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PATH II > epithelial neoplasms > Flashcards

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)
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2
Q

SCCa of the oral cavity metastisis?

A

can metastisize to the neck creating a mass

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3
Q

lesions on lateral tongue

A

cautious of cancer, esp. SCCa

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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

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5
Q

what can lead to SCCa at lips

A

actinic rad from sun

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6
Q

what cna cause SCCa of tongue

A

alc and tobacco

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7
Q

what can cause SCCa of the oropharynx

A

HPV 16/18
alc
tobacco

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8
Q

what can cause SCCa of the nasopharynx

A

EBV

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9
Q

Tobacco Pouch Keratosis

A

can be seen on oral mucosa as a bluish grey, can regress with cessation

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10
Q

smokless tobacco and ginigiva

A

can cause gingival recession

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11
Q

smokless tobacco can lead to what oral cancer?

A

SCCa

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12
Q

why?

betel quid can cause what cancer

A

SCCa, due to reactive o2 spp and nitrosamnes

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13
Q

actinic damage mainly occurs where

A

lips

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14
Q

actinic chelitis

A

present on the lips and is a premalignant condition

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15
Q

what can arise from actinic chelitis

A

SCCa

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16
Q

when should oral cancer be diagnosed

A

ASAP, improves survival

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17
Q

The larger the tumor the higher the incidence of?

A

the higher the incidence of metastasis, meaning decreased survival

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18
Q

What Does Oral Squamous Cell Carcinoma Look Like Clinically?

A
  • Exophytic or Endophytic
  • Leukoplakia, Erythroplakia, or even Erythroleukoplakia
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19
Q
  • Exophytic SCCa app
A

– Mass-forming
– Fungating
– Papillary
– Verruciform

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20
Q

Endophytic SCCa app

A

– Invasive
– Burrowing
– Ulcerated

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21
Q

leukoplakia

A

A white patch or plaque that can’t be characterized clinically or pathologically as any other disease.

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22
Q

erythroplakia

A

A red patch that can’t be characterized clinically or pathologically as
any other disease.

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23
Q
  • Erythroleukoplakia
A

– a red-and-white patch

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24
Q

Early Diagnosis of Oral Cancer

A
  • Identify precursor lesions
    – Leukoplakia
    – Erythroplakia
  • Be suspicious - biopsy clinically
    suspicious lesions
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25
Q

why are leukoplakias white

A
  • Hyperkeratosis - increased opacity
  • Acanthosis - increased thickness
  • Surface coating - fibrin membrane or fungal hyphae
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26
Q

moderate epithelial dysplasia may indicate what?

A

premalignant condition

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27
Q

Morsicatio Buccarum

A

not a leukoplakia, occurs on the buccal mucosa due to cheek biting

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28
Q

What is the likelihood of Leukoplakia being Premalignant?

A

Rule of thumb: 20% of Leukoplakia will be premalignant

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29
Q

why are erythroplakias red

A
  • Thin epithelium
  • Red blood cells
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30
Q

What is the likelihood of Dysplasia in Erythroplakia?

A

Rule of thumb: 90% of Erythroplakia will be dysplastic

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31
Q

how would this be described?

A

erythroleukoplakia

32
Q

High Risk Areas for Premalignancy and Malignancy facial/oral

A
  • Lower Lip
  • Floor of Mouth
  • Ventral Tongue
  • Lateral Border of Tongue
  • Soft Palate
33
Q

what is req for this

Diagnosis of Oral Squamous Cell Carcinoma

A
  • Incisional or excisional biopsy is required for definitive diagnosis, get suff amount of tissue
34
Q

epithelial dysplasia represents what change?

A

a premalignant change

35
Q

what alterations occur with epithelial dysplasia

A

Cellular alterations
Architectural alterations

36
Q

stages of epithelial dysplasia

A

based on thrids

37
Q

* Size, Shape, Proliferation, Keratinization, Maturation

Cytologic and Architectural Features of Squamous Epithelial Dysplasia

A
  • 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
Q

stage determines?

how are oral SCCa staged

A

TMN stagng
Tumor size
Metastasis
* Regional lymph nodes
* Distant sites

Stage determines:
* Treatment
* Prognosis

39
Q

tx of H/N SCCa

A
  • Surgery
  • Radiation
  • Chemotherapy
  • Combined therapy
40
Q

tx planning for H/N SCCa

A

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
Q

Oral Cavity Cancer Five-Year Survival by Stage: combined (local, regional, distant metastasis)

A
  • All stages combined 59%
    – Local disease 81%
    – Regional metastasis 51%
    – Distant metastasis 30%
42
Q

side effects of radio tx

A

rad mucositis
xero
rad caries
osteoradionecrosis

43
Q

failure of local control of SCCa results in?

A

spread of lesion and death

44
Q

what to look at

components of oral cancer exam

A
  • Extraoral examination
  • Lips
  • Buccal mucosa
  • Tongue
  • Floor of mouth
  • Hard palate
  • Soft palate and oropharynx
45
Q

extraoral exam

A

– Inspect head and neck.
– Bimanually palpate lymph nodes and salivary glands

46
Q

lip exam

A

– Inspect and palpate outer surfaces of lip and vermilion border.
– Inspect and palpate inner labial mucosa.

47
Q

buccal mucosa exam

A

– Inspect and palpate inner cheek lining.

48
Q

gingiva/ridge exam

A

– Inspect maxillary/mandibular gingiva and alveolar ridges on both the buccal and lingual aspects.

49
Q

tongue exam

A

– 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
Q

floor of mouth exam

A

Inspect and palpate floor of mouth.

51
Q

soft palate and oropharynx exam

A

– Gently depressing the patient’s tongue with a mouth mirror or tongue blade, inspect the soft palate and oropharynx.

52
Q

variant, invasive, cyto, associated with?

Verrucous Carcinoma

A
  • Low-grade variant of squamous cell carcinoma
  • Locally invasive, no metastasis
  • Cytologically bland, no real issues
  • Clinicopathologic correlation
  • Associated with smokeless
    tobacco
53
Q

potential for? associations? demo?

Proliferative Verrucous Leukoplakia

A

High-risk, aggressive type of oral leukoplakia
* High potential for malignant transformation
* Not associated with tobacco use
* Women outnumber men

54
Q

growth? begins as? becomes?

Proliferative Verrucous Leukoplakia app

A
  • Slow-growing
  • Begins as hyperkeratosis
  • Spreads to become multifocal and verruciform
55
Q

Proliferative Verrucous Leukoplakia resistance

A

Resistant to therapy - recurs

56
Q

Proliferative Verrucous Leukoplakia diagnosis is often?

A

retrospective

57
Q

types of skin cancers

A

basal cell
Scca
malignant melanoma

58
Q

which skin cancers can also occur orally

A

Scca and melanomas

59
Q

most common skin cancer

A

basal cell

60
Q

which skin cancer has no metastasis

A

BCCa

61
Q

which skin cancer is least common/ most fatal

A

melanoma

62
Q

common? where? invasive? metas? arises from?

BCCa

A
  • 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
Q

can BCCa be fatal

A

yes can progress without tx
“rodent ulcer”

64
Q

also called?

freckles

A

areas of increased melanin
Ephelis/ Ephelides

65
Q

#melanocytes? most commonly where?

Oral Melanotic Macule

A
  • Focal increase in melanin
  • Normal number of melanocytes
  • Lower lip vermillion most common
66
Q

ABCDE Clinical Features of Melanoma

A
  • 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
Q

Nevus

A
  • Generic term for a developmental malformation of skin or musosa
68
Q

Acquired Melanocytic Nevi

A
  • A benign proliferation of nevus cells that develops during
    childhood and evolves through clinical stages (nevus life cycle)
  • Less than 6 mm
69
Q

Nevus Life Cycle

A
  • Nevi evolve through clinical stages
70
Q

where may melanocytic nevi occur orally?

A

mucosa

71
Q

blue nevi

A
  • Spindled nevus cells in connective tissue appearing bluish
72
Q

due to? prognosis based on?

Malignant Melanoma

A
  • Malignant lesion of melanocytic origin
  • Acute rather than chronic sun damage
  • Prognosis related to depth of invasion
73
Q

melanomas have a tendency to?

A

metastasize

74
Q

melanomas growth patterns

A

Melanomas Exhibit Two Directional Patterns of Growth
* Radial Growth Phase - within the epithelium (in situ)
* Vertical Growth Phase – invasion

75
Q

scales?

prognosis of melanomas correlates to?

A

Depth of invasion based on:
* Clark’s levels
* Breslow depth

76
Q

demo, location, possible form?

Oral Mucosal Melanoma

A
  • White adults over 50 years
  • Hard palate, maxillary alveolus
  • Amelanotic forms possible
77
Q

forms of skin melanomas

A

nodular and spreading superficial melanomas

PATH II (25 decks)

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