Epithelial Neoplasms Flashcards
Head and Neck Cancer
(5)
- Squamous Cell Carcinoma
- Adenocarcinoma
- Lymphoma
- Metastatic Carcinoma
- Sarcoma
Etiology of Oral and Oropharyngeal Carcinoma
Primary etiologic agents
(4)
- Tobacco
- Alcohol
- Actinic radiation
- Human papilloma virus – HPV
– High risk subtypes: HPV-16 and 18
HPV-(2) are low-risk subtypes associated with genital warts
6 and 11
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Betel Quid - Paan
(5)
- Areca nut
- Betel leaf
- Lime
- Reactive Oxygen Species
- Nitrosamines
Early Diagnosis of Oral Cancer Improves Survival
* The larger the tumor the —
the incidence of metastasis
* The occurrence of metastasis
— survival
higher
decreases
What Does Oral Squamous Cell Carcinoma Look Like Clinically?
(5)
- Exophytic
- Endophytic
- Leukoplakia – a white patch
- Erythroplakia – a red patch
- Erythroleukoplakia – a red-and-white patch
- Exophytic
(4)
– Mass-forming
– Fungating
– Papillary
– Verruciform
- Endophytic
(3)
– Invasive
– Burrowing
– Ulcerated
Early Diagnosis of Oral Cancer
Identify precursor lesions
(2)
– Leukoplakia
– Erythroplakia
* Be suspicious - biopsy clinically
suspicious lesions
Leukoplakia
A white patch or plaque that can’t be characterized clinically or
pathologically as any other disease.
Why are White Lesions White?
(3)
- Hyperkeratosis
- Acanthosis
- Surface coating
- Hyperkeratosis -
increased opacity
- Acanthosis -
increased thickness
- Surface coating -
fibrin membrane
or fungal hyphae
What is the likelihood of Leukoplakia being Premalignant?
Rule of thumb: —% of Leukoplakia will be premalignant
20
Erythroplakia
A red patch that can’t be characterized clinically or pathologically as
any other disease.
Why are Red Lesions Red?
(2)
Thin epithelium
* Red blood cells
What is the likelihood of Dysplasia in Erythroplakia?
Rule of thumb: —% of Erythroplakia will be dysplastic
90
High Risk Areas for Premalignancy and Malignancy
(5)
- Lower Lip **
- Floor of Mouth
- Ventral Tongue
- Lateral Border of Tongue
- Soft Palate
Diagnosis of Oral Squamous Cell Carcinoma
* — is
required for definitive diagnosis
Incisional or excisional biopsy
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Epithelial Dysplasia - Premalignant Change
(2)
- Cellular alterations
- Architectural alterations
Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Size
(1)
– N/C Ratio
Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Shape
(1)
– Pleomorphism
Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Proliferation
(3)
– Hyperchromatism
– Mitotic figures
– Abnormal mitoses
Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Keratinization
(1)
– Dyskeratosis
Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Maturation
(3)
– Loss of cohesion
– Loss of polarity
– Rete-ridge architecture
Oral Squamous Cell Carcinoma Staging: TNM Classification
Tumor size
Metastasis
Stage determines:
Metastasis
(2)
- Regional lymph
nodes - Distant sites
Stage determines:
(2)
- Treatment
- Prognosis
Treatment of Head and Neck Squamous Cell Carcinoma
(4)
- Surgery
- Radiation
- Chemotherapy
- Combined therapy
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Multidisciplinary Head and Neck Tumor Board for Treatment Planning
- Surgical oncologist
- Medical oncologist
- Radiation oncologist
- Radiologist
- Pathologist
- Dentists
– Oral surgeon
– Maxillofacial prosthodontist - Speech pathologist
- Social worker
- Physical therapist
- Occupational therapist
Oral Cavity Cancer Five Year Survival by Stage - ACS
* All stages combined —%
– Local disease —%
– Regional metastasis —%
– Distant metastasis —%
59
81
51
30
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Components of an Oral Cancer
(8)
- Extraoral examination– Inspect head and neck.– Bimanually palpate lymph nodes and salivary glands.
- Lips– Inspect and palpate outer surfaces of lip and vermilion border.– Inspect and palpate inner labial mucosa.
- Buccal mucosa– Inspect and palpate inner cheek lining.
- Gingiva/alveolar ridge– Inspect maxillary/mandibular gingiva and alveolar ridges on both the buccal and lingual aspects.
- Tongue– Have patient protrude tongue and inspect the dorsal surface.– Have patient lift tongue and inspect the ventral surface.– Grasping tongue with a piece of gauze and pulling it out to each side, inspect the lateral borders of the tongue from its tip back to the lingual tonsil region.– Palpate tongue.
- Floor of mouth– Inspect and palpate floor of mouth.
- Hard palate– Inspect hard palate.
- Soft palate and oropharynx– Gently depressing the patient’s tongue with a mouth mirror or tongue blade, inspect the soft palate and oropharynx.
Verrucous Carcinoma
(5)
- Low-grade variant
of squamous cell carcinoma - Locally invasive, no metastasis
- Cytologically bland
- Clinicopathologic correlation
- Associated with smokeless
tobacco
Proliferative Verrucous Leukoplakia
(10)
- High-risk, aggressive type
of oral leukoplakia - High potential for
malignant transformation - Not associated with
tobacco use - Women outnumber men
- Slow-growing
- Begins as hyperkeratosis
- Spreads to become multifocal
and verruciform - Resistant to therapy - recurs
- Malignant transformation
- Diagnosis often retrospective
skin cancers
(3)
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Malignant Melanoma
- Basal Cell Carcinoma
(2)
- Most common
– No metastasis
- Malignant Melanoma
(2)
- Least common
– Most deaths
Basal Cell Carcinoma
(5)
- Most common skin cancer
- Sun-exposed skin of adults
with fair complexions - Locally invasive
- Metastasis extremely rare
- Arises from basal cell layer
and skin appendages
Oral Melanotic Macule
(3)
- Focal increase in melanin
- Normal number of melanocytes
- Lower lip vermillion most common
ABCD Clinical Features of Melanoma
- A Asymmetry
- B Border irregularity
- C Color variegation
- D Diameter
E Changing
- A Asymmetry
- Uncontrolled growth pattern
- B Border irregularity
- Often with notching
- C Color variegation
- Amount and depth of melanin
- Brown, black, red, white and blue
- D Diameter
- Diameter greater than 6mm
Nevus
(7)
- Generic term for a
developmental
malformation of skin or
musosa - Melanocytic nevus
- Epithelial nevus
- Vascular nevus
- Basal cell nevus
- White sponge nevus
- Sebaceous nevus
Acquired Melanocytic Nevi
(2)
- A benign proliferation
of nevus cells that
develops during
childhood and evolves
through clinical stages
(nevus life cycle) - Less than 6 mm
Nevus Life Cycle
* Nevi evolve through
clinical stages
Malignant Melanoma
(3)
- Malignant lesion of
melanocytic origin - Acute rather than
chronic sun damage - Prognosis related to
depth of invasion
Melanomas Exhibit Two Directional Patterns of Growth
(2)
- Radial Growth Phase - within the epithelium (in situ)
- Vertical Growth Phase – invasion
Prognosis of Malignant Melanoma correlates with Depth of invasion
(2)
- Clark’s levels
- Breslow depth
Oral Mucosal Melanoma
(3)
- White adults over 50 years
- Hard palate, maxillary alveolus
- Amelanotic forms
