Dysplasia and Oral Cancer Flashcards
(39 cards)
Incidence of oral cavity cancer?
male vs female
male 2:1 female
What are the high risk sites for oral cancer?
(6)
- floor of mouth
- lateral border of the tongue
- retromolar regions
- soft and hard palate
- gingivae
- buccal mucosa
Incidence of oro-pharyngeal cancer
male vs female
male 4.8:1 female
Oro-pharyngeal cancer rates are rapidly rising, especially in high income areas (north america). What is this suggested to be linked to?
Rise in HPV epidemic
According to the Scottish Cancer Registry, what is the increase for oro-pharyngeal cancer?
85% inncrease from 2001-2012
highest increase for any cancer
According to the Scottish Cancer Registry, what is the increase for oral cavity cancer?
10% inncrease from 2001-2012
What are the main risk factors for oral cancer?
(2)
Tobacco-use (smoking)
Drinking alcohol
What is the risk of oral cancer for smokers?
Risk of oral cancer is doubled in smokers.
The risk increases with quantity, duration and frequency of tobacco use.
What is the risk of oral cancer in those who drink alcohol?
3-4 drinks a day
Risk of oral cancer is doubled in those who drink alcohol.
Frequency is more important that duration (those who drink more per day have greater risk).
What is the risk of oral cancer in those who smoke and drink alcohol?
Risk of oral cancer in those who smoke and drink alcohol is 5 times more.
This risk increases with frequency and duration of smoking and alcohol consumption.
What is the risk of oral cancer for betel quid (paan)?
Risk is 3 times more.
Betel quid is a mixture of substances including arecca nut with or without tobacco wrapped in a betel leaf and placed in the mouth.
What are the benefits of stopping smoking and drinking alcohol?
Smoking cessation benefits:
* demonstrable benefits within 1-4 years after stopping smoking
* risks reduced and reached a similar level to those who had never smoked after 20 years of quitting
Stopping alcohol consumption benefits:
* takes 20 years
What is considered to be potentially malignant lesions?
- white lesions (leukoplakia)
- red lesions (erythroplakia)
- lichen planus (candidal leukoplakia, chronic hyperplastic candidiasis)
- oral submucous fibrosis
What is the incidence of leukoplakia becoming malignant?
0.2-4%
2.5% in 10 years
4% in 20 years
What is the incidence of erythroplakia becoming malignant?
Higher risk of cancer compared to leukoplakia.
Risk of dysplasia is 50%.
However, erythroplakia is less frequent than leukoplakia.
How is dysplasia categorised?
Categorised based on:
* cellular atypia
* epithelial architectural organisation
What are the histological gradings of oral mucosal dysplasia?
- low grade
- high grade
- carcinoma-in-situ
What is low-grade oral mucosa dysplasia?
histological grading
- easy to identify that the tumour originates from squamous epithelium
- architectural change into lower third
- cytological atypia or dysplasia may not be prominent
- shows a considerable amount of keratin production
- evidence of stratification
- well formed basal cell layer
- tumour islands are usually **well define **and are often continuous with the surface epithelium
- invasion pattern with intact large branching rete pegs pushing into underlying CT
What is high-grade oral mucosa dysplasia?
histological grading
- show little resemblance to a normal squamous epithelium
- architectural change upper third
- usually show considerable atypia
- invade in a non-cohesive pattern with fine cords, small islands and single cells infiltrtating widely through the CT
- mitotic figures are prominent and many may be abnormal
What are the histological prognostic factors?
oral cancer and dysplasia
Pattern of invasion:
* bulbous rete pegs infiltrating at same level is considered of a better prognosis than widely infiltrating small islands and single cells
Depth of invasion:
* risk of metastases for a tumour greater than 4mm was 4x greater than for a tumour less thhan 4mm
Perineural invasion:
* most signnificant when a tumour is seen within a large nerve at a site some distance from the main tumour mass
Invasion of vessels:
* associated with lymph node metastases and a poor prognosis
Describe the Field Cancerisation Concept.
Multiple primary cancers possible over time.
High cancer risk in 5cm radius of the original primary tumour.
How is oral cancer clinically staged?
Variables:
* site
* size (T)
* spread (N&M)
Describe Stage 1 cancer.
TNM
T1 tumour ≤2cm in greatest dimension
N0 no regional lymph node metastasis
M0 no distant metastasis
Describe Stage 2 cancer.
TNM
T2 tumour 2<T≤4cm in greatest dimension
N0 no regional lymph node metastasis
M0 no distant metastasis
