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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
what is the 5 year survival rate for early?
Stage I and II = 75-85%
26
what causes this
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
26
what is the 5 year survival rate for advanced
Stage III-IV: 35-45%
27
lesions like this need to be what?
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.
28
what are other causes of oral cancers
*Chronic candidiasis *Human papilloma virus *Ultraviolet radiation *AIDS *Other immune compromises: *Chemotherapy/ Radiation; Immunosuppressive drugs *Cultural: Betel Nut chewing *Chronic irritation: ill fitting prostheses
29
Feature: TP53 mutations what is the frequency of HPV-negative HNSCC and HPV-positive HNSCC
HPV-negative HNSCC: frequent HPV-positive HNSCC: infrequent
30
what is the role of dentist in oral cancer
1. education: identify at risk patients and suspicious lesions 2. patient history: identify risk factors
31
what soft tissue changes do you look for in clinical examin
color: normal, red, white, mixed, pigemented
32
do you ever biopsy a red lesion?
NO! because it's blood and can be spread elsewhere
33
do you ever bopsy this
no
34
what this
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
what this
Mixed lesion, along with central ulceration
36
whta this
Verrucous Hyperkeratosis
37
what is the surface texture of verrucous hyperkeratosis
rough, ridgid, smooth, shiny
38
what this?
exophytic lesion
39
morphology of exophytic lesion
ulcerated, raised, exophytic
40
are cancers painful early or late in disease course
LATER
41
T/F: ulceration or desquamation that is large would ordinarily be painful. It not, it is extremely suspicious
TRUE
42
what should you document when looking for oral cancers
Document any areas that are not normal and include descriptions and lesion location and diameter.
43
what this? what should you do
Any finding of tonsillar asymmetry should be referred for evaluation of HPV mediated squamous cell carcinoma
44
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?
Don't biopsy right away. Restore #18. If it heals up, it's okay - wouldn't be painful if it was cancer
45
document palpable nodes which are ___ or ___
fixed or freely moveable
46
what are these locations
location of submandibular and cervical nodes
47
Asymmetry in salivary or thyroid glands from one side to the other. This includes differences in size, shape, and consistency.
48
thyroid cancer affects men or women more
women 3x more than men
49
what are hard tissue changes to look for
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
where to look for in skin lesions
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
prevention strategies
1. barrier protection 2. smoking cessation 3. alcohol abatement
52
ways to quick smoking
1. counseling programs 2. nicotone replacement 3. Zyban, chantix 4. e-cigs 5. hypnosis
53
what is used for early detection of oral cancer
1. orascan, orascreen, oratest: 1% toluidine blue
54
what is a blue stain on tissue after applciation to area indicates increased mitotic activity
Orascan, Orascreen, Oratest: 1% toluidine blue
55
false positive are common due to inflammation, irritation or ulceration using what
Orascan, Orascreen, Oratest: 1% toluidine blue
56
what helps identify an area for biopsy
1. Orascan, Orascreen, Oratest: 1% toluidine blue 2. Vizilite 3. Velscope 4. Oral CDx 5. Surgical biopsy
57
what was denied ADA Seal of Acceptance in 2004
vizilite
58
what utilizes visible blue LED light to cause natural tissue fluorescence, enhancing visualization of oral cancers and pre- malignant dysplasias
VELscope
59
disadvantages of Velscope
Disadvantages are false positives requiring biopsy and need to use in darkened environment
60
what is a brush that identifies abnormal cells by computer optical scan and if positive results, reviewed by a pathologist
oral CDX
61
are negative results common in oral CDx
*Negative results are frequent, commonly due to inflammation causing the suspicious lesion
62
any lesion that does not resolve in how many weeks should be considered for biopsy
2 weeks
63
what are several etiologies that can cause a lesion
cancer, trauma, burn, herpetic
64
what is necessry for confirming diagnosis
surgical biopsy
65
what removes entire lesion(lesions less than 1 cm in diatmer)
excisional biospy
66
what biopsy has a small part of larger lesion removed for histologic examination
incisional biopsy
67
what biopsy used for large surface area lesions
punch surgical biopsy
68
where do you refer for biopsy and treatment
1. oral lesions- oral surgeon 2. skin - dermatologist 3. pahryngeal - ENT
69
what are the types of cancer therapies
1. surgical excision 2. chemotherapy 3. radiation therapy
70
what is the most effective cancer therapy
surgical excision
71
what cancer therapy has high moribidity and disfiguration
surgical exicison
72
what cancer therapy is more effective for metastatic disease
chemo
73
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
TRUE
74
what is a common side effect of chemotherapy
mucositis
75
how are mucositis ulcerations treated
50/50 solution of viscous lidocaine and kaopectate
76
Cancer of the nasopharynx, base of the tongue, tonsils, or soft palate are best treated with ___. why?
Radiation/chemotherapy or a combination of both due to access issues or morbidity from surgery
77
Cancers of the alveolar ridge or salivary glands are best treated ___. why?
surgically due to the risk of cancer infiltration into bone, possibly in combination with radiation therapy
78
CONTINUE SLIDE 46

23 Oral Diagnosis (13 decks)

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