis, necessitating adjuvant therapy. *Systemic chemotherapy* - **Systemic chemotherapy alone** is not used as adjuvant treatment after resection of oral tongue carcinoma. - It may be combined with radiotherapy (**concurrent chemoradiotherapy**) in cases with **extranodal extension** or multiple positive nodes, but standalone chemotherapy is reserved for **palliative treatment** of distant metastatic disease. *Surgical neck dissection* - **Neck dissection** is typically performed **at the same time** as primary tumor resection (concurrent procedure), not as a separate "after treatment." - It addresses **regional lymph node metastasis** rather than controlling the primary tumor site. - If not done initially and nodes become clinically positive later, it would be therapeutic neck dissection, but this is not routine adjuvant therapy. *Postoperative observation* - **Observation alone** is appropriate only for **very early-stage disease** (T1N0) with **clear margins** (>5 mm), **no depth invasion** (<4 mm), and **absence of adverse features** like PNI or LVI. - Given the presence of **high-risk features** in this scenario, observation would result in unacceptably high rates of **local recurrence**.
Question 4: What is the most significant factor associated with the causation of head and neck carcinoma?
- A. Intravenous drug abuse
- B. Exposure to nickel
- C. History of syphilis
- D. Tobacco use (Correct Answer)
Explanation: ***Tobacco use*** [1] - Tobacco use is the most significant risk factor for head and neck carcinomas, with strong evidence linking it to both oral and pharyngeal cancers. [1] - It promotes carcinogenic changes in the mucosal lining of the head and neck, significantly increasing the risk of malignancy. [1] *History of syphilis* - While syphilis has been linked to oropharyngeal squamous cell carcinoma, its role is less significant than tobacco. - Other factors, such as HPV infection, are more clinically relevant for head and neck cancers associated with syphilis. [1] *Exposure to nickel* - Nickel exposure is primarily associated with respiratory cancers, particularly lung cancer, rather than head and neck cancers. - The connection to head and neck carcinoma is not well established, making it a minor risk factor compared to tobacco. *Intravenous drug abuse* - Although intravenous drug abuse may lead to other health complications, it is not a direct significant risk factor for head and neck carcinoma. - Other lifestyle choices and exposures, particularly tobacco, play a much larger role in the development of these cancers.
Question 5: All are premalignant conditions of oral cavity except:
- A. Oral submucosal fibrosis
- B. Oral lichen planus (Correct Answer)
- C. Leucoplakia
- D. Chronic hyperplastic candidiasis
Explanation: ***Oral lichen planus*** - While certain forms of **oral lichen planus (OLP)**, particularly the erosive type, are considered to have a small potential for malignant transformation, it is generally considered a **potentially malignant disorder** rather than a definitively premalignant condition with high rates of progression. - Its transformation rates are significantly lower and less consistent across studies compared to other conditions listed. *Oral submucosal fibrosis* - This is a well-established **premalignant condition** characterized by chronic, progressive fibrotic changes in the oral mucosa, primarily due to **areca nut chewing**. - It has a high malignant transformation rate, particularly into **oral squamous cell carcinoma**. *Leucoplakia* - This is defined as a white plaque of the oral mucosa that cannot be rubbed off and cannot be characterized as any other diagnosable disease. - It is histologically often associated with **epithelial dysplasia** and has a significant risk of developing into **oral squamous cell carcinoma**, making it a definitive premalignant condition. *Chronic hyperplastic candidiasis* - This is a form of **mucocutaneous candidiasis** that presents as a persistent white plaque that cannot be scraped off. - Unlike other forms of candidiasis, it is considered a **premalignant lesion** with a potential for malignant transformation, especially if associated with epithelial dysplasia.
Question 6: 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
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.
Question 7: A 59-year-old woman has discomfort in the posterior part of her tongue. A biopsy confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior third of the tongue?
- A. Lymph gland spread is often encountered. (Correct Answer)
- B. There is an excellent prognosis.
- C. The tissue is well differentiated.
- D. Lymphoid tissue is absent.
Explanation: ***Lymph gland spread is often encountered.*** - Carcinomas of the posterior third of the tongue (base of tongue) are typically aggressive and have a rich **lymphatic drainage** network, making early metastasis to **cervical lymph nodes** common. - This high rate of **lymphatic spread** significantly impacts prognosis and treatment planning. *There is an excellent prognosis.* - Carcinomas of the posterior third of the tongue generally have a **poor prognosis** due to their late presentation, aggressive nature, and high likelihood of regional lymph node metastasis. - The inaccessibility of the tumor often leads to diagnosis at an advanced stage, limiting treatment success compared to anterior tongue or lip cancers. *The tissue is well differentiated.* - Carcinomas of the posterior tongue are often **poorly differentiated** or undifferentiated, which correlates with more aggressive behavior and a higher potential for metastasis. - While some may be moderately differentiated, well-differentiated tumors are less common and usually associated with a better prognosis and less aggressive spread. *Lymphoid tissue is absent.* - The posterior third of the tongue, particularly the base of the tongue, is rich in **lymphoid tissue**, forming part of **Waldeyer's ring** (lingual tonsils) [1]. - This abundance of lymphoid tissue is a critical anatomical feature that facilitates lymphatic drainage and potentially contributes to early lymphatic spread in carcinomas of this region. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 744-745.
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
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.
Question 9: Tongue fixation in a patient with carcinoma tongue is staged as
- A. T1
- B. T2
- C. T3
- D. T4 (Correct Answer)
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.
Question 10: Which of the following statements are true? 1. Due to increasing mammography there occurs over diagnosis of breast carcinoma 2. Colon cancer screening is done by digital rectal examination 3. Oral cancer screening is done by visual inspection 4. Cervix cancer screening is done by a pap smear
- A. 1,2,3,4
- B. 4 only
- C. 1,3,4 (Correct Answer)
- D. 2,3,4
Explanation: ***Correct: 1,3,4*** - **Statement 1 is TRUE**: Overdiagnosis is a well-documented consequence of increased mammography screening. It detects slow-growing tumors that might never have caused clinical symptoms or harm during a woman's lifetime, leading to unnecessary treatment and associated morbidities. - **Statement 3 is TRUE**: Oral cancer screening primarily involves thorough visual inspection by a healthcare professional to identify suspicious lesions, ulcers, or color changes in the oral cavity. - **Statement 4 is TRUE**: Cervical cancer screening is effectively done by Pap smear, which detects precancerous and cancerous cells. - **Statement 2 is FALSE**: Digital rectal examination is NOT the primary screening method for colon cancer. Standard screening methods include colonoscopy, fecal occult blood testing (FOBT), and fecal immunochemical test (FIT). *Incorrect: 1,2,3,4* - While statements 1, 3, and 4 are true, statement 2 is incorrect. Digital rectal examination is not a primary or definitive screening method for colon cancer—it only examines the rectum and misses most of the colon. *Incorrect: 4 only* - While cervical cancer screening by Pap smear is true, this option is incomplete as it misses other true statements (1 and 3) regarding mammography overdiagnosis and oral cancer screening. *Incorrect: 2,3,4* - This option incorrectly includes statement 2. Colon cancer screening is NOT done by digital rectal examination. Proper screening methods include colonoscopy, FOBT, FIT, and flexible sigmoidoscopy.
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