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23 Oral Diagnosis > 8 - Oral Cancer Prevention, Management, and Treatment > Flashcards

8 - Oral Cancer Prevention, Management, and Treatment Flashcards

1
Q

key of long term survival is what

A

early detection - do head and neck exams!

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2
Q

claims alleging ___ are among the most difficult to defend of all dental malpractice claims

A

failure to diagnose oral cancer

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3
Q

cancer screening is primarily the responsibility of who

A

general dentist

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4
Q

what percent of patients report that they have ever received an oral cancer screning

A

fewer than 15%

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5
Q

what dis

A

squamous cell carcinoma

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6
Q

what is the incidence of oral cancer in oral cavity and oropharynx and prevalence

A

2/3 oral cavity
1/3 oropharynx

90% squamous cell carcinomas

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7
Q

carcinomas that metastasize to oral region are usually found where? what are these usually?

A

usually in mandible. these are usually adenocarcinoma of the breast or lung

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8
Q

places where oral cancer is found

A

lateral and ventral surfaces of tongue is most common

lower lip is next

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9
Q

oroparyngeal cancer accounts for ___% of cancer in U.S., with ___% of cases are in adults over age 40

A

4%; 90%

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10
Q

what is the 5 year survival rate of oral cancer? what percent for Stage III or IV?

A

5 year survival rate 50% overall
30% Stage III or IV

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11
Q

who has the highest oral cancer mortality

A

black males - due to lack of access to ca

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12
Q

what is the prognosis of patients at the advanced stage of oral cancer

A

poor prognosis overall

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13
Q

what else can be diagnosed with up to 15% of patients diagnosed with oral cancer

A

a second cancer within the head and neck

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14
Q

prognosis depends on ___

A

stage

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15
Q

stage is based on ___

A

TNM

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16
Q

what is T1S

A

carcinoma in situ

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17
Q

what is T1

A

2 cm or less in diameter

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18
Q

what is T2

A

2-4 cm

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19
Q

what is T3

A

greater than 4 cm

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20
Q

what is TNM

A

tumor, nodes, metasasis

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21
Q

what is NO

A

no nodes

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22
Q

what is N3

A

large palpable nodes

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23
Q

what is MO

A

no metastasis

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24
Q

what is M1

A

clinical or radiographic metastaeses present

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25
Q

what is the 5 year survival rate for early?

A

Stage I and II = 75-85%

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26
Q

what causes this

A
  1. Tobacco use is the primary cause
    smoke or smokeless
  2. Alcohol: ¾ of all oral cancer are due to the combination of alcohol and tobacco
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26
Q

what is the 5 year survival rate for advanced

A

Stage III-IV: 35-45%

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27
Q

lesions like this need to be what?

A

Small, benign appearing
lesions like this need to be followed
up. If it’s not healed in 2 weeks you need to refer to an Oral Surgeon for evaluation.

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28
Q

what are other causes of oral cancers

A

*Chronic candidiasis
*Human papilloma virus
*Ultraviolet radiation
*AIDS
*Other immune
compromises:
*Chemotherapy/
Radiation; Immunosuppressive drugs
*Cultural: Betel Nut
chewing
*Chronic irritation: ill fitting
prostheses

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29
Q

Feature: TP53 mutations

what is the frequency of HPV-negative HNSCC and HPV-positive HNSCC

A

HPV-negative HNSCC: frequent
HPV-positive HNSCC: infrequent

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30
Q

what is the role of dentist in oral cancer

A
  1. education: identify at risk patients and suspicious lesions
  2. patient history: identify risk factors
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31
Q

what soft tissue changes do you look for in clinical examin

A

color: normal, red, white, mixed, pigemented

32
Q

do you ever biopsy a red lesion?

A

NO! because it’s blood and can be spread elsewhere

33
Q

do you ever bopsy this

A

no

34
Q

what this

A

White lesion=leukoplakia,
check to see if it wipes off
with gauze. If it does and
reveals an erythematous
base underneath, it could be
candidiasis or a
desquamative condition.

35
Q

what this

A

Mixed lesion, along
with central
ulceration

36
Q

whta this

A

Verrucous Hyperkeratosis

37
Q

what is the surface texture of verrucous hyperkeratosis

A

rough, ridgid, smooth, shiny

38
Q

what this?

A

exophytic lesion

39
Q

morphology of exophytic lesion

A

ulcerated, raised, exophytic

40
Q

are cancers painful early or late in disease course

A

LATER

41
Q

T/F: ulceration or desquamation that is large would ordinarily be painful. It not, it is extremely suspicious

A

TRUE

42
Q

what should you document when looking for oral cancers

A

Document any areas that
are not normal and include
descriptions and lesion
location and diameter.

43
Q

what this? what should you do

A

Any finding of tonsillar asymmetry should be referred for evaluation of HPV mediated squamous cell carcinoma

44
Q

38 year-old female, painful lesion, no nodes,
adjacent to broken down #18, 2X3 cm. Patient is taking immunosuppresssive drugs. If you see this in your practice are
you going to refer the patient for an incisional biopsy?

A

Don’t biopsy right away. Restore #18. If it heals up, it’s okay - wouldn’t be painful if it was cancer

45
Q

document palpable nodes which are ___ or ___

A

fixed or freely moveable

46
Q

what are these locations

A

location of submandibular and cervical nodes

47
Q
A

Asymmetry in salivary or thyroid glands from one side to the other. This includes
differences in size, shape, and consistency.

48
Q

thyroid cancer affects men or women more

A

women 3x more than men

49
Q

what are hard tissue changes to look for

A
  1. radiographic changes in trabeculation pattern
  2. boney expansion
  3. inferior alveolar nerve parasthesia or anesthesia without recent history of injection trauma
  4. prostheses that fit too tight
50
Q

where to look for in skin lesions

A

observe skin of head and neck for suspicious lesions (squamous and basal cell carcinomas are the must numerous cancer lesions Dr. Carney has observed)

51
Q

prevention strategies

A
  1. barrier protection
  2. smoking cessation
  3. alcohol abatement
52
Q

ways to quick smoking

A
  1. counseling programs
  2. nicotone replacement
  3. Zyban, chantix
  4. e-cigs
  5. hypnosis
53
Q

what is used for early detection of oral cancer

A
  1. orascan, orascreen, oratest: 1% toluidine blue
54
Q

what is a blue stain on tissue after applciation to area indicates increased mitotic activity

A

Orascan, Orascreen,
Oratest: 1% toluidine blue

55
Q

false positive are common due to inflammation, irritation or ulceration using what

A

Orascan, Orascreen,
Oratest: 1% toluidine blue

56
Q

what helps identify an area for biopsy

A
  1. Orascan, Orascreen, Oratest: 1% toluidine blue
  2. Vizilite
  3. Velscope
  4. Oral CDx
  5. Surgical biopsy
57
Q

what was denied ADA Seal of Acceptance in 2004

A

vizilite

58
Q

what utilizes visible blue LED light to cause
natural tissue fluorescence, enhancing visualization of oral cancers and pre- malignant dysplasias

A

VELscope

59
Q

disadvantages of Velscope

A

Disadvantages are
false positives
requiring biopsy and
need to use in
darkened
environment

60
Q

what is a brush that identifies abnormal cells by computer optical scan and if positive results, reviewed by a pathologist

A

oral CDX

61
Q

are negative results common in oral CDx

A

*Negative results are
frequent, commonly due
to inflammation causing
the suspicious lesion

62
Q

any lesion that does not resolve in how many weeks should be considered for biopsy

A

2 weeks

63
Q

what are several etiologies that can cause a lesion

A

cancer, trauma, burn, herpetic

64
Q

what is necessry for confirming diagnosis

A

surgical biopsy

65
Q

what removes entire lesion(lesions less than 1 cm in diatmer)

A

excisional biospy

66
Q

what biopsy has a small part of larger lesion removed for histologic examination

A

incisional biopsy

67
Q

what biopsy used for large surface area lesions

A

punch surgical biopsy

68
Q

where do you refer for biopsy and treatment

A
  1. oral lesions- oral surgeon
  2. skin - dermatologist
  3. pahryngeal - ENT
69
Q

what are the types of cancer therapies

A
  1. surgical excision
  2. chemotherapy
  3. radiation therapy
70
Q

what is the most effective cancer therapy

A

surgical excision

71
Q

what cancer therapy has high moribidity and disfiguration

A

surgical exicison

72
Q

what cancer therapy is more effective for metastatic disease

A

chemo

73
Q

T/F: No invasive dental treatment unless
neutrophils at least 1000/cubic mm, and platelets at least 20,000/cubic mm. MD consult and bloodwork before invasive treatment

A

TRUE

74
Q

what is a common side effect of chemotherapy

A

mucositis

75
Q

how are mucositis ulcerations treated

A

50/50 solution of viscous lidocaine and kaopectate

76
Q

Cancer of the nasopharynx, base of the tongue, tonsils, or soft palate are best treated with ___. why?

A

Radiation/chemotherapy or a combination of both

due to access issues or morbidity from
surgery

77
Q

Cancers of the alveolar ridge or salivary glands are best treated ___. why?

A

surgically

due to the risk of
cancer infiltration into bone, possibly in
combination with radiation therapy

78
Q

CONTINUE SLIDE 46

A

23 Oral Diagnosis (13 decks)

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