Dysplasia and oral cancer

Question 1

What are risk factors for oral cancer?

Answer 1

Smoking
Alcohol
Chewing tobacco
Lower socio-economic status
Family history
Poor OH
HPV
Sexual history - increased sexual partners = increased risk

Question 2

What is the specific risk to smoking for oral cancer?

Answer 2

x2 risk for smokers who DO NOT drink
Risk increases with quantity, frequency and duration

Question 3

What is specific risk of alcohol for oral cancer?

Answer 3

x2 risk for drinkers who DO NOT smoke
Risk increased for frequency - no. of drinks per day rather than duration

Question 4

What is combined risk of smoking and alcohol for oral cancer?

Answer 4

5x risk of OCC

Question 5

What are the clinical features/ red flag signs for oral cavity cancer (OCC)?

Answer 5

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

Question 6

What are the clinical features/ red flag signs for oropharyngeal cancer?

Answer 6

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

Question 7

What are some OPMD’s?

Answer 7

Leukoplakia
Erythroplakia
Discoid lupus erythematosus
Lichen planus
Oral submucous fibrosis

Question 8

What are 2 types of OPMD leukoplakia?

Answer 8

Proliferative verrucous leukoplakia - aggressive, slow-growing form of leukoplakia VERY HIGH RISK TRANSFORMATION
Chronic hyperplastic candidosis

Question 9

Specific risk for leukoplakia OPMD transformation

Answer 9

F > M
Site - FOM, tongue
Non-homogenous
Lesion >200mm squared
Advanced age

Question 10

What is the dysplasia grading?

Answer 10

Low-grade
High-grade
Carcinoma in situ

Question 11

What is dysplasia?

Answer 11

Abnormal cells or cellular changes within tissue/ organ

Question 12

What does the T mean in TNM cancer staging?

Answer 12

Size and extent of primary tumour

Question 13

Name some CYTOLOGICAL changes seen in dysplasia? (cytological atypia)

Answer 13

Pleomorphism
Atypical mitotic figures
Hyperchromatism
Abnormal variation in cell shape
Abnormal variation in cell size

Question 14

Name some ARCHITECTURAL changes seen in dysplasia?

Answer 14

Altered basal cell polarity
Drop-shaped rete ridges
Increased abnormal mitoses
Abnormal keratinisation
Loss of epithelial cell cohesion/ adhesion
Abnormal stratification

Question 15

What are some ways of oral cancer screening?

Answer 15

Toluidine blue
Tissue autofluorescence
Clinical judgement from experienced clinician

Question 16

How does cancer spread?

Answer 16

Local
lymphatic system
Blood

Question 17

What does the N mean in TNM cancer staging system?

Answer 17

Regional lymph nodes - number of nearby lymph nodes with cancer

Question 18

What does M mean in TNM staging?

Answer 18

Distant metastasis
MX - cannot be measured
M0 - cancer has NOT metastasised
M1 - cancer HAS metastasised

Question 19

How to restore function to the tongue following excisional surgery?

Answer 19

Soft tissue grafting

Question 20

What are the main histological signs of oral cancer?

Answer 20

Invasion of cells
Pleomorphism - change in shape and size of cells
Hyperchromatism - increased staining of nuclei

Question 21

What are the requirements for T1, 2, 3, 4?

Answer 21

T1 - <2cm

T2 - 2-4cm
T3 - >4cm
T4 - >4cm with gross local invasion

Question 22

What are the requirements for N staging?

Answer 22

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