Dysplasia and Oral Cancer Flashcards
what are the 2 distinct disease patterns of oral cancer?
- oral cavity cancer
- oro-pharyngeal cancer
which sex is more commonly affected by oral cavity cancer?
Male 2:1 Female
what are the high risk sites for mouth cancer?
- floor of mouth
- lateral border of tongue
- retromolar regions
- soft & hard palate
- gingivae
- buccal mucosa
which area of the world is oro-pharyngeal cancer most commonly seen?
North America and South Central Asia
What condition is thought to be associated with oro-pharyngeal cancer?
HPV
what affect does smoking and drinking have oral cavity cancer?
- smokers who don’t drink 2x risk
- drinkers (3/4 drinks/day) who don’t smoke 2x risk
- smoke & drink… 5x risk
what risk factors are associated with oral cancer?
- smoking
- alcohol
- betel quid (paan)
- socioeconomic status
- family history
- diet
what are examples of potentially malignant lesions?
- white lesions
- red lesions
- lichen planus
- oral submucous fibrosis
what type of white patches tend to be potentially malignant?
leukoplakia
what is erythroplakia?
- red patch
- more likely to be malignant
are white or red patches more likely to be cancerous?
red lesions more likely
what might suggest that a white lesion is malignant?
- non-homogeneous (variation within lesion)
- atrophic background
what is dysplasia risk based on?
- cellular atypia
- epithelial architectural organisation
how are dysplastic lesions categorised?
- low grade
- high grade
- carcinoma in situ
how are dysplastic lesions classified into either low-grade or high-grade risk?
based on cytological and architectural changes
what is meant by Cytological changes in dysplastic lesions?
Changes in individual cells reflecting abnormal DNA content in the nucleus, failure to mature and keratinise correctly and increased proliferation.
Give some examples of cytological changes seen in dysplastic lesions:
- abnormal variation in nuclear size or shape
- abnormal variation in cell size or shape
- increased/altered nuclear-cytoplasmic ratio
- atypical mitosis figures
- increased number & size of nucleoli
Give some examples of architectural changes seen in dysplastic lesions:
- irregular epithelial stratification
- loss/disturbed polarity of basal cells
- drop-shaped rete ridges
- increased & abnormal mitoses
- premature keratinisation in single cells
- abnormal keratinisation
what are some features that are present in a low-grade dysplasia?
- easy to identify that tumour originates from squamous epithelium
- considerable amount of keratin production
- well formed basal cell layer
- tumour islands usually well defined & often continuous with the surface epithelium
what are some features that are present in a high-grade dysplasia?
- show little resemblance to a normal squamous epithelium
- usually show considerable atypia
- mitotic figures are prominent
what is meant by carcinoma-in-situ?
cytologically malignant but not invading
what histological prognostic factors suggest that a lesion is potentially malignant?
- Pattern of invasion = widely infiltrating small islands & single cells
- Depth of invasion = greater that 4mm more likely to metastases
- Perineural invasion
- Invasion of vessels
what does the concept of “field cancerisation” refer to?
high cancer risk in 5cm radius of original primary cancer lesion (most of mouth & pharynx in oral cases)
- mouth must be continually reviewed after discovery of original cancer lesion
how is oral cancer staged?
Based on:
- site
- size (T)
- spread (N&M)
