8 Malignant Epithelial Lesions Flashcards
- high-risk premalignant condition
- chronic, progressive, scarring
oral submucous fibrosis
prevalent in India, Southeast Asia, Taiwan, China, Papua New Guinea, results from habitual use of betel quid (betel quid/betel “nut” or paan
oral submucous fibrosis
Contents of betel quid:
A) betel leaf from piper betel pepper plant
B) slacked lime (calcium hydroxide) stimulates release of alkaloids from areca nut to produce feeling of euphoria and well-being
C) areca nut from the areca palm tree
D) tobacco
E) sweeteners and condiments
Signs and symptoms:
- brown/red colored mucosa with rigidity
- irregular surface tends to desquamate
- may be painful when eating spicy foods
- submucosal fibrous bands (buccal mucosa, soft palate, labial mucosa, may extend beyond oral cavity to oropharynx and upper esophagus)
- leukoplakia of the surface mucosa
- development of SCC (high risk)
- does not regress with habit cessation
oral submucous fibrosis
tx for oral submucous fibrosis
- monitor for premalignant/malignant change
- mild cases = intralesional corticosteroids to attempt to reduce the scarring/fibrous bands
- later stages = surgical splitting or excision of the fibrous bands may improve mouth opening and mobility
Head and neck cancer is the ____th most common type of cancer. Men? Women?
7th
5th
12th
Percentage of new cases of cancers that are oral and pharynx?
How many of these die?
Percentage of patients that live 5 years?
Median age at dx
Median age at death
3%
2%
67%
64/68
lowest % of dx but highest % of death from oral and pharyngeal cancers
black males
cancer staging
Stage 1: primary tumor < 2 cm, no nodal metastasis
Stage 2: primary tumor >2 but < 4 cm
Stage 3: metastasis to regional lymph node, primary tumor > 4 cm
Stage 4: distant metastasis
What percentage of cases or cancer are diagnosed at stages III or IV?
65-70%
About ___% of cancers in the oral cavity are SCC.
SCC is the ____th most common type of cancer in the world.
90%
11th
SCC is seen most often in men who…
have been aware of an alteration in an oral cancer site for 4-8 months.
men:women for SCC
2.5:1
types of genes affected that cause SCC
- oncogenes, proto-oncogenes
- tumor suppressor genes
- replication error repair genes
Head and neck cancers in NONSMOKERS are more likely to be?
- female
- oral (especially tongue)
- younger
- demonstrate mutations of the p53 and other tumor suppressor genes
extrinsic vs intrinsic risk factors for oral and oropharyngeal SCC
Extrinsic
- smoked tobacco
- smokeless tobacco
- alcohol
- betel quid
- HPV (oropharynx primarily)
- sunlight (lip and skin lesions only)
- radiation therapy
Intrinsic
- age
- reduced cellular immunity
- immunodeficiency
- general malnutrition
- severe irone deficiency
risk vs relative risk of tobacco smoking
Risk is dose and time dependent
Relative risk is dose dependent for cigarette smokers
- 5x greater = smoke 40 cigs
- 17x greater = smoke 80 or more cigs daily
- 10-100x in people who drink and smoke
*Risk increases as # of years smoking increases (packs/day x # of years)
Most likely to be smokers:
- men ages 25-44
- non-Hispanic Indians/Alaksa natives and people of multiple races
- disability/limitation
- US midwest
- persons living below the poverty level
- those with a GED
of carcinogens in tobacco smoke
70+
% of patients with head and neck cancers who are smokers
65-86%
major risk factor for ocal cavity SCC
smoking with a synergistic association with alcohol consumption
When it comes to alcohol, is dose or time put you at a greater risk for pharyngeal/oral cancer?
of years heavy drinking is more important (not the # of drinks/day)
Effects of alcohol (local vs systemic):
Local
- solvent action increases the permeability of oral mucosa to carcinogens in tobacco smoke
- contaminates in the alcohol
- alters epithelial metabolism
- ethanol by oral flora to acetaldehyde (known carcinogen)
Systemic
- nutritional deficiencies
- decreases liver’s ability to detoxify carcinogens
% of oral cavity proper SCC are HPV associated
2.2% (HPV 16 is highly prevalent –> 90%)
