Diseases Flashcards
Most common type of oral cancer is?
oral squamous cell carcinoma
What can cause mouth ulcers?
systemic disease
idiopathic
trauma
neoplasia
Give some examples of systemic conditions which could cause mouth ulcers.
Bechets Anaemia HIV Primary heretiform gingiva stomatitis Pemphigus Pemphigoid Lupus erythematosus IBD Peutz Jeghers Gardener's syndrome
Persistant oral white patches which don’t rub off are likely to be?
leucoplakia (premalignant lesion)
What would a histological biopsy of leucoplakia show?
alteration in keratinization (hence looks white) AND dysplasia of epithelium
what is lichenoid inflammation?
chronic inflammation along the base of the epithelium causing damage to keratinocytes (seen in Lichen planus)
which is more concerning a red or white oral patch and why?
red, many are due to dysplasia or malignancy
Name 2 causative diseases of oral pigmentation.
Addison’s disease
Peutz-Jegher’s syndrome
What is Sjorgren’s syndrome?
a disorder of the immune system with common symptoms of dry mouth and eyes
What systemic disease can cause boggy gingivae and why?
leukaemia due to infiltration by malignant cells and immune-compromise
How can lymphoma affect the mouth?
palable lymph nodes causing
extra/intraoral diffuse swellings causing ulceration and tooth migration
What is recurrent aphthous ulceration (explain the types)?
multiple oral ulcers: 2 types minor (common, <10mm diameter with grey/white centre and thin halo, heals within 14 days with NO scar) and major (>10mm in diameter, persist for weeks/months, heal WITH scarring)
Recurrent aphthous ulceration is most common in who?
females and non-smokers
How would you treat recurrent aphthous ulceration?
Avoiding triggering food and drink
Corticosteroids may be used to lessen duration and severity
Where are the high risk sites for oral squamous cell carcinoma?
floor of mouth, lateral border and ventral surface of the tongue, soft palate and retromolar pad/tonsillar pillars
Where will oral squamous cell carcinoma rarely present?
on hard palate or dorsum of the tongue
which pre-malignant lesions could become oral squamous cell carcinoma?
leukoplakia (white patch)
lichen planus
submucous fibrosis
erythroplakia (red patch)
what are some risk factors for oral squamous cell carcinoma?
Smoking Alcohol HPV Chronic infection Nutritional deficiencies UV exposure
How might an oral squamous cell carcinoma present?
Variably: white/red/speckled ulcer/lump non-healing ulcer unexplained pain in head or back of neck numbness dysphagia odynophagia
What is the prognosis for oral squamous cell carcinoma?
5 year survival in 40-50% of cases as is normally detected late
What is more common in the oesophagus, a benign or malignant tumour?
malignant
which types of malignancy affect the oesophagus?
squamous cell carcinoma
adenocarcinoma
What can GORD be caused by?
incompetent LOS poor oesophageal clearance barrier/visceral sensitivity hiatus hernia systemic sclerosis
what are the risk factors for GORD?
increased abdominal pressure (pregnancy or obesity) high fat diet caffeine alcohol smoking
What are the main presentations for GORD?
heartburn (mainly)
regurgitation and odynophagia (due to oesophagitis)
What does GORD cause?
Oesophagitis and if long standing can progress to Barrett’s oesophagus which predisposes to cancer
what pharmacological treatment would you give a patient with GORD?
Antacids (symptom relief)
H2 antagonists (symptom relief)
PPI (symptom relief + healing) - best eg: omeprazole
which drugs may cause reflux?
antihistamines steroids CCBs benzodiazepines antidepressants
what is Barrett’s oesophagus?
A complication of GORD where intestinal metaplasia has occured (change from squamous to columnar epithelium), hiatus hernia is almost always present
what does Barrett’s oesophagus increase your risk of?
adenocarcinoma
why does Barrett’s oesophagus occur?
a protective response aiming to change to have goblet cells (stomach mucosa) which will secrete mucin to neutralise the acid but instead results in unstable muscosa at risk of dysplasia
How do you diagnose Barrett’s oesphagus?
endosopy and biopsy
What is the treatment for Barrett’s oesophagus?
surveillance
PPI
removal of lesion endoscopically
radiofrequency ablation of lesion
What is reflux oesophagitis?
inflammation of the oesophagus due to refluxed gastric contents causing hyperplasia
What occurs pathologically in reflux oesophagitis?
basal zone hyperplasia and elongation of CT papillae (due to contant stress on the cells)
Why could the LOS be defective?
CNS depressants (alcohol)
Pregnancy
Hypothyroidism
Systemmic sclerosis
What is eosinophilic oesophagitis?
inflammation of the oesophagus due to increased eosinophils even though no reflux is occuring
what does eosinophilic oesophagitis cause the oesophagus to look like?
corrugated or spotty
how would someone with eosinophilic oesophagitis present?
long history of dysphagia
heartburn
oesophageal pain
where is squamous cell carcinoma and adenocarcinoma of the oesophagus most likely to affect?
squamous cell carcinoma: middle and upper thirds
adenocarcinoma: lower 1/3 (normally due to reflux)
what is squamous cell carcinoma of the oesophagus associated with?
smoking and alcohol
what is adenocarcinoma associated with?
Barrett’s and GORD
how do patient’s with oesophageal malignancy often present (is same for both types)?
initially asymptomatic then progressive dysphagia, wt loss, loss of appetite, anorexia and lymphadenopathy
