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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
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
26
How does homogenous leukoplakia present?
Uniform white, flat and plaque like lesion
27
How does homogenous leukoplakia present on histology?
Thick layer of keratin | Often no evidence dysplasia
28
What is non-homogenous leukoplakia?
Variation in colour/texture
29
What expect to see on histology of non-homogenous leukoplakia?
May see dysplasia
30
Issue w/ leukoplakia?
5% chance malignant change 5 years | Depends on severity dysplasia
31
Is malignant risk different w/ homogenous and non-homogenous lesions?
Non-homogenous greater risk
32
What features are more indicative of having malignant potential?
High risk sites Variation colour and texture - non-homogenous Presence of candida Degree dysplasia
33
What are high risk oral cancer sites?
Floor mouth - ventral tongue Lateral border tongue Retromolar Soft palate
34
What is erythroplakia?
A red patch that can't be clinically or histologically described as any other condition
35
What are clinical variation of erythroplakia?
Erosive/ speckles lesion
36
What often seen in histology of erythroplakia?
Severe dysplasia/ CIS
37
What must consider if see erythroplakia?
Often early sign SCC
38
What has greater malignant potential leukoplakia/ erythroplakia?
Erythroplakia
39
What does epithelial dysplasia mean?
Aytical features | Can be graded as mild/moderate or severe
40
Issue w/ grading dysplasia
Subjective
41
What is severe dysplasia often referred to as?
Carcinoma in situ
42
Has categories features of dysplasia?
Architectural and cytological
43
Examples architectural atypia?
Irregular epithelial stratification Loss basal cell polarity Drop-shaped rete pegs
44
Examples cytological feature atypia?
Increased no mitotic figures Cellular and nuclear pleomorphism Nuclear hyperchromatism Individual cell keratinisation
45
What see in mild dysplasia?
Changes in lower third - basal layer | Mild architectural changes
46
What see in moderate dysplasia?
Changes into middle third
47
What see is severe dysplasia?
Changes into upper third
48
What is carcinoma in situ?
Malignant features present but non invasive
49
What are different fates of dysplastic leasions?
Progress malignant Regress No change Increase in size
50
Examples of premalignant oral disorders
Chronic hyperplastic candidosis Actinic keratosis Oral submucous fibrosis Lichen planus
51
How does CHC present?
Non-homogenous red/white lesion affect lat border tongue/ commisure of mouth
52
What see histology of CHC?
Keratinised surface Hyphae candida Hyperplastic epithelium Dense inflammatory infiltrate
53
What is actinic keratosis?
UV damage to skin and lips
54
What see in actinic keratosis?
Red atrophic - crusting lesions
55
What is oral submucous fibrosis associated with?
Areca nut use
56
How does OSMF present?
Generalise whitening of tissue around tonsilar pillars | Oral tissue become stiff = trismus
57
Malignant potential lichen planus?
1-3% | Higher change if lichen planus on high risk site combined w/ RFs e.g smoking
58
Examples of screening tools used for oral cancer?
Mucosal stains Imaging systems Brush biopsies DNA image cytometry
59
What is used for mucosal stains?
Toluidine blue - stains nucleic acid = increased DNA contenet
60
What does imaging systems used?
Fluorsent light
61
What is a bush biopsy?
Technique collect sample of lesion
62
Issue w/ brush biopsy
Can be traumatic - want to see basal layer cells | Don't get relationship of cells to each other
63
What symptoms may pt present with if malignant lesion?
``` None Soreness/ irritation Paraestheisa Disruption of function Dysphagia ```
64
What to do if pt has symptoms of malignancy?
If pt has symptom for 3 weeks + needed assessment
65
Signs of malignancy?
``` Persistant ulceration White/red/mixed patch Fixation of tissue Indurated lesion Unexplained tooth movement/ mobility Lymph node enlargement ```
66
Why is tongue high risk site for oral cancer?
Due to oreintation of muscle fibres
67
What might see if lymph node metastasis?
Painless enlargement Rock hard mass Fixed underlying tissue
68
Incidence of lymph node involvement in oral cancer?
47%
69
What site in oral cancer has highest invovlement of lymph node involvmeent
Ventral tongue > oralpharygneal > lateral tongue > retromolar > floor mouth
70
What is late event of cancer?
Hameatological spread
71
Gives examples of types oral cancer?
Squamous cell carcinoma Verrucous carcinoma Spindle cell
72
What is verrucous carcinoma?
Low grade cancer which rarely metastasises
73
How does verrucous carcinoma present?
Exophytic surface
74
What can be assessed w/ biopsy that gives indication of prognosis?
Differentiation of lesion
75
How are differentiation of lesions clasified?
Well differentiated Moderately differentiated Poorly differentiated
76
What see in well defined lesions?
Cells resemble origin | Well organised epithelium
77
What see in mod defined lesion?
Cell resemble origin | Less organisation
78
What see poorly diff lesions?
May not resemble cells of origin | Cytologically abnormal
79
How is spread of oral cancer graded?
TNM T = local extension of disease N = node invovlement M = distant metastaiss
80
What is assessed in local extension of disease?
Overall tumour size Depth invasion Invasion - muscle/ nerves/ blood vessel/ bone
81
What types of tumours in peri-neural invasion common in?
Salivary gland tumours

5th OD - Oral Cancer (7 decks)

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