Cancer and Precancer Flashcards
What is H&N cancer?
Any cancer above clavicle not including the brain
Most common H&N cancer?
Squamous cell carcinoma (lining)
Trend in H&N cancer?
Rising incidence - both men and women
Classic pt who has oral cancer?
Older males - are starting to see in younger pt
Issue w/ oral cancer?
Pt present late - late stage disease/ metastasis
Aetiology of oral cancer?
No single factor - genetic predisposition and environmental
What is an inherited factor linked to increase individual susceptibility?
Polymorphism of gene - alteration DNA structure
Give examples of inherited syndromes which can increase risk of oral cancer?
Li-Fraumeni
Faconi anaemia
Xeroderma pigmentosum
RFs of oral cancer?
Tobacco Alcohol Sunlight Infection - virus/ fungi/ bacteira Obesity
What different types of tobacco products increase risk oral cancer?
Smoking and smokeless
Examples of smokeless tobacco products?
Betel nut/ snuff/ chewing tobacco
Relationship of cacner and tobacco?
Both smoking/smokeless tobacco have definitive relationship w/ risk greater in heavy user and when accompanied by alcohol use
Why is alcohol RF?
Ethanol can act as solvent for other substance
Risk greatest when accompanied by tobacco use
Why is sunlight a RF for cancer?
UV cause of skin cancer - BCC/SCC/melanoma
How does UV cause cancer?
UV causes solar keratosis and dysplasia of the skin
What virus is heavily linked to oral cancer?
HPV - role orophaynx cancer
Types HPV oncogenic?
16 and 18 - oropharyngeal/ cervical cancer
When see HPV related oropharyngeal SCC?
Often younger pt w/ less traditional RF
What is the relationship of candida and oral cancer?
Candida has association
Candida can be seen in pre-malignant lesions - CHC
What tumour suppressor genes are improtant?
In oral cancer mutation p53 - inactivation
Stages of cancer devleopment?
Keratosis
Dysplasia - mild/mod/severe
Carcinoma-in-situ
Carcinoma
What is field change?
Large areas of cells are affected by carcinogenic alterations
What can see as result of field cahnge?
Subsequent tumour development in field of abnormal mucosa
What is premaliginant lesion?
Morphologically altered tissue in which cancer is more likely to occur in
What is leukoplakia?
White patch that can’t be rubbed off and can’t be characterised clinically/histologically as any other disease and isn’t associated w/ physical or chemical cause excpet use of tobacco
How does homogenous leukoplakia present?
Uniform white, flat and plaque like lesion
How does homogenous leukoplakia present on histology?
Thick layer of keratin
Often no evidence dysplasia
What is non-homogenous leukoplakia?
Variation in colour/texture
What expect to see on histology of non-homogenous leukoplakia?
May see dysplasia
Issue w/ leukoplakia?
5% chance malignant change 5 years
Depends on severity dysplasia
Is malignant risk different w/ homogenous and non-homogenous lesions?
Non-homogenous greater risk
What features are more indicative of having malignant potential?
High risk sites
Variation colour and texture - non-homogenous
Presence of candida
Degree dysplasia
What are high risk oral cancer sites?
Floor mouth - ventral tongue
Lateral border tongue
Retromolar
Soft palate
What is erythroplakia?
A red patch that can’t be clinically or histologically described as any other condition
What are clinical variation of erythroplakia?
Erosive/ speckles lesion
What often seen in histology of erythroplakia?
Severe dysplasia/ CIS
What must consider if see erythroplakia?
Often early sign SCC
What has greater malignant potential leukoplakia/ erythroplakia?
Erythroplakia
What does epithelial dysplasia mean?
Aytical features
Can be graded as mild/moderate or severe
Issue w/ grading dysplasia
Subjective
What is severe dysplasia often referred to as?
Carcinoma in situ
Has categories features of dysplasia?
Architectural and cytological
Examples architectural atypia?
Irregular epithelial stratification
Loss basal cell polarity
Drop-shaped rete pegs
Examples cytological feature atypia?
Increased no mitotic figures
Cellular and nuclear pleomorphism
Nuclear hyperchromatism
Individual cell keratinisation
What see in mild dysplasia?
Changes in lower third - basal layer
Mild architectural changes
What see in moderate dysplasia?
Changes into middle third
What see is severe dysplasia?
Changes into upper third
What is carcinoma in situ?
Malignant features present but non invasive
What are different fates of dysplastic leasions?
Progress malignant
Regress
No change
Increase in size
Examples of premalignant oral disorders
Chronic hyperplastic candidosis
Actinic keratosis
Oral submucous fibrosis
Lichen planus
How does CHC present?
Non-homogenous red/white lesion affect lat border tongue/ commisure of mouth
What see histology of CHC?
Keratinised surface
Hyphae candida
Hyperplastic epithelium
Dense inflammatory infiltrate
What is actinic keratosis?
UV damage to skin and lips
What see in actinic keratosis?
Red atrophic - crusting lesions
What is oral submucous fibrosis associated with?
Areca nut use
How does OSMF present?
Generalise whitening of tissue around tonsilar pillars
Oral tissue become stiff = trismus
Malignant potential lichen planus?
1-3%
Higher change if lichen planus on high risk site combined w/ RFs e.g smoking
Examples of screening tools used for oral cancer?
Mucosal stains
Imaging systems
Brush biopsies
DNA image cytometry
What is used for mucosal stains?
Toluidine blue - stains nucleic acid = increased DNA contenet
What does imaging systems used?
Fluorsent light
What is a bush biopsy?
Technique collect sample of lesion
Issue w/ brush biopsy
Can be traumatic - want to see basal layer cells
Don’t get relationship of cells to each other
What symptoms may pt present with if malignant lesion?
None Soreness/ irritation Paraestheisa Disruption of function Dysphagia
What to do if pt has symptoms of malignancy?
If pt has symptom for 3 weeks + needed assessment
Signs of malignancy?
Persistant ulceration White/red/mixed patch Fixation of tissue Indurated lesion Unexplained tooth movement/ mobility Lymph node enlargement
Why is tongue high risk site for oral cancer?
Due to oreintation of muscle fibres
What might see if lymph node metastasis?
Painless enlargement
Rock hard mass
Fixed underlying tissue
Incidence of lymph node involvement in oral cancer?
47%
What site in oral cancer has highest invovlement of lymph node involvmeent
Ventral tongue > oralpharygneal > lateral tongue > retromolar > floor mouth
What is late event of cancer?
Hameatological spread
Gives examples of types oral cancer?
Squamous cell carcinoma
Verrucous carcinoma
Spindle cell
What is verrucous carcinoma?
Low grade cancer which rarely metastasises
How does verrucous carcinoma present?
Exophytic surface
What can be assessed w/ biopsy that gives indication of prognosis?
Differentiation of lesion
How are differentiation of lesions clasified?
Well differentiated
Moderately differentiated
Poorly differentiated
What see in well defined lesions?
Cells resemble origin
Well organised epithelium
What see in mod defined lesion?
Cell resemble origin
Less organisation
What see poorly diff lesions?
May not resemble cells of origin
Cytologically abnormal
How is spread of oral cancer graded?
TNM
T = local extension of disease
N = node invovlement
M = distant metastaiss
What is assessed in local extension of disease?
Overall tumour size
Depth invasion
Invasion - muscle/ nerves/ blood vessel/ bone
What types of tumours in peri-neural invasion common in?
Salivary gland tumours
