Chapter 7 Flashcards
what does anaplastic mean
- loss of cellular differentiation
- characteristic of malignant tumors
what does benign mean
- condition that, if left untreated, will not become life threatening
what is a benign tumour
- not malignant and favourable for treatment and recovery
what does carcinoma mean
- malignant tumour of EPITHELIUM
what does dysplasia mean
- disordered growth
- alteration of size, shape and organization of cells
what does encapsulated mean
- surrounded by capsule of fibrous connective tissue (benign)
what does hyperchromatic mean
- staining more intensely than normal
what does in situ mean
- dysplasia that is confined to tissue of origin, right before it crosses into basal layer
- once in basal layer vessels can carry and metastasize
what is invasion
- infiltration and active destruction of neighbouring tissue
what does malignant mean
- resistant to treatment
- able to metastasize and kill the host
what is a malignant tumour
- cancer
- tumour that is resistant to treatment, with potential for uncontrolled growth or recurrence, or both
what does metastasis mean
- transport of neoplastic cells (cancer cells) to parts of the body remote from the primary tumour with establishment of new tumours at that site
what is a metastatic tumour
- tumour formed by cells that have been transported from the primary tumour site, not connected to the primary tumour
what is a mitotic figure
- dividing cells caught in process of mitosis
what is a neoplasia
- new growth
- formation of tumours by uncontrolled proliferation of cells
- tumour = swelling, often used as a synonym for neoplasm
what is a neoplasm
- tumour
- new growth of tissue which is uncontrolled and progressive
what is a nevus
- circumscribed malformation on the skin or oral mucosa, also benign tumour of melanocytes (another word for mole)
what does odontogenic mean
- tooth forming
what is oncology
- study of tumors/neoplasms
what does pleomorphic mean
- occurring in various forms
what is a primary tumour
- original tumour, source of metastasis
what is a sarcoma
- malignant tumour of CONNECTIVE tissue
what does undifferentiated mean
- absence of normal differentiation = anaplasia
what is the difference between neoplasia and hyperplasia
- unregulated and uncontrolled growth
- cells are abnormal
- new abnormal cells grow unregulated
- in hyperplasia: normal cells proliferate in response to tissue damage – once stimulus is removed, healing occurs. some control on growth
along with a sample of the lesion, what else would a surgeon send for biopsy/pathology
- patient information, ex: smoker, diabetic male, lesion – white patch, 2x8 mm buccal mucosa
- 2-4 differential diagnoses
what can cause cancer
- chemicals
- viruses – oncogenic viruses
- radiation – sunlight, x-rays
- genetic mutation
what are characteristics of benign tumours
- encapsulated
- can invade adjoining tissues but cannot spread to distant sites
- resemble normal cells
what are characteristics of malignant cells
- invades and destroys tissue
- unencapsulated and invasive
- histologic appearance varies – can appear well differentiated (like normal cells) or poorly differentiated (do not resemble tissue from which it is derived)
- can be pleomorphic: various size and shape of cells
- hyperchromatic: dark nucleus
- abnormal mitotic figures: due to growth
what does the prefix in the name of a tumour mean
- the tissue/cell of origin
what is the suffix for benign tumours
- -oma (ex osteoma)
what is the suffix for malignant tumours
- carcinomas: of epithelial tissue, ex squamous cell carcinoma
- melanoma: of melanocytes
- sarcoma: of connective tissue, ex osteosarcoma (malignant tumour of bone)
what acronym do we use to remember malignant tumour names
- SaMe Car (sarcoma, melanoma, carcinoma)
how do we treat benign and malignant tumours
- benign: surgical excision or enucleation (removal of entire lesion without cutting it)
- malignant: surgery, chemotherapy, radiation therapy, combination
what is leukoplakia
- a premalignant lesion
- clinical term, NOT histological term
- white plaque like, does not rub off, no specific cause identified
- histologically: hyperkeratosis, hyperplasia
what is epithelial dysplasia
- a premalignant lesion
- abnormal cell growth
- premalignant
- in 5%-25% of leukoplakias, floor of mouth, ventrolateral tongue, lip, soft palate
what do we do if we see a premalignant lesion
- attempt to identify the cause,
- rough teeth
- rough places on dentures, fillings, crowns
- smoking or other tobacco use (smoker’s keratosis), especially pipes
- holding chewing tobacco or snuff in mouth for a long period of time
- remove the cause
- if not, biopsy
- if in hot spots, maybe remove anyway
what is erythroplakia
- a premalignant lesion
- granular or velvet red patch
- floor of mouth
- tongue
- soft palate
- 1 erythro for every 60 leuko
- however, 90% epithelial dysplasia
- must perform biopsy
- treatment varies
what is spekled leukoplakia
- premalignant
- red and white
- very common
what is the microscopic diagnosis of epithelial dysplasia
- disordered growth = premalignant (squamous cell carcinoma)
- revert to normal – remove stimulus
- no invasion into connective tissue
- surgically removed
- dysplasia in other tissues NOT considered premalignant condition, only epithelium
- carcinoma in situ – when the epithelial dysplasia involves the full thickness of the epithelium
what is the clinical appearance of squamous cell carcinoma
- clinical appearance: exophytic appearance. early tumours – eryth or leuko or combo
- microscopic: invasion of tumour cells. through basement membrane – hyperchromatic, mitotic figures
what are common oral areas we see squamous cell carcinoma
- floor of mouth
- ventrolateral tongue
- soft palate
- tonsillar pillar
- retromolar pad
what are some extra oral areas we may see squamous cell carcinoma
- vermillion border of lips
- skin – associated with sun. better prognosis than intraoral
what are risk factors for developing squamous cell carcinoma
- tobacco (smoking, snuff, chewing)
- alcohol consumption
- chronic irritation – no evidence of progression to cancer (ie ill-fitting denture)
- HPV 16
what is a papilloma
- epithelial tumour
- squamous cell epithelium
- benign. pedunculated or sessile
- exophytic (grows out)
- cauliflower like
- soft palate and tongue
- color – depends on keratin
- surgical excision of the base
what are some options for differential diagnoses for a papilloma
- verruca vulgaris and condyloma acuminatum
- different histologically
- same treatment
what is squamous cell carcinoma
- aka epidermoid carcinoma
- a malignant tumour of squamous epithelium
- the most common primary malignancy of the oral cavity
- it can infiltrate adjacent tissues and form distant metastases
- usually metastasizes to lymph nodes in the neck and then to distant sites, such as the lungs and liver
- clinically, it usually is an exophytic ulcerative mass
- can infiltrate and destroy bone
what can cause squamous cell carcinoma
- exposure to the sun causes the lips to turn from dark pink to mottled grayish pink
- the interface becomes blurred; linear fissures are seen at right angles to the line of the interface
- solar cheilitis: a condition in which mild to severe epithelial dysplasia occurs
- most patients are over 40 years old; most have been men, but the incidence has increased in women
- tobacco: smoking, snuff dipping, tobacco chewing
- alcohol consumption
what is the TNM staging system
- universal “communication and treatment planning” protocol
- considers the following:
- tumour size
- nodes – palpable, same side, opposite side
- metastasis
- stages I-IV
- prognosis worsens
what is the TNM staging
- T: tumour
- T1: less than 2 cm in diameter
- T2: 2-4 cm in diameter
- T3: greater than 4 cm in diameter
- T4: invades adjacent structures
- N: nodes
- N0: no palpable nodes
- N1: ipsilateral palpable nodes
- N2: contralateral or bilateral nodes
- N3: fixed palpable nodes
- M: metastasis
- M0: no distant metastasis
- M1: clinical metastasis
HPV 16 vs oral cancers
- oral cancer due to HPV = back fo tongue, tonsillar pillars, oropharynx. typically seen in younger populations
- oral cancer due to smoking and alcohol = buccal mucosa, floor of mouth, alveolar ridge, anterior tongue and lateral borders. typically in older populations
signs and symptoms of HPV 16 related cancers
- hoarseness
- continual sore throat, throat infection not responding to antibiotics
- pain when swallowing or difficulty swallowing
- pain when chewing
- continual lymphadenopathy
- non-healing oral lesions
- bleeding in the mouth or throat
- ear pain
- lump in throat or feeling that something is stuck in the throat
what are the treatments and prognosis for squamous cell carcinoma
- surgical
- radiation/chemo
- radiation results in xerostomia due to salivary gland damage
- HPV related – better prognosis even though discovered later
- size of tumour - smaller
- in cervical lymph nodes
- metastases distance
what is a verrucous carcinoma
- pebbly white and red surface – a lot of keratin
- form of SCC – smokeless tobacco
- better prognosis. rarely metastasizes, men over 55 years old, vestibule and buccal mucosa
what is basal cell carcinoma
- caused by excessive sun exposure
- extra oral only
- rolled borders, non healing
- prognosis good to fair. rarely metastasizes, invasive
what are the microscopic characteristics of basal call carcinoma
- composed of basal cells derived from squamous epithelium
- a proliferation of basal cells into underlying connective tissue
what is the treatment of basal cell carcinoma
- surgical excision
- radiation therapy may be used to treat large lesions
- rarely metastasizes
what are salivary gland tumours
- may arise in either major or minor salivary glands
- minor salivary gland tumours are most often located at the junction of the hard and soft palate
- major – parotid, submandibular or sublingual
what are adenomas and adenocarcinomas
- salivary gland tumours
- adenomas are benign
- adenocarcinomas are malignant
what are the different kinds of salivary gland tumours
- pleomorphic adenoma
- monomorphic adenoma
- mucoepidermoid carcinoma
- adenoid cystic carcinoma
what is a pleomorphic adenoma
- a benign salivary gland tumour – 90% of all salivary gland tumours
- microscopic: an encapsulated tumour composed of tissue that appears to be a mix of both epithelium and connective tissue
- the most common extraoral location is the parotid gland; the most common intraoral location is the palate
- slow-growing, painless, dome-shaped mass
- > 40 years old
how do we treat pleomorphic adenomas
- parotid gland – remove part of gland containing tumour
- minor gland – surgical excision
- tumour grows with projections into surrounding tissue therefore difficult to remove entirely
- CAN undergo malignant transformation
what is a monomorphic ademona
- a benign encapsulated salivary gland tumour. occurs less often than the pleomorphic adenoma
- a uniform pattern of epithelial cells
- occurs most commonly in adult females
- occurs most often in the upper lip and buccal mucosa
- treatment: surgical excision
what is a warthin tumour
- (papillary cystadenoma lymphomatosum) is a unique type of monomorphic adenoma
- an encapsulated tumour with epithelial and lymphoid tissue. a painless, soft, compressible or fluctuant mass
- usually occurs on the parotid gland, rarely intraorally. often develops bilaterally
- occurs predominantly in adult men
what is an adenoid cystic carcinoma
- malignant tumour
- major or minor salivary glands
- unencapsulated, infiltrates surrounding tissue
- slow growing – parotid common, palate common
- excision followed by radiation if necessary
- metastasis possible, usually distant – LUNGS
- can metastasize in lymph nodes
- poor prognosis
what is a mucoepidermoid carcinoma
- a malignant salivary gland tumour
- unencapsulated, infiltrating tumour
- a combination of mucous cells interspersed with squamous-cell like epithelial cells called epidermoid cells
- major gland tumours are most often found in the parotid gland , minor tumours on the palate
- appear clinically as slowly enlarging masses
- may appear in bone as either a unilocular or multilocular radiolucency
- may occur over a wide age range; usually occurs in adults, but is the most common malignant salivary gland tumour in children
- treatment: surgical excision
what are odontogenic tumours
- tooth forming tissues, most are benign
how do we characterize odontogenic tumours
- by origin:
- epithelial odontogenic tumours
- mesenchymal odontogenic tumours
- mixed odontogenic tumours
- peripheral odontogenic tumours
what is an ameloblastoma
- benign
- can be invasive
- destruction
- death if in max (spreads to brain)
- soap bubble
- 80% in mandible, causes expansion of bone
- complete surgical excision, though common to reoccur
what is a calcifying epithelial odontogenic tumour
- benign
- pindborg tumour
- unilocular or multilocular
- calcifications visible
- less frequent than ameloblastoma
- excision – can reoccur though less likely than ameloblastoma
what is an adenomatoid odontogenic tumour
- benign
- 70% in females
- does not reoccur
- younger than 20 years
- maxilla more common
- seen with impacted teeth
how does an adenomatoid odontogenic tumour appear if with impacted teeth
- asymptomatic
- like dentigerous cysts; except extends beyond CEJ and down root
- excision/enucleation; removal of tumour only
what is a mesenchymal odontogenic tumour
- benign
- 10-29 years old
- soap bubble
- poorly defined
- cause displacement
- most reoccur within 2 years
- excision
what is a central cementifying fibroma
- ossifying – more bone
- or cemento-ossifying; bone in cementum
- benign; radiolucent to radiopaque. excision. recurrence is rare
what is a mixed odontogenic tumour
- odontoma: enamel, denten, cementum, and pulp
- most common odontogenic tumour
- compound: numerous small teeth, anterior max
- complex: tooth tissues, does not resemble tooth, posterior mandible
- clinically: prevent eruption, surgical treatment, rare to recur
what is an ameloblastic fibro-odontoma
- benign
- cross between ameloblastic fibroma and complex odontoma
- young adults
what is a hemangioma
- a benign vascular tumour
- proliferation of blood vessels
- limited growth
- many present at birth
- deep – macroglossia
- superficial – bluish
- spontaneous remission
- surgical or injection of sclerosing solution
what are the ABCDEs of melanin producing tumours
- used when assessing pigmented skin lesions
- asymmetry: if one half different from other
- borders: irregular?
- colour: varies from tan/black to red/blue
- diameter: greater than 6 mm
- evolving: changing!
what is a melanocyte nevi
- benign
- tumours on skin
- buccal mucosa
- 2x as common in women
- if ulcerate or change, malignant (needs excision)
what is a malignant melanoma
- tumour of melanocytes
- malignant
- all melanomas are malignant
- usually secondary in oral
- aggressive
- blue to black mass
- rapid growth
- prognosis poor
- surgery and chemo
what is osteoma
- benign
- slow growing
- radiopaque mass within bone – associated with Gardner’s syndrome – genetic disorder
what is osteosarcoma
- malignant tumour of bone
- most common primary malignant tumour of bone under 40 yrs
- average age of occurrence is 37 for jaw
- swelling, pain
- destructive
- radiopaque or radiolucent
- chemo and excision
- 20% live past 5 years
what is leukemia
- overproduction of atypical white blood cells
- acute: proliferation of immature wbcs, mostly children/young adults
- fills up space so normal cells can’t be produced then spill into blood stream and affect other organs
- treat immediately
- chronic: mature wbcs, adults, slower progression. bone marrow transplant, chemo for chronic. oral manifestation – gingival enlargement with persistent bleeding
what is lymphoma
- non hodgkins - 89%. many various forms. T cell and B cell – 85% B cell. neoplasm of lymph nodes. aggressive. begins in lymph nodes/lymph tissue and then spreads via blood strea. may show intraoral neoplasms. slow. prognosis varies
- hodgkins lymphoma: reed sternberg cells – one of most curable forms of cancer. orderly spread from one lymph node to another. affects B cells. tx: chemo, radiation. 90% cure rate.
