11 Oral Cancer Flashcards
Describe the distribution of oral cancer based on type.
> 90% is Squamous Cell Carcinoma, also called Epidermoid Carcinoma.
What is the typical rate of occurrence and survival rate for patients affected with oral cancer?
Squamous Cell Carcinoma: 30k new cases every year. 9k die every year. Average survival rate at 5yrs is 50%. 5th lowest survival rate and the rate is not improving as it has in other types of cancer.
Describe the age distribution and typical popluation affected by oral cancer
Affects all ages, but the peak is from 50 -70. Increasing incidence under age 40!!! Affects more males than females 2:1. Risk factors correlate with incidence.
What are seven risk factors for oral cancer?
actinic radiation, tobacco products, alcohol abuse, infectious agents (HPV), immunocuppression, genetic defects, environmental contacts
Oral cancer risk factor: Actinic radiation
sun damage - lip cancers only
Oral cancer risk factor: smoked tobacco products
Smoked tobacco:
- In 75% of cases of oral cancer, the patient was/is a smoker
- Longer duration of smoking = increased incidence of cancer
- Increased usage of tobacco = increased incidence of cancer
- Risk for cigars and pipe smoking essentially = risk for cigarettes (for intraoral squamous
cell carcinoma)
Oral cancer risk factor: smokeless tobacco products
Smokeless tobacco:
- A much lower incidence of development of carcinoma when compared with smoked
tobacco
- Usually associated with prolonged use of smokeless products
- Cancer develops in the site of placement of the quid
- Moist vs dry snuff is the critical determinant in carcinogenicity
- Typically 20-30 years usage
Oral cancer risk factor: alcohol abuse
Statistically a greater risk factor than tobacco
Risk > 2 pack per day smokers
Effects of alcohol
- Drying agent (alters epithelial metabolism)
- Solvent effects
- Contaminants
More factors come into play as potential causes
- Nutritional deficiencies are common
- Detoxification of carcinogens hindered by liver disease
What constitutes alcohol abuse?
What constitutes abuse: - A total of 6 alcohol equivalents per day Alcohol equivalents: - One shot (1.5 oz) “hard” liquor - One glass (6 oz) wine - One glass/can (12 oz) beer
Oral cancer risk factor: immunosupression
A healthy immune system seeks out and destroys cells in the pre-cancerous stages
Factors that degrade the immune system lead to increased cancer incidence:
-Aging!!
-Chronic nutritional deficiency
-Disease states
-Therapeutic intervention
(see details in lecture on each)
Oral cancer risk factor: genetic defects (syndrome association and family disposition)
Syndrome associations include basal cell nevus syndrome and gardner’s syndrome. (A specific syndrome associated with oral squamous cell carcinoma has not been reported however)
Family disposition-family history increases risk by about 25x
Oral cancer risk factor: environmental contacts
carcinogenic chemicals, foods and/or additives, heat
Oral cancer risk factor: infectious agents (HPV)
chronic candidal infection?, HPV 16 and 18 (today, nearly 80% of throat cancer is due to HPV). Any chronic disease state resulting in continuous stimulation of the immune system can result in accumulated genetic defects–>potential cancerous changes)
What are some ways the patient can decrease morbidity and mortality of squamous cell carcinoma?
healthy diet, healthy lifestyle, avoid known risk factors, know warning signs, regular screening exams
What are some ways the health care provdier can decrease morbidity and mortality of squamous cell carcinoma?
educate patients, regular screening exams, improved screening tools, early detection (find early, while small, and before metastasis)
Describe warning signs for oral/head and neck squamous cell carcinoma using the “CAUTION” acronym.
C-Change in sensation/numbness
A-A sore that will not heal
U-Unexplained hoarseness and/or difficulty swallowing
T-Thickening or a lump of recent onset
I-Inability to pronounce certain sounds or slurring of speech
O-Obvious change in a mole, wart, or discolored area
N-Nagging cough
Describe clinical presentation of squamous cell carcinoma
white plaque (leukoplakia), red plaque-like (erythroplakia), ulcerated, exophytic mass
Describe clinical presentation of leukoplakia
White plaque
Describe clinical presentation of erythroplakia
Red plaque-like, Smooth, velvety surface,Slightly raised margin, White surface speckling
Describe ulcererated characteristic of squamous cell carinoma
Often with a raised, rolled border
Often with a very deep, central crater
What does exophytic mass refer to?
Often with an irregular surface texture
Describe clinical presentation of early lesions.
Earliest lesions do NOT show characteristic features that increase index of suspicion!!!
Describe clinical presentation of advanced lesions.
Advanced lesions:
Firm to hard (indurated)
Non-movable (bound down to adjacent tissues)
Irregular, exophytic growth with poorly defined margins
Non-healing ulceration
Rolled borders are particularly ominous
Pain
List the high risk sites for oral cancer.
Lower lip
Posterior lateral border of the tongue,Floor of the mouth (Males mostly Increasing incidence in females though) Tonsillar pillars
Recognize the potential for oral cancer anywhere in the oral cavity.
It occurs everywhere!!!
Describe the TNM staging system
T-tumor size (1-4 depending on size of tumor)
N-nodal metastasis (0-3 depending on lymph node involvement)
M-metastatic spread (0-1 depending on metastasis)
Describe the STNMP staging system
S-site of primary tumor T-tumor size N-nodal metastasis M-metastatic spread P-pathologic grade of the tumor
Classify five year survival rate by stage of disease.
Stage 1: 77-85%
Stage 2: 66-76%
Stage 3: 41-44%
Stage 4: 9-20%
What are some key principles of early diagnosis?
identify and document abnormalities, identify risk factors and eliminate them where possible, follow up, and biopsy unless the lesion resolves
What are some variations in treatment for patients with oral squamous cell carcinoma?
Selection of treatment depends on the stage of the disease and location of the cancer. Modes of therapy: surgical, radioation, chemotherapy, or a combination
Describe potential complications of surgical treatment.
functional deficit, impaired nutrition, post-surgical infection, speech impairment, drooling, facial deformity
Describe potential complications of radiation therapy.
dermatitis, mucositis and ulceration, decreased salivation, impaired nutrition, difficulty swallowing, taste alteration, infection (candidiasis/bacterial)
Describe potential complications of chemotherapy.
mucositis and ulceration, xerostomia, infection (fungal/viral/bacterial), bleeding (anemia), N/V/D, loss of apetitie and neurotoxicity
Name (and be able to discuss) four long-term complications of oral cancer treatment.
Xerostoma, osteoradionecrosis, trismus/fibrosis, alopecia
