Dysplasia and oral cancer Flashcards
What are risk factors for oral cancer?
Smoking
Alcohol
Chewing tobacco
Lower socio-economic status
Family history
Poor OH
HPV
Sexual history - increased sexual partners = increased risk
What is the specific risk to smoking for oral cancer?
x2 risk for smokers who DO NOT drink
Risk increases with quantity, frequency and duration
What is specific risk of alcohol for oral cancer?
x2 risk for drinkers who DO NOT smoke
Risk increased for frequency - no. of drinks per day rather than duration
What is combined risk of smoking and alcohol for oral cancer?
5x risk of OCC
What are the clinical features/ red flag signs for oral cavity cancer (OCC)?
Site - FOM, tongue (lateral border), soft palate
Non-homogenous
Indurated/ firm
Rolled borders of ulcers
Exophytic
Present >3 weeks
Non-moveable
Not always painful - numbness
Unexplained weight loss
Pain - late presentation
Rapidly changing/ growing lesion
What are the clinical features/ red flag signs for oropharyngeal cancer?
lump in neck
Hoarseness/ voice changes
Unexplained weight loss
Fatigue
Ear ache/ pain that does not go away
Trismus
Sore throat
Difficulty/ pain on swallowing
Indurated
Coughing blood
What are some OPMD’s?
Leukoplakia
Erythroplakia
Discoid lupus erythematosus
Lichen planus
Oral submucous fibrosis
What are 2 types of OPMD leukoplakia?
Proliferative verrucous leukoplakia - aggressive, slow-growing form of leukoplakia VERY HIGH RISK TRANSFORMATION
Chronic hyperplastic candidosis
Specific risk for leukoplakia OPMD transformation
F > M
Site - FOM, tongue
Non-homogenous
Lesion >200mm squared
Advanced age
What is the dysplasia grading?
Low-grade
High-grade
Carcinoma in situ
What is dysplasia?
Abnormal cells or cellular changes within tissue/ organ
What does the T mean in TNM cancer staging?
Size and extent of primary tumour
Name some CYTOLOGICAL changes seen in dysplasia? (cytological atypia)
Pleomorphism
Atypical mitotic figures
Hyperchromatism
Abnormal variation in cell shape
Abnormal variation in cell size
Name some ARCHITECTURAL changes seen in dysplasia?
Altered basal cell polarity
Drop-shaped rete ridges
Increased abnormal mitoses
Abnormal keratinisation
Loss of epithelial cell cohesion/ adhesion
Abnormal stratification
What are some ways of oral cancer screening?
Toluidine blue
Tissue autofluorescence
Clinical judgement from experienced clinician
How does cancer spread?
Local
lymphatic system
Blood
What does the N mean in TNM cancer staging system?
Regional lymph nodes - number of nearby lymph nodes with cancer
What does M mean in TNM staging?
Distant metastasis
MX - cannot be measured
M0 - cancer has NOT metastasised
M1 - cancer HAS metastasised
How to restore function to the tongue following excisional surgery?
Soft tissue grafting
What are the main histological signs of oral cancer?
Invasion of cells
Pleomorphism - change in shape and size of cells
Hyperchromatism - increased staining of nuclei
What are the requirements for T1, 2, 3, 4?
T1 - <2cm
T2 - 2-4cm
T3 - >4cm
T4 - >4cm with gross local invasion
What are the requirements for N staging?
N0 - no positive nodes
N1 - single ipsilateral node <3cm
N2a - single ipsilateral nodes 3-6cm
N2b - multiple ipsilateral nodes <6cm
N2c - bilateral or contralateral nodes <6cm
N3 - any node >6cm diameter
