ASCO Connection

July 2017

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50 I 07.2017 BOARD PREPARATION: Head and Neck Cancers, Gastrointestinal Cancers A 56-year-old nonsmoking man presents with a complaint of neck swelling for a duration of 2 months. He denies pain, fever, chills, sore throat, or dental issues. He received several courses of antibiotics without relief. Flexible pharyngolar- yngoscopy did not demonstrate any lesions. An exam demonstrates a 3-cm firm, right level 2 neck mass. The mass is not tender to palpation. Fine needle aspiration of the mass demonstrates squamous cell carcinoma. What is the most appropriate next step in order to define a primary site of disease? A. Serologic evaluation for Epstein- Barr virus B. HHV-8 testing of tumor sample C. p16 immunohistochemistry of tumor sample D. Serologic evaluation of HIV ANSWERS: 1-C, 2-D, 3-E, 4-A. Find complete rationales and suggested reading at ASCOconnection.org/TEC. A 34-year-old man presents with a chief complaint of double vision for a duration of approximately 1 week. On exam, he is found to have a VI nerve palsy on the left. He is also noted to have a 2-cm left level IV cervi- cal lymph node. Flexible laryngopha- ryngoscopy demonstrates a mass in the nasopharynx. Biopsy of the mass demonstrates squamous cell carcinoma and the tumor is positive for EBV gene expression. PET/CT scan demonstrates a mass in the nasopharynx with exten- sion to the base of the skull and bilat- eral involved cervical lymph nodes. What is the most appropriate next step? A. Surgery followed by radiation ther- apy B. Surgery followed by cisplatin-based concurrent chemoradiotherapy C. Radiation therapy alone D. Sequential chemotherapy and chemoradiotherapy A 64-year-old patient with a 20-year history of hepatitis C and mild cirrhosis (Child-Pugh A) who is being monitored with yearly alpha-fetoprotein (AFP) levels and abdominal MRI shows an increase in AFP levels from 18 ng/dL to 200 ng/mL. The MRI identifies a new 4-cm lesion in the periphery of the right liver lobe with imaging characteristics supportive of a hepatocellular carcinoma (HCC). No other new focal abnormalities can be found in the liver. What is the best next step in the man- agement of the patient's disease? A. Ultrasound-guided biopsy of the sus- picious intrahepatic lesion B. PET/CT scan to rule out distant metastases C. Transarterial chemoembolization (TACE) of the liver followed by surgi- cal resection of the liver lesion D. Radiofrequency ablation of the liver lesion E. Surgical resection of the liver lesion A 46-year-old woman presents with mild abdominal fullness and reflux symptoms. The physical exam was negative. Lab test results were unre- markable. Upper endoscopy showed a sub-serosal gastric mass. Biopsy showed sheets of spindle cells, invasive, and CD117+ (cKIT) on immunohistochemistry staining. A partial gastrectomy is per- formed and the tumor measures 6 cm and has more than 10 mitoses per HPF, with zero of seven nodes positive. She recovers well from the surgery. Staging work-up, including a PET scan, is negative for metastasis. Which of the following treatments should you recommend? A. 36 months of imatinib at 400 mg a day B. Four cycles of ifosfamide and doxorubicin C. Post-operative radiation therapy D. 12 months of imatinib at 400 mg a day E. 6 months of imatinib at 400 mg a day TRAINEE & EARLY-CAREER l Board Prep Test your knowledge of head and neck cancers and gastrointestinal cancers with questions from a past edition of ASCO-SEP ® , ASCO's self-evaluation program in oncology. The fifth edition of ASCO-SEP is available for purchase in the ASCO University ® bookstore (university.asco.org/SEP). Featuring 21 updated chapters and more than 180 new self-assessment questions in the book, as well as a 120-question compre- hensive mock exam online, this resource is perfect for board preparation, and can be used to earn Maintenance of Certification and continuing medical education credit. Visit university.asco.org for information about the latest edition of ASCO- SEP and other self-assessment resources. Correct answers are listed at the bottom of the page. Find complete answer rationales and suggested reading at ASCOconnection.org/TEC, as well as addi- tional questions to test your knowledge.

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