Carcinoma of Tongue

Carcinoma of Tongue

Q. 1

 Referred otalgia can be due to

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Q. 1

 Referred otalgia can be due to

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Ans. D

Explanation:

 

Causes of referred otalgia

Ear receives nerve supply from Vth (auriculotemporal), 1Xth (tympanic br.) and Xth (auricular br.) cranial nerves; and from C2 (lesser occipital) and C2 and C3 (greater auricular), pain may be referred from these remote areas

1. Via Vth cranial nerve

  • Dental; Caries tooth, apical abscess, impacted molar, malocclusion.
  • Oral cavity; Benign or malignant ulcerative lesions of oral cavity or tongue.
  • Temporomandibular joint disorders; Bruxism, osteoarthritis, recurrent dislocation,  ill-fitting denture.
  • Sphenopalatine neuralgia.

2. Via IXth cranial nerve

  • Oropharynx; Acute tonsillitis, peritonsillar abscess, tonsillectomy. Benign or malignant ulcers of soft palate, tonsil and its pillars.
  • Base of tongue; Tuberculosis or malignancy.
  • Elongated styloid process.

3.   Via Xth cranial nerve. Malignancy or ulcerative lesion of: vallecula, epiglottis, larynx or laryngopharynx, esophagus.

4.   Via C2 and C3 spinal nerves. Cervical spondylitis, injuries of cervical spine, caries spine.


Q. 2

A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is

 A

>No

 B

N1

 C

N2

 D

N3

Q. 2

A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is

 A

>No

 B

N1

 C

N2

 D

N3

Ans. C

Explanation:

Q. 3

Referred otalgia is due to:

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of above

Q. 3

Referred otalgia is due to:

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of above

Ans. D

Explanation:

Q. 4

A patient with carcinoma of tongue is found to have lymph nodes in the lower neck. The treatment of choice for the lymph nodes is:

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Tele radiotherapy

 D

Radical neck dissection

Q. 4

A patient with carcinoma of tongue is found to have lymph nodes in the lower neck. The treatment of choice for the lymph nodes is:

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Tele radiotherapy

 D

Radical neck dissection

Ans. D

Explanation:

Traditionally, the gold standard for control of cervical metastasis has been the radical neck dissection (RND).

The classic RND removes levels I to V of the cervical lymphatics in addition to the SCM, internal jugular vein, and the spinal accessory nerve (CN XI). 

 
Any modification of the RND that preserves nonlymphatic structures (i.e., CN XI, SCM muscle, or internal jugular vein) is defined as a modified radical neck dissection (MRND).

A neck dissection that preserves lymphatic compartments normally removed as part of a classic RND is termed a selective neck dissection (SND).
 
Ref: Weber R.S. (2010). Chapter 18. Disorders of the Head and Neck. In T.R. Billiar, D.L. Dunn (Eds), Schwartz’s Principles of Surgery, 9e.

Q. 5

Which of the following is TRUE differential cause of referred otalgia?

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Q. 5

Which of the following is TRUE differential cause of referred otalgia?

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Ans. D

Explanation:

Otalgia can occur as a symptom of carcinoma on the base of tongue, pharynx or larynx.

 
Ear receives nerve supply from 4 cranial nerves such as trigeminal, facial, glossopharyngeal and vagus; and from two branches of cervical plexus called C2 (lesser occipital) and C2 and C3 (greater auricular), pain maybe referred from these remote areas.
 
Facial nerve refers pain to the external ear canal and post auricular region. Second and third cervical nerves refer pain to the postauricular and mastoid regions. 
 
Trigeminal referred otalgia arise from lesions involving the oral cavity and floor of mouth, teeth, mandible, temporomandibular joint, palate and pre auricular skin.
 
Glossopharyngeal referred otalgia arise from the tonsil, base of the tongue, soft palate, nasopharynx, Eustachian tube and pharynx.
 
Vagal referred otalgia arise from the hypopharynx, larynx and trachea.
 
Differential causes of referred otalgia includes migraine, TMJ syndrome, cervical myalgia, fibromyalgia, dental abscess, head and neck malignancy (neoplasm of nasopharynx, sinus, tonsil, base of tongue, hypopharynx), temporal arteritis, inflammatory sinusitis, carotidynia, trigeminal neuralgia, glossopharyngeal neuralgia and GERD.

Q. 6

A patient has carcinoma of right tongue on its lateral border of anterior 2/3 rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is:

 A

N0

 B

N1

 C

N2

 D

N3

Q. 6

A patient has carcinoma of right tongue on its lateral border of anterior 2/3 rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is:

 A

N0

 B

N1

 C

N2

 D

N3

Ans. C

Explanation:

Since this patient’s cancer has spread to ipsilateral lymph node and is greater than 3cm in size he falls under stage 2a of cancer of oral cavity. 
  • N0: There is no evidence of regional metastasis
  • N1: Metastasis occur to a single ipsilateral lymph node, 3 cm or less in greatest dimension
  • N2a: Metastasis in single ipsilateral lymph node, >3 cm and
  • N2b: Metastasis occur in multiple ipsilateral lymph nodes, all nodes
  • N2c: Metastasis occur in bilateral or contralateral lymph nodes, all nodes

Q. 7

In carcinoma bas of tongue pain is refered to the ear through-

 A

Hypoglossal nerve

 B

Vagus nerve

 C

Glossopharyngeal nerve

 D

Lingual nerve

Q. 7

In carcinoma bas of tongue pain is refered to the ear through-

 A

Hypoglossal nerve

 B

Vagus nerve

 C

Glossopharyngeal nerve

 D

Lingual nerve

Ans. C

Explanation:

C i.e. Glossopharyngeal nerve


Q. 8

Radiotherapy is used for which stage-I cancer 

 A

Colon

 B

Larynx

 C

Anterior 2/3 of tongue

 D

b and c 

Q. 8

Radiotherapy is used for which stage-I cancer 

 A

Colon

 B

Larynx

 C

Anterior 2/3 of tongue

 D

b and c 

Ans. D

Explanation:

B i.e. Larynx; C i.e. Ant 2/3 of tongue

  • Radiotherapy is reserved for early larynx CA which has not involved cartilage or cervical lymphnodes & don’t impair cord mobilityQ.
  • Surgery is the treatment of choice for early lesions suitable for simple infra oral excision, for tumors on the tip of tongue but brachy therapy with iridium wires has the advantage of preserving the tongue.
  • Stomach, colon, lung CA in early stage are treated by surgery.

Q. 9

A patient presented with a 1 x 1.5 cms growth on the lateral border of the tongue. The treatment indicated would be –

 A

Laser ablation

 B

Interstitial brachytherapy

 C

External beam radiotherapy

 D

Chemotherapy

Q. 9

A patient presented with a 1 x 1.5 cms growth on the lateral border of the tongue. The treatment indicated would be –

 A

Laser ablation

 B

Interstitial brachytherapy

 C

External beam radiotherapy

 D

Chemotherapy

Ans. A

Explanation:

Ans is ‘a’ i.e. laser ablation 

Treatment of oral tongue cancer is primarily surgical, with wide local excision and negative margin control.

Small tumors (T1- T2)- may be removed by wide local excision and primary closure or closure by secondary intention.

Excision of larger tumors – requires partial glossectomy or hemiglossectomy.

Schwartz writes- “The CO2 laser may be used for excision of early tongue cancers or for ablation of premalignant lesions.”

If regional lymphnodes are involved- Modified radical neck dissection or selective neck dissection is done.

Indications for postoperative radiation therapy include evidence of perineural or angiolymphatic spread or positive nodal disease.


Q. 10

A patient has carcinoma of tongue in the right lateral aspect with lymph node of 4 cm size in level 3 on the left side of neck, what is the stage ?

 A

NO

 B

N1

 C

N2

 D

N3

Q. 10

A patient has carcinoma of tongue in the right lateral aspect with lymph node of 4 cm size in level 3 on the left side of neck, what is the stage ?

 A

NO

 B

N1

 C

N2

 D

N3

Ans. C

Explanation:

Ans. is ‘c’ i.e. N2 

According to American Joint Committee on Cancer (AJCC), 2002, the regional lymph node staging (N) is common to all head and neck sites, except the nasopharynx.

Regional Lymph Node Staging of Head & Neck Cancers

Classification

Description

NO

No regional lymph node metastasis

N1

Metastasis in a single ipsilateral lymph node,  3 cm in

greatest dimension

N2

Metastasis in a single ipsilateral lymph node, > 3 cm but

< 6 cm in greatest dimension; or in multiple ipsilateral

lymph nodes, none > 6 cm in greatest dimension; or in

bilateral or contralateral lymph nodes, none > 6 cm in

greatest dimension

N2a

Metastasis in single ipsilateral lymph node > 3 cm but

< 6 cm in greatest dimension

N2b

Metastasis in multiple ipsilateral lymph nodes, none > 6

cm in greatest dimension

N2c

Metastasis in bilateral or contralateral lymph nodes, none

> 6 cm in greatest dimension

N3

Metastasis in a lymph node > 6 cm in greatest dimension


Q. 11

Multiple painful ulcers on tongue are seen in all except

 A

Aphthous ulcers

 B

Tuberculous ulcers

 C

Herpes ulcers

 D

Carcinomatous ulcers

Q. 11

Multiple painful ulcers on tongue are seen in all except

 A

Aphthous ulcers

 B

Tuberculous ulcers

 C

Herpes ulcers

 D

Carcinomatous ulcers

Ans. D

Explanation:

Ans is ‘d’ i.e., Carcinomatous ulcer 

Carcinomatous ulcers are painless but may become painful in advanced stages, with extension into surrounding tissues.


Q. 12

A pt. with Ca tongue is found to have lymph nodes in the lower neck. The t/t of choice for the lymph nodes is

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Tele radiotherapy

 D

Radical neck dissection

Q. 12

A pt. with Ca tongue is found to have lymph nodes in the lower neck. The t/t of choice for the lymph nodes is

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Tele radiotherapy

 D

Radical neck dissection

Ans. D

Explanation:

Ans. is ‘d’ ie Radical neck dissection 

“For clinically Node positive necks, frequently the surgical treatment of choice is the MRND or RND.”- Schwartz 9/e p505

The management of cervical node metastasis has already been described in previous question.

Surgical management can be of 3 types: Radical neck dissection (RND), Modified radical neck dissection (MRND) & Selective neck dissection (SND)

Radical neck dissection

is the traditional gold standard for control of cervical metastasis.

–  RND involves removal of levels I to V of the cervical lymph nodes + Sternocleidomastoid, UV and the spinal accessory nerve (CN XI).

Modified radical neck dissection

– is modification of RND that preserves nonlymphatic structures i.e. CN XI, SCM and UV.

MRND has been found to be equally effective in controlling neck disease as RND with superior functional outcome.

Selective neck dissection

– Preservation of any of the levels I through V during neck dissection is known as Selective neck dissection.

– The principle behind preservation of certain nodal groups is that specific primary sites preferentially drain their lymphatics in a predictable pattern. Types of SND include the supraomohyoid neck dissection, the lateral neck dissection, and the posterolateral neck dissection.

“SND is performed on a clinically negative (NO) neck with preservation of nodal groups carrying less than 20% chance of being involved with metastatic disease”- Sabiston 18/e p819


Q. 13

Commonest site of carcinoma tongue –

 A

Apical

 B

Lateral borders

 C

Dorsum

 D

Posterior 1/3

Q. 13

Commonest site of carcinoma tongue –

 A

Apical

 B

Lateral borders

 C

Dorsum

 D

Posterior 1/3

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lateral borders 

Most common site is middle of the lateral border or the ventral aspect of the tongue.


Q. 14

Carcinoma tongue less than 2 cm is treated by

 A

Excision

 B

Radiotherapy

 C

Chemotherapy

 D

Excision and Radiotherapy

Q. 14

Carcinoma tongue less than 2 cm is treated by

 A

Excision

 B

Radiotherapy

 C

Chemotherapy

 D

Excision and Radiotherapy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Excision


Q. 15

Commonest site of carcinoma tongue is –

 A

Dorsum

 B

Ventral aspects

 C

Anterior 2/3 lateral aspect

 D

Tip

Q. 15

Commonest site of carcinoma tongue is –

 A

Dorsum

 B

Ventral aspects

 C

Anterior 2/3 lateral aspect

 D

Tip

Ans. C

Explanation:

Ans. is ‘c’ i.e., Anterior 2/3 lateral aspect


Q. 16

Which is not true of Carcinoma tongue-

 A

Lateral border is involved

 B

Cervical lymph node involvement

 C

Commonly adeno carcinoma

 D

Tobacco chewing is a risk factor

Q. 16

Which is not true of Carcinoma tongue-

 A

Lateral border is involved

 B

Cervical lymph node involvement

 C

Commonly adeno carcinoma

 D

Tobacco chewing is a risk factor

Ans. C

Explanation:

Ans. is ‘c’ i.e., Commonly adeno carcinoma 


Q. 17

60 year old man presents with an ulcer on lateral margin of tongue also complains of ear pain, most probable diagnosis is –

 A

Dental ulcer

 B

Carcinomatous ulcer

 C

Tuberculosis ulcer

 D

Syphilitic ulcer

Q. 17

60 year old man presents with an ulcer on lateral margin of tongue also complains of ear pain, most probable diagnosis is –

 A

Dental ulcer

 B

Carcinomatous ulcer

 C

Tuberculosis ulcer

 D

Syphilitic ulcer

Ans. B

Explanation:

Ans. is ‘b’ i.e., Carcinomatous ulcer 


Q. 18

Carcinoma of the tongue – 

 A

Occurs most commonly on the lateral border of the middle third of tongue

 B

Metastasize readily to cervical lymph nodes

 C

Is usually radiosensitive

 D

All of the above

Q. 18

Carcinoma of the tongue – 

 A

Occurs most commonly on the lateral border of the middle third of tongue

 B

Metastasize readily to cervical lymph nodes

 C

Is usually radiosensitive

 D

All of the above

Ans. D

Explanation:

Ans. is `d’ i.e., All of the above 


Q. 19

Which carcinoma most commonly metastasizes to cervical lymph nodes –

 A

Maxillary sinus

 B

Posterior tongue

 C

Cheek

 D

Hard palate

Q. 19

Which carcinoma most commonly metastasizes to cervical lymph nodes –

 A

Maxillary sinus

 B

Posterior tongue

 C

Cheek

 D

Hard palate

Ans. B

Explanation:

Ans. is ‘b’ i.e., Posterior tongue

See below

Here is the incidence of cervical lymphnode metastasis of various head & Neck tumours

  • Posterior tongue —> 70% (Schwartz 7th/e page 638)
  • Hard palate            —> 10-25 % (7thle page 632)
  • Buccal mucosa —> 56% (7th/e page 631)
  • Maxillary Sinus —> Nodal metastases are rare and occur only in 10-15% cases (p 253 E.N.T. Dhingra 3/e)

Q. 20

The commando operation is – 

 A

Abdomino-perineal resection of the rectum for carcinoma

 B

Disarticulation of the hip for gas gangrene of the leg

 C

Extended radical mastectomy

 D

Excision of carcinoma of the tongue, the floor of the mouth, part of the jaw and lymph nodes enbloc

Q. 20

The commando operation is – 

 A

Abdomino-perineal resection of the rectum for carcinoma

 B

Disarticulation of the hip for gas gangrene of the leg

 C

Extended radical mastectomy

 D

Excision of carcinoma of the tongue, the floor of the mouth, part of the jaw and lymph nodes enbloc

Ans. D

Explanation:

Ans. is ‘d’ i.e., Excision of carcinoma of the tongue, the floor of the mouth, part of the jaw and lymph nodes enbloc


Q. 21

In carcinoma, base of tongue pain is referred to the ear through:

 A

Hypoglossal nerve

 B

Vagus nerve

 C

Glossopharyngeal nerve

 D

Lingual nerve

Q. 21

In carcinoma, base of tongue pain is referred to the ear through:

 A

Hypoglossal nerve

 B

Vagus nerve

 C

Glossopharyngeal nerve

 D

Lingual nerve

Ans. C

Explanation:

 

In carcinoma base of tongue pain is referred to the ipsilateral ear because of the common nerve supply of the base of tongue and ear i.e. Glossopharyngeal nerve.

  • The anterior 2/3 of tongue is supplied by Lingual nerve
  • Lingual nerve is a branch of mandibular N and auriculotemporal N which supplies ear is also a branch of mandibular N. Hence any pain of anterior 2/3 of tongue is referred to ear via mandibular N.
  • Any pain in the posterior 1/3 of tongue is referred to ear via Glossopharyngeal and vagus N.
  • Any pain in the base of tongue is referred to ear via glossopharyngeal N.



Q. 22

Carcinoma tongue most frequently develops from:

 A

Tip

 B

Lateral border

 C

Dorsal portion

 D

All portions equally

Q. 22

Carcinoma tongue most frequently develops from:

 A

Tip

 B

Lateral border

 C

Dorsal portion

 D

All portions equally

Ans. B

Explanation:

Most common site of carcinoma tongue is middle of lateral border or the ventral aspect of the tongue followed by tip and dorsum.


Q. 23

A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is:

 A

NO

 B

N1

 C

N2

 D

N3

Q. 23

A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is:

 A

NO

 B

N1

 C

N2

 D

N3

Ans. C

Explanation:

 

Classification of stage of tumor of oral cavity based on size of lymph node.


Q. 24

A patient with Ca tongue is found to have lymph nodes in the lower neck. Treatment done is :

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Teleradiotherapy

 D

Radical neck dissection

Q. 24

A patient with Ca tongue is found to have lymph nodes in the lower neck. Treatment done is :

 A

Lower cervical neck dissection

 B

Suprahyoid neck dissection

 C

Teleradiotherapy

 D

Radical neck dissection

Ans. D

Explanation:

Q. 25

A patient presented with a 1×1.5 cms growth on the lateral border of the tongue. The treatment indicated would be:

 A

Laser ablation

 B

Interstitial brachytherapy

 C

External beam radiotherapy

 D

Chemotherapy

Q. 25

A patient presented with a 1×1.5 cms growth on the lateral border of the tongue. The treatment indicated would be:

 A

Laser ablation

 B

Interstitial brachytherapy

 C

External beam radiotherapy

 D

Chemotherapy

Ans. B

Explanation:

 

Tumor of lateral border of tongue

T1 stage (< 2cm in size): Insterstitial irradiation or excision (partial glossectomy).

T2 stage (> 2 cm) in size: External beam radiotherapy or hemiglossectomy


Q. 26

Referred pain in the ear is commonly from ___

 A

Maxillary carcinoma

 B

Nasopharyngeal carcinoma

 C

Carcinoma tongue

 D

Malignant otitis externa

Q. 26

Referred pain in the ear is commonly from ___

 A

Maxillary carcinoma

 B

Nasopharyngeal carcinoma

 C

Carcinoma tongue

 D

Malignant otitis externa

Ans. C

Explanation:

 

Referred causes of earache:

As the ear receives nerve supply from:

  • Vth (auriculotemporal branch) cranial nerve-dental, oral cavity, temporomandibular joint disorders and sphenopalatine neuralgia
  • IXth (tympanic branch) cranial nerve -oropharynx, base of tongue, elongated styloid process
  • Xth (auricular branch) cranial nerve-vallecula, epiglottis, larynx, esophagus
  • From C2 (lesser occipital) and C2 and C3 (greater auricular), pain may be referred from these remote areas.

Q. 27

Carcinoma of tongue most commonly occur at:

March 2009

 A

Dorsum

 B

Lateral border of anterior 2/3rd

 C

Lateral border of posterior 1/3rd

 D

Tip

Q. 27

Carcinoma of tongue most commonly occur at:

March 2009

 A

Dorsum

 B

Lateral border of anterior 2/3rd

 C

Lateral border of posterior 1/3rd

 D

Tip

Ans. B

Explanation:

Ans. B: Lateral border of anterior 2/3rd

Carcinoma of the tongue is relatively common in India and forms a significant group.

The anatomical sites that are frequently involved in mouth cancer include the floor of the mouth, the lateral border of the anterior tongue and the retromolar trigone.

Although lesion is either ulcerative or proliferative on an easily visible organ with exceptional mobility,it usually present in late stages. Hence, even though the disease is curable and has a high five years survival rate, presenting in the late stages, reduces five years survival rate.

According to Frenzel, though tumor size does not have direct correlation with prognosis, larger tumor size is associated with shorter survival.


Q. 28

Most common histological type of carcinoma of tongue:

March 2007

 A

Squamous cell carcinoma

 B

Adeno carcinoma

 C

Basal cell carcinoma

 D

Transitional cell carcinoma

Q. 28

Most common histological type of carcinoma of tongue:

March 2007

 A

Squamous cell carcinoma

 B

Adeno carcinoma

 C

Basal cell carcinoma

 D

Transitional cell carcinoma

Ans. A

Explanation:

Ans. A: Squamous cell carcinoma

Tongue development begins during the fourth embryonic week and develops from the region of the first 3-4 branchial arches. The tongue is supplied by the lingual arteries.

Innervation of the tongue includes the lingual and hypoglossal nerves for sensation and movement and the sympathetic, parasympathetic, and special sensory fibers for salivation and taste ability.

The most common histology finding in patients with malignant neoplasms of the base of the tongue is squamous cell carcinoma.

SCC is the predominant histology for tumours arising in the oral cavity and oropharynx.



Leave a Reply

%d bloggers like this:
Malcare WordPress Security