NO neck

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Q) Treatment of No neck in head and neck cancers is

a) Elective lymph node dissection

b) Modified radical lymph node dissection

c) Radiotherapy

d) Chemotherapy

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In patients with a clinically negative neck, the incidence of occult metastases varies with the site, size and thickness of the primary tumour.  The high rate of occult cervical metastases (> 20%) in tumours of the lower part of the oral cavity is the main argument in favour of elective treatment of the neck even if it is N0. Several clinical and pathological studies have demonstrated that the pattern of metastatic lymph node metastases occurs in a predictable fashion in patients with oral and oropharyngeal carcinoma.

The risk of metastases increases as one progresses from the anterior to posterior part of the upper aero-digestive tract; from lip (10%) progressing along the tongue (25%), gum (30%), floor of mouth (40%), oropharynx (55%) to hypopharynx (65%). Endophytic tumors, poorly differentiated tumors, and tumors with a greater thickness (tongue and floor of mouth) are more likely to have metastases

Anti rejection drugs

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Q) Anti Rejection medicine which also prevents tumor recurrence? MCH Questions ...

a) M tor inhibitors

b) IL2 blockers

c) Steroids

d) Azathioprine

Ans a) mtor inhibitors 

One Question is always asked about anti rejection medicines, Salient points i am enumerating

  1. Three drug regimen is classic includes IL2 blocker, Mycophenolate and steroids which are tapered . IL 2 blocker  Tacrolimus is used more than Cyclosporine ( cyclosporine less used now). IL2 blocker side effects are hirsutism, hyperkalemia, gum hypertrophy etc) 
  2. Mycophenolate is preferred over azathioprine . Both cause fall in cell lines
  3. Steroids have many side effects like weight gain, cataract, infections and are used in tapering dose

M-tor inhibitors are sirolimus and Everolimus which are used when transplant is done for HCC, IT has anti tumor action.