Dysplasia And Oral Cancer Flashcards
What are the two distinct diease pattern in oral cancer
Oral cavity cancer
Oreo-pharyngeal cancer
What are some high risk sites for mouth cancer
It can happen anywhere in the mouth
Floor of mouth
Lateral border of tongue
Retromolar regions
Soft and hard palate
Gingival
Buccal mucosa
How many more times at risk are smokers who dont drink for oral cancer
2x at risk
Increases quantity duration and frequency of tobacco use
Fewer cigarettes for longer duration worse than high number, short term
A person who smokes and drinks is how many more times at risk of oral cancer
5x
What are the benefits of stopping smoking and drinking in relation to oral cancer
Demonstrable benefits of quitting smoking were identified within 1-4 years after smoking
Risks reduced and reached a similar level to those who had nevr smoked after 20 years a of quitting
In contrast, the risk effects associated with quitting heavy alcohol consumption takes 20 years to emerge
Why must we be careful when giving a patient oral cancer risk in white lesions
No clear on how reliable the data is so we must be very guarded about giving pt information about malignant change in white lesions as this is probably very small compared to the amount of white lesions we see
Pt should know that there is a risk of oral cancer change and it should be monitored
Does erythroplakia or leukoplakia have a higher oral cancer risk
Erthroplakia is much higher risk of cancer
They are much less frequent than leukoplakia, much less likely to see a red lesion without a cause
What two things is dysplasia based on?
Cellular atypia
Epithelial architectural organisation
What is the new categorisation of dysplasia and what is this based on?
Low grade
High grade
Carcinoma in situ
This is based on cytotological and architectural changes
What is a cytological histological change
These are changes in individual cells reflecting abnormal DNA content in the nucleas, failure to mature and keratinise correctly and increased proliferation
What is an architectural histological change
These are changes in the organisation and maturation and normal layering of the epithelium
With architectural change what is the difference between high grade and low grade dysplasia
High grade change is in the upper third
Low grade change in the lower third
What are the 4 histological prognostic factors
Pattern of invasion
Depth of invasion
Perineural. Invasion
Invasion of vessels
Explain multistage promtion with regards to oral cancer
Cancer does not happen suddenly it is a multistage process that involves genetic and environmental changes.
E.g. there may be a tendency of the cell to make unusual changes and this can be aggravated bytobacco , alcohol and other stimuli that cause and promote the change from altered cell expression to actual malignany and invasion.
This process takes time and will happen at different stages in different parts of the mouth depending upon how these environmental stimuli are applied to different parts of the mucosa - this is important as it raises the concept of field cancerisation
What is the field cancerisation concept
What this means is where a cancer develops in part of the mouth is not the only part of the mouth that has been subjected to the changes and stimuli that lead to the cancer.
However, they have been coalescenct in the cancer area to produce the change at this time.
But these same changes may be progressing in other parts of the mucosa at a slower rate and may at some point in the future produce an oral cancer
- this would be a new primary rather than a recurrence of the other tumour.
Field cancerisaiton tells us - that any patient presenting with dysplasia or a carcinoma has a risk of developing further tumours in other parts of the mucosa — calculated that high in 5cm radius of orinigial cancer
Must consider whole mouth as risk and constantly review
