epithelial malignancy 3

Question 1

T/F: Squamous cell carcinomas of the Gingiva and Alveolar Mucosa are relatively common

Answer 1

FALSE

Question 2

when are SCCa’s more likely to be found on the gingiva or alveolar mucosa?

Answer 2

More common in women at this site (2:1)

More common in patients with no identifiable risk factors for oral SCCa

Question 3

Most SCCa’s affecting the palate arise on the _________

Answer 3

lateral soft palate

Question 4

T/F: Palatal SCCa lesions can originate in oral cavity or develop in maxillary antrum and perforated sinus floor

Answer 4

True

Question 5

what are the differential diagnoses for Squamous cell carcinoma?

Answer 5

A) Non-specific ulcer
B) Specific infection (TB, syphilis, deep fungal)
C) Immune-mediated (Wegener’s, Crohn’s)

Question 6

what are the radiographic findings for Squamous cell carcinoma?

Answer 6

A) Due to direct invasion of bone – usually a late phenomenon

B) Ragged, “moth-eaten” radiolucency

C) Ill-defined borders

Question 7

what are the Histological characteristics of SCCa?

Answer 7

• invasive cords and nests of malignant squamous epithelial cells arise from dysplastic surface epithelium
• Tumor cells show an increased nuclear/cytoplasmic ratio, cellular and nuclear pleomorphism, and mitotic activity
• Varying degrees of keratin production may be seen (well vs. poorly differentiated)

Question 8

what are the treatments for SCCa?

Answer 8

wide surgical excision and/or radiation therapy

Combined radiochemotherapy used with extensive loco-regional involvement or in cases where surgery is contraindicated

Question 9

why is the prognosis for SCCa poor?

Answer 9

because most patients present in Stage III or IV

Metastasis to regional lymph nodes

Question 10

what is the 5-year-survival for SCCa?

Answer 10

60%

one of the worst prognoses of any major cancer

Question 11

In patients treated for Squamous cell carcinoma, _____% of these patients will develop new upper aerodigestive tract malignancies, particularly if carcinogenic habits are continued

Answer 11

10-25%

Question 12

_____________ is a less aggressive, relatively uncommon, form of squamous cell carcinoma

Answer 12

Verrucous Carcinoma

Question 13

what group is at the highest risk for Verrucous Carcinoma?

Answer 13

• Usually develops in elderly male patients

Question 14

T/F: smokeless tobacco is a risk factor in the development of Verrucous Carcinoma

Answer 14

FALSE

Question 15

Clinical presentation of Verrucous Carcinoma:

physical appearance, location, spread

Answer 15

• diffuse white or mixed red and white plaque
• Alveolar mucosa, hard palate and buccal mucosa are most frequent sites
• Tends to grow laterally

Question 16

Histological characteristics of Verrucous Carcinoma:

Answer 16

• Microscopically appears very bland
• Often misdiagnosed by pathologists who are not familiar with the features
• Diagnosis is based on the overall architecture of the tumor, rather than on the appearance of individual cells

Question 17

why is radiation therapy not recommended for Verrucous Carcinoma?

Answer 17

due to reports of transformation of verrucous carcinoma to a more aggressive squamous cell carcinoma

Question 18

Approximately ______% of verrucous carcinomas, upon complete excision, show foci of transformation to routine squamous cell carcinoma

Answer 18

20-25