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5th OD - Oral Cancer > Cancer and Precancer > Flashcards

Cancer and Precancer Flashcards

1
Q

What is H&N cancer?

A

Any cancer above clavicle not including the brain

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2
Q

Most common H&N cancer?

A

Squamous cell carcinoma (lining)

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3
Q

Trend in H&N cancer?

A

Rising incidence - both men and women

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4
Q

Classic pt who has oral cancer?

A

Older males - are starting to see in younger pt

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5
Q

Issue w/ oral cancer?

A

Pt present late - late stage disease/ metastasis

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6
Q

Aetiology of oral cancer?

A

No single factor - genetic predisposition and environmental

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7
Q

What is an inherited factor linked to increase individual susceptibility?

A

Polymorphism of gene - alteration DNA structure

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8
Q

Give examples of inherited syndromes which can increase risk of oral cancer?

A

Li-Fraumeni
Faconi anaemia
Xeroderma pigmentosum

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9
Q

RFs of oral cancer?

A 
Tobacco 
Alcohol
Sunlight
Infection - virus/ fungi/ bacteira 
Obesity
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10
Q

What different types of tobacco products increase risk oral cancer?

A

Smoking and smokeless

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11
Q

Examples of smokeless tobacco products?

A

Betel nut/ snuff/ chewing tobacco

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12
Q

Relationship of cacner and tobacco?

A

Both smoking/smokeless tobacco have definitive relationship w/ risk greater in heavy user and when accompanied by alcohol use

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13
Q

Why is alcohol RF?

A

Ethanol can act as solvent for other substance

Risk greatest when accompanied by tobacco use

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14
Q

Why is sunlight a RF for cancer?

A

UV cause of skin cancer - BCC/SCC/melanoma

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15
Q

How does UV cause cancer?

A

UV causes solar keratosis and dysplasia of the skin

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16
Q

What virus is heavily linked to oral cancer?

A

HPV - role orophaynx cancer

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17
Q

Types HPV oncogenic?

A

16 and 18 - oropharyngeal/ cervical cancer

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18
Q

When see HPV related oropharyngeal SCC?

A

Often younger pt w/ less traditional RF

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19
Q

What is the relationship of candida and oral cancer?

A

Candida has association

Candida can be seen in pre-malignant lesions - CHC

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20
Q

What tumour suppressor genes are improtant?

A

In oral cancer mutation p53 - inactivation

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21
Q

Stages of cancer devleopment?

A

Keratosis
Dysplasia - mild/mod/severe
Carcinoma-in-situ
Carcinoma

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22
Q

What is field change?

A

Large areas of cells are affected by carcinogenic alterations

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23
Q

What can see as result of field cahnge?

A

Subsequent tumour development in field of abnormal mucosa

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24
Q

What is premaliginant lesion?

A

Morphologically altered tissue in which cancer is more likely to occur in

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25
Q

What is leukoplakia?

A

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

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26
Q

How does homogenous leukoplakia present?

A

Uniform white, flat and plaque like lesion

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27
Q

How does homogenous leukoplakia present on histology?

A

Thick layer of keratin

Often no evidence dysplasia

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28
Q

What is non-homogenous leukoplakia?

A

Variation in colour/texture

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29
Q

What expect to see on histology of non-homogenous leukoplakia?

A

May see dysplasia

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30
Q

Issue w/ leukoplakia?

A

5% chance malignant change 5 years

Depends on severity dysplasia

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31
Q

Is malignant risk different w/ homogenous and non-homogenous lesions?

A

Non-homogenous greater risk

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32
Q

What features are more indicative of having malignant potential?

A

High risk sites
Variation colour and texture - non-homogenous
Presence of candida
Degree dysplasia

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33
Q

What are high risk oral cancer sites?

A

Floor mouth - ventral tongue
Lateral border tongue
Retromolar
Soft palate

34
Q

What is erythroplakia?

A

A red patch that can’t be clinically or histologically described as any other condition

35
Q

What are clinical variation of erythroplakia?

A

Erosive/ speckles lesion

36
Q

What often seen in histology of erythroplakia?

A

Severe dysplasia/ CIS

37
Q

What must consider if see erythroplakia?

A

Often early sign SCC

38
Q

What has greater malignant potential leukoplakia/ erythroplakia?

A

Erythroplakia

39
Q

What does epithelial dysplasia mean?

A

Aytical features

Can be graded as mild/moderate or severe

40
Q

Issue w/ grading dysplasia

A

Subjective

41
Q

What is severe dysplasia often referred to as?

A

Carcinoma in situ

42
Q

Has categories features of dysplasia?

A

Architectural and cytological

43
Q

Examples architectural atypia?

A

Irregular epithelial stratification
Loss basal cell polarity
Drop-shaped rete pegs

44
Q

Examples cytological feature atypia?

A

Increased no mitotic figures
Cellular and nuclear pleomorphism
Nuclear hyperchromatism
Individual cell keratinisation

45
Q

What see in mild dysplasia?

A

Changes in lower third - basal layer

Mild architectural changes

46
Q

What see in moderate dysplasia?

A

Changes into middle third

47
Q

What see is severe dysplasia?

A

Changes into upper third

48
Q

What is carcinoma in situ?

A

Malignant features present but non invasive

49
Q

What are different fates of dysplastic leasions?

A

Progress malignant
Regress
No change
Increase in size

50
Q

Examples of premalignant oral disorders

A

Chronic hyperplastic candidosis
Actinic keratosis
Oral submucous fibrosis
Lichen planus

51
Q

How does CHC present?

A

Non-homogenous red/white lesion affect lat border tongue/ commisure of mouth

52
Q

What see histology of CHC?

A

Keratinised surface
Hyphae candida
Hyperplastic epithelium
Dense inflammatory infiltrate

53
Q

What is actinic keratosis?

A

UV damage to skin and lips

54
Q

What see in actinic keratosis?

A

Red atrophic - crusting lesions

55
Q

What is oral submucous fibrosis associated with?

A

Areca nut use

56
Q

How does OSMF present?

A

Generalise whitening of tissue around tonsilar pillars

Oral tissue become stiff = trismus

57
Q

Malignant potential lichen planus?

A

1-3%

Higher change if lichen planus on high risk site combined w/ RFs e.g smoking

58
Q

Examples of screening tools used for oral cancer?

A

Mucosal stains
Imaging systems
Brush biopsies
DNA image cytometry

59
Q

What is used for mucosal stains?

A

Toluidine blue - stains nucleic acid = increased DNA contenet

60
Q

What does imaging systems used?

A

Fluorsent light

61
Q

What is a bush biopsy?

A

Technique collect sample of lesion

62
Q

Issue w/ brush biopsy

A

Can be traumatic - want to see basal layer cells

Don’t get relationship of cells to each other

63
Q

What symptoms may pt present with if malignant lesion?

A 
None
Soreness/ irritation
Paraestheisa
Disruption of function
Dysphagia
64
Q

What to do if pt has symptoms of malignancy?

A

If pt has symptom for 3 weeks + needed assessment

65
Q

Signs of malignancy?

A 
Persistant ulceration
White/red/mixed patch
Fixation of tissue
Indurated lesion
Unexplained tooth movement/ mobility 
Lymph node enlargement
66
Q

Why is tongue high risk site for oral cancer?

A

Due to oreintation of muscle fibres

67
Q

What might see if lymph node metastasis?

A

Painless enlargement
Rock hard mass
Fixed underlying tissue

68
Q

Incidence of lymph node involvement in oral cancer?

A

47%

69
Q

What site in oral cancer has highest invovlement of lymph node involvmeent

A

Ventral tongue > oralpharygneal > lateral tongue > retromolar > floor mouth

70
Q

What is late event of cancer?

A

Hameatological spread

71
Q

Gives examples of types oral cancer?

A

Squamous cell carcinoma
Verrucous carcinoma
Spindle cell

72
Q

What is verrucous carcinoma?

A

Low grade cancer which rarely metastasises

73
Q

How does verrucous carcinoma present?

A

Exophytic surface

74
Q

What can be assessed w/ biopsy that gives indication of prognosis?

A

Differentiation of lesion

75
Q

How are differentiation of lesions clasified?

A

Well differentiated
Moderately differentiated
Poorly differentiated

76
Q

What see in well defined lesions?

A

Cells resemble origin

Well organised epithelium

77
Q

What see in mod defined lesion?

A

Cell resemble origin

Less organisation

78
Q

What see poorly diff lesions?

A

May not resemble cells of origin

Cytologically abnormal

79
Q

How is spread of oral cancer graded?

A

TNM
T = local extension of disease
N = node invovlement
M = distant metastaiss

80
Q

What is assessed in local extension of disease?

A

Overall tumour size
Depth invasion
Invasion - muscle/ nerves/ blood vessel/ bone

81
Q

What types of tumours in peri-neural invasion common in?

A

Salivary gland tumours

5th OD - Oral Cancer (7 decks)

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