2- oral medicine, malignancies & manifestation of systemic disease

Question 1

what is 2 most common types of oral cancer?

Answer 1

• squamous cell carcinoma = most common
• salivary gland = second most common

Question 2

what parts of oral area is characterised as mouth vs oropharynx?

Answer 2

mouth = tongue (anterior 2/3) - anything anterior to anterior 2/3 of tongue

oropharynx = tongue (bottom 1/3), soft palate

Question 3

what are areas of mouth where you get squamous cell carcinoma?

Answer 3

→you can get at any mucosal surface of mouth - most common areas at lateral ventral tongue at floor of mouth (lingogutter) = where saliva naturally pulls under forces of cavity at rest so any carcinogens lie there

Question 4

what is some epidemiology facts about squamous cell carcinoma? (probs not too important)

Answer 4

• less than 50% 5 year survival
• still increasing in last decade
• more prevalent in older age group
• association with social deprivation, obesity + poor diet

Question 5

what is tricky about screening and finding oral cancers?

Answer 5

often asymptomatic so people don’t know there’s a problem, also lack of education so don’t know whats normal vs not normal
- also high dentist anxiety

Question 6

what are some signs in oral cavity and when can be they be serious?

Answer 6

• white patches - if in unusual area or very big
• red patches - can be sinister
• lumps - can be normal as a result of rubbing etc but also can be pretty sinister
• ulcers - can be pretty normal and usually heal within first days/weeks - if longer than 3 weeks then might cause concern

Question 7

what causes oral cancer?

Answer 7

• Tobacco
• Alcohol
• HPV
• Poor nutrition
• Lower socioeconomic status
• UV light
• Immunocompromise
• Genetic – Fanconi’s anaemia, Blooms syndrome, dyskeratosis congenita
• Potentially malignant conditions – lichen planus

Question 8

how does alcohol cause oral cancer?

Answer 8

• Alcohol is metabolised to acetaldehyde a known mutagen and carcinogen
• Alcohol is metabolised in salivary glands, mucosa, oral bacteria hence exposure to Acetaldehyde
• 5 x risk
• Additive effect with smoking

Question 9

what type of cancer does HPV have big role in?

Answer 9

oropharyngeal cancers - in about 25% of mouth cancers

Question 10

what are signs of potentially malignant oral lesion or cancer look like?

Answer 10

• White patch
• Red patch
• Red/white speckled patch
• Ulcer
• Indurated margins
• Endophytic and exophytic lesions

Question 11

what are worrying features of cancer?

Answer 11

• Painless ulcers
• High risk sites – floor of mouth / lateral tongue
• Duration
• Size
• Bone involvement
• Spread to draining lymph nodes
• Perineural spread (infiltration along nerves pathways)
• Vascular invasion

Question 12

what should you do if find mouth cancer?

Answer 12

• photograph/document in notes
• ask dentist to eliminate trauma
• review within 2 weeks
• refer using urgent pathways

Question 13

what will happen to patient after referral?

Answer 13

• biopsy
• imaging
• diagnosis
• treatment - chemoradiotherapy etc
• follow up for 5 years