epithelial neoplasms Flashcards
1
Q
which are not epithelial dervied
forms of H/N cancer
A
- Squamous Cell Carcinoma
- Adenocarcinoma
- Lymphoma (not epi)
- Metastatic Carcinoma
- Sarcoma (not epi)
2
Q
SCCa of the oral cavity metastisis?
A
can metastisize to the neck creating a mass
3
Q
lesions on lateral tongue
A
cautious of cancer, esp. SCCa
4
Q
primary etiological agents
Etiology of Oral and Oropharyngeal Carcinoma
A
Primary etiologic agents
* Tobacco
* Alcohol
* Actinic radiation
* Human papilloma virus – HPV
– High risk subtypes: HPV-16 and 18
5
Q
what can lead to SCCa at lips
A
actinic rad from sun
6
Q
what cna cause SCCa of tongue
A
alc and tobacco
7
Q
what can cause SCCa of the oropharynx
A
HPV 16/18
alc
tobacco
8
Q
what can cause SCCa of the nasopharynx
A
EBV
9
Q
Tobacco Pouch Keratosis
A
can be seen on oral mucosa as a bluish grey, can regress with cessation
10
Q
smokless tobacco and ginigiva
A
can cause gingival recession
11
Q
smokless tobacco can lead to what oral cancer?
A
SCCa
12
Q
why?
betel quid can cause what cancer
A
SCCa, due to reactive o2 spp and nitrosamnes
13
Q
actinic damage mainly occurs where
A
lips
14
Q
actinic chelitis
A
present on the lips and is a premalignant condition
15
Q
what can arise from actinic chelitis
A
SCCa
16
Q
when should oral cancer be diagnosed
A
ASAP, improves survival
17
Q
The larger the tumor the higher the incidence of?
A
the higher the incidence of metastasis, meaning decreased survival
18
Q
What Does Oral Squamous Cell Carcinoma Look Like Clinically?
A
- Exophytic or Endophytic
- Leukoplakia, Erythroplakia, or even Erythroleukoplakia
19
Q
- Exophytic SCCa app
A
– Mass-forming
– Fungating
– Papillary
– Verruciform
20
Q
Endophytic SCCa app
A
– Invasive
– Burrowing
– Ulcerated
21
Q
leukoplakia
A
A white patch or plaque that can’t be characterized clinically or pathologically as any other disease.
22
Q
erythroplakia
A
A red patch that can’t be characterized clinically or pathologically as
any other disease.
23
Q
- Erythroleukoplakia
A
– a red-and-white patch
24
Q
Early Diagnosis of Oral Cancer
A
- Identify precursor lesions
– Leukoplakia
– Erythroplakia - Be suspicious - biopsy clinically
suspicious lesions
25
why are leukoplakias white
* Hyperkeratosis - increased opacity
* Acanthosis - increased thickness
* Surface coating - fibrin membrane or fungal hyphae
26
moderate epithelial dysplasia may indicate what?
premalignant condition
27
Morsicatio Buccarum
not a leukoplakia, occurs on the buccal mucosa due to cheek biting
28
What is the likelihood of Leukoplakia being Premalignant?
Rule of thumb: 20% of Leukoplakia will be premalignant
29
why are erythroplakias red
* Thin epithelium
* Red blood cells
30
What is the likelihood of Dysplasia in Erythroplakia?
Rule of thumb: 90% of Erythroplakia will be dysplastic
31
how would this be described?
erythroleukoplakia
32
High Risk Areas for Premalignancy and Malignancy facial/oral
* Lower Lip
* Floor of Mouth
* Ventral Tongue
* Lateral Border of Tongue
* Soft Palate
33
# 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
34
epithelial dysplasia represents what change?
a premalignant change
35
what alterations occur with epithelial dysplasia
Cellular alterations
Architectural alterations
36
stages of epithelial dysplasia
based on thrids
37
# * 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
38
# stage determines?
how are oral SCCa staged
TMN stagng
Tumor size
Metastasis
* Regional lymph nodes
* Distant sites
Stage determines:
* Treatment
* Prognosis
39
tx of H/N SCCa
* Surgery
* Radiation
* Chemotherapy
* Combined therapy
40
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
41
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%
42
side effects of radio tx
rad mucositis
xero
rad caries
osteoradionecrosis
43
failure of local control of SCCa results in?
spread of lesion and death
44
# what to look at
components of oral cancer exam
* Extraoral examination
* Lips
* Buccal mucosa
* Tongue
* Floor of mouth
* Hard palate
* Soft palate and oropharynx
45
extraoral exam
– Inspect head and neck.
– Bimanually palpate lymph nodes and salivary glands
46
lip exam
– Inspect and palpate outer surfaces of lip and vermilion border.
– Inspect and palpate inner labial mucosa.
47
buccal mucosa exam
– Inspect and palpate inner cheek lining.
48
gingiva/ridge exam
– Inspect maxillary/mandibular gingiva and alveolar ridges on both the buccal and lingual aspects.
49
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.
50
floor of mouth exam
Inspect and palpate floor of mouth.
51
soft palate and oropharynx exam
– Gently depressing the patient’s tongue with a mouth mirror or tongue blade, inspect the soft palate and oropharynx.
52
# 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
53
# 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
54
# growth? begins as? becomes?
Proliferative Verrucous Leukoplakia app
* Slow-growing
* Begins as hyperkeratosis
* Spreads to become multifocal and verruciform
55
Proliferative Verrucous Leukoplakia resistance
Resistant to therapy - recurs
56
Proliferative Verrucous Leukoplakia diagnosis is often?
retrospective
57
types of skin cancers
basal cell
Scca
malignant melanoma
58
which skin cancers can also occur orally
Scca and melanomas
59
most common skin cancer
basal cell
60
which skin cancer has no metastasis
BCCa
61
which skin cancer is least common/ most fatal
melanoma
62
# 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
63
can BCCa be fatal
yes can progress without tx
"rodent ulcer"
64
# also called?
freckles
areas of increased melanin
Ephelis/ Ephelides
65
# #melanocytes? most commonly where?
Oral Melanotic Macule
* Focal increase in melanin
* Normal number of melanocytes
* Lower lip vermillion most common
66
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
67
Nevus
* Generic term for a developmental malformation of skin or musosa
68
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
69
Nevus Life Cycle
* Nevi evolve through clinical stages
70
where may melanocytic nevi occur orally?
mucosa
71
blue nevi
* Spindled nevus cells in connective tissue appearing bluish
72
# due to? prognosis based on?
Malignant Melanoma
* Malignant lesion of melanocytic origin
* Acute rather than chronic sun damage
* Prognosis related to depth of invasion
73
melanomas have a tendency to?
metastasize
74
melanomas growth patterns
Melanomas Exhibit Two Directional Patterns of Growth
* Radial Growth Phase - within the epithelium (in situ)
* Vertical Growth Phase – invasion
75
# scales?
prognosis of melanomas correlates to?
Depth of invasion based on:
* Clark’s levels
* Breslow depth
76
# demo, location, possible form?
Oral Mucosal Melanoma
* White adults over 50 years
* Hard palate, maxillary alveolus
* Amelanotic forms possible
77
forms of skin melanomas
nodular and spreading superficial melanomas
