Dysplasia and Oral Cancer Flashcards
What are the 2 distinct disease patterns
Oral Cavity Cancer (OCC)
Oro-Pharyngeal Cancer (OPC)
What are the high risk sites for mouth cancer
Floor of the mouth
Lateral border of the tongue
Retromolar regions
Soft and hard palate
Gingivae
Buccal mucosa
What is the risk for smokers who dont drink
x2 risk
What is the risk for drinkers who dont smoke
x2
What is the risk for those who smoke and drink
x5
What is the risk for those who take Betel quid
x3 risk
What else can increase your risk of oral cancer
Family history
Oral health
Sexual activity
What are the potentially malignant lesions
White lesions (leukoplakia)
Red lesions (erythroplakia)
Lichen planus
-Candidal Leukoplakia
-Chronic Hyperplastic Candidiasis
Oral Submucous Fibrosis
What is the incidence of oral cancer in white lesions
0.2-4% incidence
Malignant change= 2.5% in 10 years, 4% in 20 years
What is the cancer risk for Erythroplakia
much less frequent than leukoplakia
much higher risk of cancer
greater dysplasia risk
-Up to 50% already be carcinoma
What is dysplasia
the abnormal development of cells within tissues or organs
What is dysplasia based on
Cellular Atypia
Epithelial Architectural Organisation
What are the categorisation of dysplasia
Low grade
High grade
Carcinoma in situ
What is meant by cytological changes
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
What is meant by architectural changes
These are changes in the organisation of maturation and normal layering of the epithelium
e.g.
-Irregular epithelial stratification
-Abnormal keratinisation
What would a low grade oral mucosa dysplasia be like
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
Where there is architectural change into middle third what descides if its low or high grade
level of cytological atypia
What would a high grade oral mucosa dysplasia be like
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
What would carcinoma in situ be like
Cytologically malignant but not invading
Abnormal architecture
-Full thickness (or almost full)
-Severe cytological atypia
Mitotic abnormalities frequent
What are the histological prognostic factors
pattern of invasion
depth of invasion
Perinerural invasion
Invasion of vessels
What is the oral cancer prognosis
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
