Dysplasia and Oral Cancer

Question 1

What are the 2 distinct disease patterns

Answer 1

Oral Cavity Cancer (OCC)

Oro-Pharyngeal Cancer (OPC)

Question 2

What are the high risk sites for mouth cancer

Answer 2

Floor of the mouth

Lateral border of the tongue

Retromolar regions

Soft and hard palate

Gingivae

Buccal mucosa

Question 3

What is the risk for smokers who dont drink

Answer 3

x2 risk

Question 4

What is the risk for drinkers who dont smoke

Answer 4

x2

Question 5

What is the risk for those who smoke and drink

Answer 5

x5

Question 6

What is the risk for those who take Betel quid

Answer 6

x3 risk

Question 7

What else can increase your risk of oral cancer

Answer 7

Family history

Oral health

Sexual activity

Question 8

What are the potentially malignant lesions

Answer 8

White lesions (leukoplakia)

Red lesions (erythroplakia)

Lichen planus
-Candidal Leukoplakia
-Chronic Hyperplastic Candidiasis

Oral Submucous Fibrosis

Question 9

What is the incidence of oral cancer in white lesions

Answer 9

0.2-4% incidence

Malignant change= 2.5% in 10 years, 4% in 20 years

Question 10

What is the cancer risk for Erythroplakia

Answer 10

much less frequent than leukoplakia

much higher risk of cancer

greater dysplasia risk
-Up to 50% already be carcinoma

Question 11

What is dysplasia

Answer 11

the abnormal development of cells within tissues or organs

Question 12

What is dysplasia based on

Answer 12

Cellular Atypia

Epithelial Architectural Organisation

Question 13

What are the categorisation of dysplasia

Answer 13

Low grade

High grade

Carcinoma in situ

Question 14

What is meant by cytological changes

Answer 14

Changes in individuals cells reflecting abnormal DNA content in the nucleus, failure to mature and keratinise properly

e.g.
-Abnormal variation in nuclear size/shape
-Abnormal variation in cell size/shape

Question 15

What is meant by architectural changes

Answer 15

These are changes in the organisation of maturation and normal layering of the epithelium

e.g.
-Irregular epithelial stratification
-Abnormal keratinisation

Question 16

What would a low grade oral mucosa dysplasia be like

Answer 16

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 surrounding the tumour islands

Tumour islands are usually well defined and are often continuous with the surface epithelium

Invasion pattern with intact large branching rete pegs ‘pushing’ into underlying CT

Question 17

Where there is architectural change into middle third what descides if its low or high grade

Answer 17

level of cytological atypia

Question 18

What would a high grade oral mucosa dysplasia be like

Answer 18

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 infiltrating widely through the CT

Mitotic figures are prominent and many may be abnormal

Question 19

What would carcinoma in situ be like

Answer 19

Cytologically malignant but not invading

Abnormal architecture
-Full thickness (or almost full)
-Severe cytological atypia

Mitotic abnormalities frequent

Question 20

What are the histological prognostic factors

Answer 20

pattern of invasion

depth of invasion

Perinerural invasion

Invasion of vessels

Question 21

What is the oral cancer prognosis

Answer 21

1/3 patients present at stage I/II

-Stage I - 80% cure rate
-Stage II – 65% cure rate
-Later than this 5 year survival <50%, cure <30%
-If untreated, with metastases, survival is about 4 months