epithelial neoplasms Flashcards
which are not epithelial dervied
forms of H/N cancer
- Squamous Cell Carcinoma
- Adenocarcinoma
- Lymphoma (not epi)
- Metastatic Carcinoma
- Sarcoma (not epi)
SCCa of the oral cavity metastisis?
can metastisize to the neck creating a mass
lesions on lateral tongue
cautious of cancer, esp. SCCa
primary etiological agents
Etiology of Oral and Oropharyngeal Carcinoma
Primary etiologic agents
* Tobacco
* Alcohol
* Actinic radiation
* Human papilloma virus – HPV
– High risk subtypes: HPV-16 and 18
what can lead to SCCa at lips
actinic rad from sun
what cna cause SCCa of tongue
alc and tobacco
what can cause SCCa of the oropharynx
HPV 16/18
alc
tobacco
what can cause SCCa of the nasopharynx
EBV
Tobacco Pouch Keratosis
can be seen on oral mucosa as a bluish grey, can regress with cessation
smokless tobacco and ginigiva
can cause gingival recession
smokless tobacco can lead to what oral cancer?
SCCa
why?
betel quid can cause what cancer
SCCa, due to reactive o2 spp and nitrosamnes
actinic damage mainly occurs where
lips
actinic chelitis
present on the lips and is a premalignant condition
what can arise from actinic chelitis
SCCa
when should oral cancer be diagnosed
ASAP, improves survival
The larger the tumor the higher the incidence of?
the higher the incidence of metastasis, meaning decreased survival
What Does Oral Squamous Cell Carcinoma Look Like Clinically?
- Exophytic or Endophytic
- Leukoplakia, Erythroplakia, or even Erythroleukoplakia
- Exophytic SCCa app
– Mass-forming
– Fungating
– Papillary
– Verruciform
Endophytic SCCa app
– Invasive
– Burrowing
– Ulcerated
leukoplakia
A white patch or plaque that can’t be characterized clinically or pathologically as any other disease.
erythroplakia
A red patch that can’t be characterized clinically or pathologically as
any other disease.
- Erythroleukoplakia
– a red-and-white patch
Early Diagnosis of Oral Cancer
- Identify precursor lesions
– Leukoplakia
– Erythroplakia - Be suspicious - biopsy clinically
suspicious lesions
why are leukoplakias white
- Hyperkeratosis - increased opacity
- Acanthosis - increased thickness
- Surface coating - fibrin membrane or fungal hyphae
moderate epithelial dysplasia may indicate what?
premalignant condition
Morsicatio Buccarum
not a leukoplakia, occurs on the buccal mucosa due to cheek biting
What is the likelihood of Leukoplakia being Premalignant?
Rule of thumb: 20% of Leukoplakia will be premalignant
why are erythroplakias red
- Thin epithelium
- Red blood cells
What is the likelihood of Dysplasia in Erythroplakia?
Rule of thumb: 90% of Erythroplakia will be dysplastic
how would this be described?
erythroleukoplakia
High Risk Areas for Premalignancy and Malignancy facial/oral
- Lower Lip
- Floor of Mouth
- Ventral Tongue
- Lateral Border of Tongue
- Soft Palate
what is req for this
Diagnosis of Oral Squamous Cell Carcinoma
- Incisional or excisional biopsy is required for definitive diagnosis, get suff amount of tissue
epithelial dysplasia represents what change?
a premalignant change
what alterations occur with epithelial dysplasia
Cellular alterations
Architectural alterations
stages of epithelial dysplasia
based on thrids
* Size, Shape, Proliferation, Keratinization, Maturation
Cytologic and Architectural Features of Squamous Epithelial Dysplasia
- Size– N/C Ratio
- Shape– Pleomorphism
- Proliferation
– Hyperchromatism
– Mitotic figures
– Abnormal mitoses - Keratinization
– Dyskeratosis - Maturation
– Loss of cohesion
– Loss of polarity
– Rete-ridge architecture
stage determines?
how are oral SCCa staged
TMN stagng
Tumor size
Metastasis
* Regional lymph nodes
* Distant sites
Stage determines:
* Treatment
* Prognosis
tx of H/N SCCa
- Surgery
- Radiation
- Chemotherapy
- Combined therapy
tx planning for H/N SCCa
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
Oral Cavity Cancer Five-Year Survival by Stage: combined (local, regional, distant metastasis)
- All stages combined 59%
– Local disease 81%
– Regional metastasis 51%
– Distant metastasis 30%
side effects of radio tx
rad mucositis
xero
rad caries
osteoradionecrosis
failure of local control of SCCa results in?
spread of lesion and death
what to look at
components of oral cancer exam
- Extraoral examination
- Lips
- Buccal mucosa
- Tongue
- Floor of mouth
- Hard palate
- Soft palate and oropharynx
extraoral exam
– Inspect head and neck.
– Bimanually palpate lymph nodes and salivary glands
lip exam
– Inspect and palpate outer surfaces of lip and vermilion border.
– Inspect and palpate inner labial mucosa.
buccal mucosa exam
– Inspect and palpate inner cheek lining.
gingiva/ridge exam
– Inspect maxillary/mandibular gingiva and alveolar ridges on both the buccal and lingual aspects.
tongue exam
– 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 exam
Inspect and palpate floor of mouth.
soft palate and oropharynx exam
– Gently depressing the patient’s tongue with a mouth mirror or tongue blade, inspect the soft palate and oropharynx.
variant, invasive, cyto, associated with?
Verrucous Carcinoma
- Low-grade variant of squamous cell carcinoma
- Locally invasive, no metastasis
- Cytologically bland, no real issues
- Clinicopathologic correlation
- Associated with smokeless
tobacco
potential for? associations? demo?
Proliferative Verrucous Leukoplakia
High-risk, aggressive type of oral leukoplakia
* High potential for malignant transformation
* Not associated with tobacco use
* Women outnumber men
growth? begins as? becomes?
Proliferative Verrucous Leukoplakia app
- Slow-growing
- Begins as hyperkeratosis
- Spreads to become multifocal and verruciform
Proliferative Verrucous Leukoplakia resistance
Resistant to therapy - recurs
Proliferative Verrucous Leukoplakia diagnosis is often?
retrospective
types of skin cancers
basal cell
Scca
malignant melanoma
which skin cancers can also occur orally
Scca and melanomas
most common skin cancer
basal cell
which skin cancer has no metastasis
BCCa
which skin cancer is least common/ most fatal
melanoma
common? where? invasive? metas? arises from?
BCCa
- 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
can BCCa be fatal
yes can progress without tx
“rodent ulcer”
also called?
freckles
areas of increased melanin
Ephelis/ Ephelides
#melanocytes? most commonly where?
Oral Melanotic Macule
- Focal increase in melanin
- Normal number of melanocytes
- Lower lip vermillion most common
ABCDE Clinical Features of Melanoma
- 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
- evolving: changing shape
Nevus
- Generic term for a developmental malformation of skin or musosa
Acquired Melanocytic Nevi
- 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
where may melanocytic nevi occur orally?
mucosa
blue nevi
- Spindled nevus cells in connective tissue appearing bluish
due to? prognosis based on?
Malignant Melanoma
- Malignant lesion of melanocytic origin
- Acute rather than chronic sun damage
- Prognosis related to depth of invasion
melanomas have a tendency to?
metastasize
melanomas growth patterns
Melanomas Exhibit Two Directional Patterns of Growth
* Radial Growth Phase - within the epithelium (in situ)
* Vertical Growth Phase – invasion
scales?
prognosis of melanomas correlates to?
Depth of invasion based on:
* Clark’s levels
* Breslow depth
demo, location, possible form?
Oral Mucosal Melanoma
- White adults over 50 years
- Hard palate, maxillary alveolus
- Amelanotic forms possible
forms of skin melanomas
nodular and spreading superficial melanomas
