4. Dysplasia Flashcards by Abbie Mitchell

What are the two distinct disease patterns in oral cancer ?

Oro-pharyngeal (OPC).
Oral cavity (OCC).

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What gender is most affected by oral cancer ?

Males.

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Name some of the most common high risk sites for mouth cancer.

FoM.
Lateral border of tongue.
Tonsils.
Retromolar regions.
Hard and soft palate.
Gingivae.
Buccal mucosa.

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What is more common - OCC or OPC ?

OCC - 2.5 per 100,000pop.

OPC - 1.4 per 100,000pop.

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At how much greater risk are smokers who don’t drink from suffering OCC ?

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At how much greater risk are drinkers (3-4 drinks daily) from suffering OCC ?

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At how much greater risk are those who smoke and drink from suffering OCC ?

x5 (cumulative effect).

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At how much greater risk are those who use betel quid (paan) from suffering OCC ?

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What are the 4 main risk factors for OCC ?

Smoke.
Alcohol.
Betel quid (paan).
Socioeconomic status (even without other risk factors).

?? FH, oral health, sexual activity.

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What are the 4 main potentially malignant lesions ?

Leukoplakia.
Erythroplakia.
Lichen planus.
Oral submucous fibrosis.

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Define leukoplakia.

Undiagnosed white patch which cannot rub off or be related to any other disease.

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Define erythroplakia.

Red patch not associated with other disease.

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Erythroplakia vs. leukoplakia - what is more commonly associated with malignancy ?

Erythroplakia.
Erythema indicative of vascular change.

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What is the incidence of malignant change of white lesion ?

<4% (over the course of 20 years).

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How many times more likely is leukoplakia more likely to progress to cancer than clinically normal mucosa ?

50-100x

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What is more common - erythroplakia or leukoplakia ?

Leukoplakia.

What is the risk of a red lesion to become malignant ?

50%

What two components is dysplasia categorisation based off of ?

Cellular atypia.
Epithelial architectural organisation.

What are the 3 grades of dysplasia categorisation ?

High grade.
Low grade.
Carcinoma-in-situ.

What are the 8 factors for a oral mucosa dysplasia to be classified as low grade ?

Originates from squamous epithelium.
Architercural change in lower third.
Considerable amount of keratin production.
Evidence of stratification.
Well formed basal cell layer surrounding.
Well defined tumour islands often continuous with surface epithelium.
Invasion pattern with intact large branching rete pegs pushing into underlying CT.
Cytological changes may not be present.

What is the key deciding factor between high and low grade ?

Architectural change into middle third depending on level of cytological atypia.

What are the 5 characteristics of high grade oral mucosal dysplasia ?

Little resemblance to normal squamous epithelium.
Architectural change upper third.
Usually show considerable atypia.
Invade in non-cohesive pattern with fine cords, small islands and single cells infiltrating through CT.
Mitotic figures prominent.

Define carcinoma in situ.

Where pathologist strongly suspects carcinoma to be present but cannot demonstrate any evidence of invasion below basement membrane.

What are some of the characteristics of carcinoma in situ ?

Cytologically malignant (but not invading).
Abnormal architecture (full thickness).
Severe cytological atypia.
Mitotic abnormalities.

What are the four histological prognostic factors ?

Pattern of invasion. Depth of invasion. Perineural invasion. Invasion of vessels.

Define the field cancerisation concept.

Where cancer is found in the mouth, doesn't mean its the only part of the mouth subject to changes and stimuli which has lead to cancer i.e. same changes can be progressing in other locations in the mouth at different rates, therefore, risk of multiple primary cancers possible over time.

Field cancerisation - what radius of the original primary lesion carries high risk in mouth and pharynx ?

5cm radius surrounding primary lesion.

Define a metachronous lesion.

A second primary lesion identified six months after (or longer) the detection of the first cancer and located no more than 3 cm from the anastomosis.

Define synchronous lesions.

Dysplasia in multiple regions of the mouth at one time (secondary neoplasms which are lower grade than index tumours) occurring within six months of primary lesion.

What are the 3 variables for clinical staging of oral cancer ?

Site, size, spread.

Cure rate of stage 1 OC ?

80%

Cure rate of stage 2 OC ?

65%

Cure rate and survival rate of > stage 2 OC ?

<50% survival. <30% cure.

What are the 3 main tx options for oral cancer ?

Surgery (primary resection). Radiotherapy. Chemo/immunotherapy.

Name different forms of oral cancer screening.

HPV16 screening. Toluidene blue (50% false negatives). VELscope. Photogynamic diagnosis (PDD). Clinical judgement from experienced clinician - i.e. free routine dental examinations.

How quickly should a patient be seen for assessment by specialist if dentists suspects OC ?

Within 2 weeks for assessment.

How quickly should treatment be initiated in patient with OC ?

62 days from referral to treatment time.

What can a GDP do in oral cancer ?

Screening through routine examination. Smoking cessation. Alcohol cessation. Healthy diet promotion - high fruit and veg. Monitor low suspicion lesions with photographs. Remove local factors and review - ulcers. Refer when suspicion.