Dysplasia And Oral Cancer Flashcards
2 distinct disease patters of oral cancer?
OCC
OPC
What gender is OCC and OPC more common in?
Males
High risk sites of mouth cancer?
FOM
Retromolar regions
Lateral border of tongue
Soft and hard palate
Buccal mucosa
Gingivae
Incidence of OCC and OPC?
OCC is 2.5 / 100,000
OPC is 1.4 / 1000,000
What are the risk factors for oral cancer
Smoking
Drinking
PAAN chewing
SES
Family history
Oral health
Sexual activity
- number of partners
Incidence of malignancy in white lesions?
.2 - 4%
What are cytlogical changes that can be seen?
Variation in nucleus size
Variation in nucleus shape
Variation in cell size and shape
Atypical mitotic figures
Increased number of nuclei
Nuclei hypochromatism
Wha are some architectural changes that can occur?
Irregular stratification
Drop shaped rete ridges
Premature / abnormal keratinisation
Loss of epithelial cell cohesion or adhesion
Increased number of mitoses
What are the typical low grade dysplasia histological changes
Architectural
- tumour originates from squamous epithelium
- considerable keratin production
- stratification
- well formed basal layer surrounding tumour islands
- tumour islands are well defined and continuous with surface epithelium
Ctyological
- atypia or dysplasia may not be prominent
Where it is into middle 1/3, cellular atypia will decide if low or high grade
Typical high grade dysplasia histologically?
Little resemblance to squamous epithelium
Architectural
- upper third changes
- little resemblance to epithelium
Cytology
- considerable atypia
- prominent mitotic figures
- non cohesive front of invasion
Prognostic factors in histological samples?
Pattern of invasion
- bulbous rete pegs better prognosis than wider small islands
Depth of invasion
- tumours greater than 4mm 4x more likely to metastasise
Perineural invasion
- significant when tumour seen within large nerve at some site distant to tumour mass
Invasion of vessels
- associated with node involvement and metastases
What is field cancerisation concept?
High cancer risk in 5cm radius of original primary cancer
How is oral cancer STAGED
T - size
N - metastases to lymph nodes
M - distant metastases
What stage cancer do most patients present?
I/II - 1/3 of patients
Cure rate of stage I and II of oral cancer?
I = 80%
II = 65%
5 year survival % and cure % if someone presents later than stage II?
5 year survival = <50%
Cure = <30%
Survival time of oral cancer if untreated with metastases?
4 months
Presentation of lip cancer?
Lower lip more common
- non healing ulcer or swelling
Aetiology of lip cancer?
Sunlight and UV
SMOKING
Behaviour of lip cancer?
Slow growth
Local invasion
Rare node metastases
- hence good prognosis as early detection
Give some ways oral cancer can be screened?
HPV16 screen
Toluidene blue stain
VELscope
Clinical judgement
Histopathological analysis and biopsy
Role of GDP in oral cancer in primary care?
Primary prevention
- smoking cessation advice
- alcohol reduction advice
- healthy diet promotion
T in TNM?
Tx - cannot be assessed
T0 - no evidence of primary tumour
Tis - carcinoma in situ
T1 - 2cm or less
T2 - 2 - 4cm
T3 - >4cm
T4a - moderately advanced local disease
T4b - advanced local disease
N in TNM?
NX - cannot be assessed
N0 - no regional LN metastases
N1 - single ipsilateral LN 3cm or less
N2a - single LN 3-6cm
N2b - multiple ipsilateral LN <6cm
N2c - mutliple bilateral LN <6cm
N3 - any metastases >6cm
M in TNM?
Metastases
Mx - distant ones cannot be assessed
M0 - no distant metastases
