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13- Epithelial Neoplasia Flashcards

1
Q

What is the largest organ in the body?

A

The skin (covers all the external surfaces)

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2
Q

What is the skin made up of ?

A

The epidermis + dermis

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3
Q

What is the superficial layer of the skin?

A

Epidermis

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4
Q

What is the supporting fibrous layer of the skin?

A

The dermis?

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5
Q

What is in-between the dermis & epidermis?

A

The basement membrane

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6
Q

What lines the cavities connecting the outside of the body?

A

The mucous membrane (mucosa)

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7
Q

What are the 3 types of tracts that line the body?

A

1.) Genitourinary tract
2.) Respiratory tract
3.) Gastrointestinal tract

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8
Q

What is the mucosa composed of?

A

Epithelium (surface layer) + lamina propria (supporting fibrous layer)

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9
Q

T or F, the epithelium is vascular.

A

False, it is avascular & no blood vessels are feeding into this tissue

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10
Q

How is the epithelium of the mucosa characterized by?

A

By the the presence of cytokeratin

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11
Q

What cell populations are chracterized as a stratified squamous epithelium?

A

1.) Epithelial cells
2.) Melanocytes
3.) Langerhans cells
4.) Merkel cell (not discussed in this lecture)

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12
Q

What are the keratinizing epithelial cells called in the epithelium?

A

Keratinocytes

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13
Q

What are the layers of the epithelium (from top to bottom)

A

1.) Stratum corneum
2.) Stratum lucidum
3.) Stratum granulosum
4.) Stratum spinosum
5.) Stratum basale

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14
Q

Where are melanocytes found in the epithelium?

A

In between cells in the basal layer.

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15
Q

How do melanocytes function in the epithelium?

A

They are the cells that account for different pigmentation in humans.

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16
Q

What can stimulate the melanocytes to produce more melanin?

A

Sunlight can result in this.

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17
Q

What are the Langerhans cells in our epithelium?

A

They act as an antigen presenting cells (aka dendritic cells) which have a major role in the immune response involving the epithelium

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18
Q

T or F Langerhans cells are dendritic cells?

A

True

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19
Q

T or F, Langerhans cells are phagocytic & part of MHC Class I molecules.

A

False, they are phagocytic but are part of the MHC Class II molecules.

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20
Q

What are the 3 oral mucosal division?

A

1.) The lining mucosa
2.) Masticatory mucosa
3.) Specialized mucosa

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21
Q

How can we characterize the lining mucosa?

A
  • For flexibility
  • for reduction of surface toughness
  • Non-keratinized

e.g: buccal mucosa
Floor of mouth

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22
Q

How can we characterize the masticatory mucosa?

A
  • For resistance to frictional forces
  • For well-keratinized
  • Minimal flexibility

e.g: Gingiva
hard palate

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23
Q

How can we characterize the specialized mucosa?

A
  • Complex surface allowing support of the taste buds.
  • Allows to maximize flexibility while still resisting masticatory forces.
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24
Q

What are neoplasms?

A

A single cell which may exhibit clonal growth. They can either benign or malignant. Where the cell has changed to grow/proliferate on its own & does NOT respond to stimuli normally anymore

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25
Q

What is defined as anaplasia?

A

When neoplastic cells are poorly differentiated that it is difficult or impossible to determine morphologically, the tissue of origin.

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26
Q

What is defined as benign?

A
  • Neoplasms in which cells do not metastasize
  • These neoplasms that can still cause local damage
  • Generally exhibit a good prognosis
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27
Q

What is defined as differentiation? `

A

In the topic of neoplasm, it is when the neoplastic cell can either have similarities to its parent cell or not.

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28
Q

When a neoplasm is “well differentiated” what that does imply?

A

That the neoplastic cell looks like the parent cell (generally better prognosis)

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29
Q

When a neoplasm is “poorly differentiated” what does that imply?

A

That the neoplasm cell does NOT resemble the parent cell (generally worse prognosis)

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30
Q

What is epithelial dysplasia?

A

It is the histologic alterations of the epithelial cells.
Correlates to the increased potential of malignancy.

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31
Q

What are the 3 degrees of dysplasia?

A

Mild
Moderate
Severe

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32
Q

Which of the 3 degrees of dysplasia has the best prognosis?

A

Mild

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33
Q

Which of the 3 degrees of dysplasia has the worst prognosis?

A

Severe

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34
Q

What does malignant mean?

A

This is a neoplasm with the potential for metastasis + generally more aggressive & associated with morbidity.

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35
Q

What is metastasis?

A

To detach neoplastic sites from original growth & migration to other sites.

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36
Q

What are examples of tumours that can be metstasize?

A
  • Lymphatic
  • Vasculature
  • Direct extension
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37
Q

What is commonly mestasizes via lymphatics?

A

Oral squamous cell carcinoma (OSCC). (which is why neck palpitation is a critical component

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38
Q

What is neoplasms?

A

They are considered as the “new grow” in neoplasms which does not respond normally to regular mechanisms.

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39
Q

What is oncology?

A

It is the study of neoplasms

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40
Q

What are the 4 models of carcinogenesis that influence genetic damage?

A

1.) Time
2.) External agents/spontaneous mutations
3.) The targeting of oncogenes
4.) Unrestrained clonal proliferation.

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41
Q

What is carcinogenesis?

A

The development of cancer due to damage to particular genes.

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42
Q

What are the two major types of genes in carcinogenesis?

A

1.) Tumour suppressor genes
2.) Oncogenes

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43
Q

What are tumour suppressor genes?

A

They are the genes that protect cells from cancerous change.

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44
Q

What occurs when tumour suppressor genes are destroyed by carcinogens + mutations?

A

The cells begin to proliferate & which can lead to cancer

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45
Q

How can changes in a tumor suppressor gene become evident?

A

When it undergoes mutations.

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46
Q

What are oncogenes?

A

They are genes that have the potential to cause cancerous changes.

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47
Q

What would occur if oncogenes are damaged + mutated?

A

Their expression can increase & may lead to cancer.

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48
Q

What is a carcinogen?

A

It is a cancer-causing agent which can cause genetic mutations & lead to the development of cancer.

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49
Q

What are some example of carcinogens?

A

1.) Tobacco smoke
2.) UV radiation
3.) Chemicals: arsenic, asbestos, benzene
4.) Viruses
5.) Alcohol

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50
Q

What is described as the nuclear hyperchromatism?

A

1.) Excessive nuclear staining
2.) Intensely dark appearance of the nucleus

51
Q

What is described within a nuclear + cellular pleomorphism?

A

Variable size of the cell & nucleus.

52
Q

What are histologic features of a malignant cells?

A

1.) Nuclear staining
2.) Size of cell + nucleus
3.) Ratio of the nucleus cytoplasm
4.) The increase + normality of the mitotic figures

53
Q

When grading a type of cancer, what kind of determination are we concluding? what does it represent?

A

It is a HISTOPATHOLOGIC determination, it represents the degree to which the cells are differentiated.
(essentially differentiating the levels of dysplasia of a cell through a microscope)

54
Q

When scaling a type of cancer, what would be the basis scale of measurement used to describe the cell?

A

A TNM scale would be used to make a clinical decision to describe how far a tumor has spread.

55
Q

What does TNM stand for when scaling a particular tumor?

A

Tumour, Nodes & Metastasis

56
Q

T or F, Staging is the most important level of measurement over grading cancer to determine the patient’s prognosis.

A

True, Staging is MORE important than grading.

57
Q

What is a neoplasm named according to ?

A

It is named according to its tissue of origin.

58
Q

What would be the indication of a benign tumour?

A

If it has a suffix “oma” attached to its name.
Prefix would indicate the tissue of origin.

e.g:
- Fibrous tissue = fibroma
- Bone = Osteoma
- Cartilage = chondroma

59
Q

What would be the indication of a malignant tumour?

A

if the tumour is grouped in to one of three main categories:
1.) epithelial = Carcinoma
2.) Mesenchymal = Sarcoma
3.) Hematopoetic = Lymphoma, leukemia

60
Q

What is an example of malignant tumour in the bone?

A

Osteosarcoma

61
Q

What is an example of a malignant tumour in the cartilage?

A

Chondrosarcoma

62
Q

What is an example of a malignant tumour in the fibrous tissue?

A

Fibrosarcoma

63
Q

What is an example of a malignant tumour in the fat?

A

Liposarcoma

64
Q

What is an example of a malignant tumour in the blood vessel?

A

Hemangiosarcoma

65
Q

What is an example of a malignant tumor in the muscles?

A

Rhabdomyosarcoma (skeletal)
Leiomyosarcoma (smooth muscle)

66
Q

What is an example of a malignant tumour in the lining of the epithelium?

A

Squamous cell carcinoma

67
Q

What is an example of a malignant tumor in the glandular epithelium?

A

Adenocarcinoma

68
Q

What is an example of a malignant tumor in the melanocytes?

A

Melanoma

69
Q

What are 90% of the causes of all oral cancers?

A

Squamous cell carcinoma

70
Q

What 3 factors would encourage oral cancers in individuals?

A

1.) Age: 95% in pts over 40 yrs old
2.) Gender: in Males (changed due to smoking habits)
3.) Site: on the lower lip, lateral & ventral tongue + floor of the mouth.

71
Q

What are the etiologies that may cause oral cancers?

A

1.) Multifactorial causes: extrinsic + intrinsic factors
2.) Multi-step process
3.) Tobacco smoking/chewing: smoking>smokeless tobacco + dose & duration dependent
4.) Alcohol abuse

other causes:
5.) Sunlight/UV exposure
6.) General malnutrition
7.) Immunodeficiency
8.) Lichen planus
9.) Iron-deficiency anemia: Plummer Vinson Syndrome
10.) HPV
11.) Oral submucous fibrosis

72
Q

What is Plummer Vinson syndrome? & who is it most prevalent to?

A

It is an oral cancer related to iron-deficiency (anemia). It is most prevalent to middle aged women.

73
Q

What are the symptoms of Plummer Vinson Syndrome?

A

1.) Dysphagia
2.) Esophageal webbing
3.) Iron deficiency anemia
4.) Increased risk of oral cancer
5.) Nail changes.

74
Q

HPV 16 & 18 are cancers associated to what region of the body?

A

The head & neck region.

*Now closely related with an oropharyngeal cancer, which is anatomically different than oral cancer

75
Q

What is an oral submucous fibrosis?

A

It is a stiffening of the oral mucosa due to the use of betel quid (increases risk of oral cancer)

76
Q

In what kind of individuals is oral submucous fibrosis typically seen in?

A

Primarily seen in East Indian populations.

77
Q

How is nicotine stomatitis described as?

A

Described as a thickened white appearance, with punctate red lesions on the palate

78
Q

How can nicotine stomatitis appear as an oral cancer?

A

Due to smoking: from the heat of smoking. (NOT considered malignant)

79
Q

How can nicotine stomatitis be treated?

A

With 1-3 months of smoking cessation.

80
Q

What are some limitations to an oral cancer examination?

A

The visualization of the oropharynx completely.

81
Q

What are the 3 questions we want to ask if we see a lesion?

A

1.) If the patient has been placing anything in their mouth
2.) If the patient attempted to treat the area
3.) If the area has been getting better or getting worse?

82
Q

What are some of the clinical presentations of oral cancer?

A

1.) Ulcerations
2.) Mass
3.) White or red/white plaque

83
Q

Clinical features of leukoplakia can be seen in what color of lesions/plaques?

A

White lesions/plaques

84
Q

Clinical features of erythroplakia can be seen in what color of lesions/plaques?

A

Red lesions/plaques

85
Q

What are examples of which oral cancers can appear in local metastasis?

A

Cervical lymph nodes

86
Q

What are examples of which oral cancers can appear in distant metastasis?

A

Lungs, liver, bones

87
Q

Can erythroplakia & leukoplakia represent as an oral cancer? why or why not?

A

Not necessarily as they are known as an oral potentially malignant disorders (PMDs)

  • Represent an elevated risk of oral cancer & as such are clinically important.
88
Q

How can an erythroplakia be described as?

A

A red mucosal patch that cannot be diagnosed as any other specific pathologic condition.

*biopsy is mandatory
* generally show malignancy or premalignant changes on biopsy: 90% will show dysplasia or cancer on biopsy

89
Q

What symptom is most directly related to an erythroplakia when discussing potential oral cancers?

A

The thinning of the red-coloured tissue due to the disordered epithelial maturation. (dysplasia + squamous cell carcinoma)

90
Q

How can a leukoplakia be described as?

A

A white mucosal patch cannot be diagnosed as any other specific pathologic condition.

*A biopsy must be performed to obtain definitive diagnosis

91
Q

What can a biopsy of a leukoplakia lesion tell us?

A

It can show us the variable histology ranging from squamous cell carcinoma (cancer) to hyper keratosis (a callus)

92
Q

What symptom is most directly related to a leukoplakia when discussing potential oral cancers?

A

The increased thickness of epithelium secondary to disordered epithelial maturation. (dysplasia + squamous cell carcinoma)

93
Q

What is proliferative verrucous leukoplakia?

A

It is a specific type of leukoplakia found in older women without the traditional risk factors of smoking or alcohol

*High risk of leukoplakia
*has the verrucous appearance
*poor prognosis

94
Q

What is the hallmark of oral squamous cell carcinoma?

A

The invasion of epithelium into underlying connective tissue.

95
Q

What would affect the prognosis of oral cancers? staging or grading?

A

Staging would affect the prognosis

96
Q

What are diagnostic adjuncts?

A

They are commercially available tools used by dental professionals to aid in the diagnosis of oral cancers & other intraoral pathologies.

97
Q

What are some examples of diagnostic adjuncts available for dental professionals?

A

1.) Autofluorescence (VELscope)
2.) Tissue reflectance (ViziLite)
3.) Vital staining (Toluidine blue)
4.) Cytologic testing (OralCDx)

98
Q

When would be an appropriate time to utilize a diagnostic adjuncts?

A

For patients with evident mucosal lesion, biopsy or referral to a specialist is indicated

99
Q

When would a biopsy be recommended?

A

When there is any positive or atypical result reinforcing the need for biopsy.

*Negative results would indicate requirement for follow-up.

100
Q

What are the 3 diagnostic adjuncts that are NOT recommended for the evaluation of potentially cancerous lesions?

A

1.) Autofluorescence
2.) Tissue reflectance
3.) Vital staining

101
Q

How is oral cancer generally treated by?

A

By surgery or radiation (or even both)

102
Q

What is typically the first option for oral cancer?

A

Performing a surgery

103
Q

What is typically used for treatments of oropharyngeal carcinomas?

A

Radiation + chemotherapy

104
Q

At what stage are oral cancers commonly diagnosed at?

A

Not until the advanced stage (>2cm)

105
Q

What does the TNM staging system include?

A

T- tumor size
N - involvement of lymph nodes
M - metastatic diseases

106
Q

What is the survival rate of a patient undergoing Stage 1-4 cancers?

A

1- 72%
2- 58%
3- 45%
4- 32%

107
Q

What is a papilloma?

A

It is a benign “cauliflower-like” proliferation of squamous epithelium.

*benign counterpart of squamous cell carcinoma

108
Q

What is the etiology a Papilloma?

A

From HPV infections (HPV 6 & HPV 11) are the most common.

109
Q

What kind of cancers are HPV 16 & HPV 18 correlated to?

A

Oropharyngeal cancers

110
Q

Where can we typically find the papilloma?

A

On the tongue, lip & soft palate

111
Q

What kind of appearance does a papilloma exhibit?

A
  • A verrucous appearance + classic papillary
112
Q

Is papilloma contagious?

A

No it is not, though it is transmissible.

113
Q

What are the treatments needed for a Papilloma?

A

1.) Surgical excision
* NO laser, as it can be in the laser plume

114
Q

What is a verruca vulgaris?

A

It is a virally induced epithelial lesion. It is most commonly known as a wart, typically found on the skin.

115
Q

Are verruca vulgaris’ contagious?

A

They are indeed very contagious.

116
Q

What is a condyloma acuminatum? what infection is it associated with?

A

It is a sexually transmitted infection associated with HPV 6, 11, 16 & 18

117
Q

What is a multifocal epithelial hyperplasia? In what population is this commonly seen in?

A

They are known as the virally induced proliferation of the epithelium. They are most commonly seen in indigenous/Inuit populations.

118
Q

What is the etiology of multifocal epithelial hyperplasia?

A

In HPV 13 & 32

119
Q

How do multifocal epithelial hyperplasias appear as? & where are they commonly seen?

A

They appear as clusters of lesions & most commonly seen on the labial + buccal gingiva

120
Q

What are the treatments performed for a multifocal epithelial hyperplasia?

A

1.) Spontaneous regression
2.) Surgical excision

121
Q

What are verruciform xanthomas?

A

They are focal papillary lesions of unknown origin. they are NOT related to HPV.

122
Q

Where are verruciform xanthomas commonly located in?

A

In the gingiva (most common area)

123
Q

What treatment is needed to cure verruciform xanthoma?

A

A surgical excision.

305 (12 decks)

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