CHONC flashcards
CHONC · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- HPV and oropharyngeal cancer
- HPV E6 and E7 inactivate p53 and Rb, driving carcinogenesis; HPV-positive oropharyngeal SCC has better prognosis and distinct AJCC 8th edition staging.
- Depth of invasion staging
- In oral cavity SCC, DOI >5 mm upstages T1 to T2 and DOI >10 mm upstages to T3, independent of surface diameter.
- Extranodal extension
- Tumor breaching the lymph node capsule; a major adverse prognostic factor that upstages HPV-negative disease to N3b and worsens survival.
- Level II/III boundary
- The spinal accessory nerve marks the boundary between neck levels II and III; the omohyoid marks III and IV.
- Elective neck dissection
- Prophylactic removal of cervical lymph nodes in clinically node-negative necks, indicated for oral cavity cancer with depth of invasion >3-4 mm.
- Modified radical neck dissection
- Removes levels I-V but preserves one or more non-lymphatic structures such as the spinal accessory nerve, internal jugular vein, or sternocleidomastoid.
- Concurrent chemoradiation
- Delivery of radiosensitizing chemotherapy (typically cisplatin) during radiotherapy; standard for locally advanced head and neck cancer and improves survival.
- IMRT parotid sparing
- Intensity-modulated radiotherapy conforms dose to targets; keeping mean parotid dose <26 Gy reduces xerostomia.
- Osteoradionecrosis prevention
- Pre-radiotherapy dental evaluation, extraction of unsalvageable teeth, and fluoride prophylaxis reduce risk of mandibular osteoradionecrosis.
- Prophylactic swallowing exercises
- Swallow therapy begun before and continued during chemoradiation reduces long-term dysphagia and stricture formation.
- Tumor board
- Multidisciplinary review of imaging, pathology, and staging by surgeons, radiation and medical oncologists, and pathologists to guide treatment planning.
- Organ preservation
- Use of chemoradiation instead of total laryngectomy for locally advanced larynx cancer in selected patients, with comparable survival in trials.
- Sentinel lymph node biopsy
- Injection of tracer to identify the first draining node; an option for early oral cavity cancer to avoid elective neck dissection.
- PET-CT staging
- Functional imaging that detects occult distant metastases and second primaries in locally advanced head and neck cancer and informs radiotherapy planning.
- Free flap reconstruction
- Transfer of vascularized tissue (radial forearm, fibula, anterolateral thigh) with microvascular anastomosis for large head and neck defects.
- Chyle leak
- Leakage of thoracic duct lymph after left neck dissection; managed with drainage, diet modification, and sometimes reoperation.
- Cetuximab
- EGFR monoclonal antibody used with radiotherapy when cisplatin is contraindicated; causes acneiform rash and infusion reactions.
- Checkpoint inhibitors
- Pembrolizumab and nivolumab are used for recurrent or metastatic head and neck SCC; HPV-positive tumors show higher response rates.
- Radiation mucositis
- Painful inflammation of oral mucosa during radiotherapy; managed with oral care, analgesia, and nutritional support.
- Trismus prevention
- Jaw stretching exercises after radiation to the masticator space help maintain interincisal opening and reduce fibrosis.
- Survivorship surveillance
- Routine follow-up for recurrence, second primaries, hypothyroidism after neck radiation, and dental health after treatment.
- Surgical safety checklist
- Structured time-out before incision verifying patient, site, procedure, and equipment; reduces wrong-site surgery and retained foreign bodies.
- Quality metrics
- Measurable indicators such as margin status, nodal yield, and time to treatment that benchmark head and neck cancer care.
- IRB approval
- Institutional review board oversight required before human subjects research; ensures protection of participants and ethical conduct.
- Belmont Report principles
- Respect for persons, beneficence, and justice form the ethical framework for human subjects research.
- Clinical equipoise
- Genuine uncertainty about which treatment is superior justifies randomization in a clinical trial.
- Conflict of interest
- Financial or personal relationships that could bias judgment; must be disclosed to preserve trust in research and clinical care.
- Spinal accessory nerve
- Runs through the posterior triangle; injury during neck dissection causes shoulder droop and weakness of trapezius.
- Facial nerve branches
- Temporal, zygomatic, buccal, marginal mandibular, and cervical branches divide within the parotid; preserved during parotidectomy unless invaded.
- Postoperative radiotherapy
- Adjuvant radiation for adverse features such as positive margins, extranodal extension, pT3-4, or multiple positive nodes.
- Induction chemotherapy
- Chemotherapy before definitive treatment; may select patients for organ preservation but does not improve overall survival over concurrent chemoradiation.
- Total laryngectomy
- Removal of the larynx with permanent tracheostoma; salvage after failed chemoradiation carries higher complication rates.