key points OSCC Flashcards
benign nomenclature
-oma
except epithelial neoplasms classified on their microscopic or macroscopic pattern
malignant nomenclature
- carcinoma for epithelial origin
- sarcoma for CT
most common types of oral cancer
SCC
NHL
mucoepidermoid carcinoma
which area has highest prevalence?
southern asia
high risk sites
tonsils (HPV)
tongue (smoking)
base of tongue
FOM
what does OSCC arise from?
oral keratinocytes
high risk sites for OSCC
tongue
FOM
gingiva
high risk sites for OSCC if betel quid chewing
buccal mucosa and gingiva
characteristics of benign tumours
expansive growth rare and typical mitoses no metastasis local consequences variable - compressions no recurrences general consequences none except secretory tumours/particular sites freq stabilisation typical structure
characteristics of malignant tumours
infiltrating growth atypical structure numerous and atypical mitoses metastasis severe local consequences - infiltration, destruction, necrosis constant and severe general consequences always fatal common recurrences
clinical appearance
OPMDs
ulceration
- solitary lesion not healing/responding to conservative
management
- irregular and indurated margins usually
speckled
- ill-defined mixed white red lesions with granular aspects
exophytic growth
- irregular outgrowth with a smooth or verrucopapillary
surface above normal mucosa
- verrucopapillary surface - verrucous carcinoma
subtypes of OSCC
verrucous carcinoma basal SCC papillary SCC spindle cell SCC adenosquamous carcinoma lymphoepithelial carcinoma acantholytic SCC carcinoma cuniculatum
which subtypes have exophytic verruco-papillary component?
verrucous carcinoma
carcinoma cuniculatum
papillary SCC
late clinical features
pain - mostly if ulcerated
trismus (buccal mucosa and infratemporal fossa)
FOM - restriction of tongue mobility, progressive difficulty in mastication and speech, drooling of saliva
gingiva - excessive mobility of involved teeth
tongue base - fullness in throat sensation, dysphagia, lump in neck sensation, voice changes, ear pain
diagnostic pathway
history and exam
histopathology and clinical adjuncts
radiologic imaging
= then grading and staging
predictors of prognosis
grading and staging
grading
cytologic differentiation of cells
how bad do the cells look?
how much do they look like healthy cells under microscope?
staging
where has the cancer spread?
size of primary lesion, LNs, metastases
morphologic features for grading
degree of keratinisation (ideally high)
nuclear polymorphism (ideally little)
number of mitoses (ideally low) - excluded from Bryne system
pattern of invasion (ideally pushing, well-delineated, infiltrating borders)
host response (ideally marked - lymphoplasmacytic infiltrate)
Grade X
differentiation can’t be assessed
Grade 1
well-differentiated
Grade 2
moderately differentiated
Grade 3
poorly differentiated
Grade 4
undifferentiated/anaplastic
how does the grade affect prognosis?
lower grade = better prognosis
predicts how quickly the cancer will spread
staging (TNM)
Tumour T0-4
Node N0-3
Metastasis M0-1
8th edition cancer staging
Tumour thickness TT
DOI
ENE
TT
perpendicular from mucosal surface of tumour to deepest point of tissue invasion
DOI
level of basement membrane adjacent to normal mucosa to deepest point of tumour invasion
>10mm sig increased risk of recurrence and nodal metastasis
elective neck dissection should be consideration for tumours <5mm deep
ENE
extension of metastatic cells through the nodal capsule into the perinodal tissue
what is CT used for?
detecting primary tumour and local bone infiltration
MDCT
precisely determine tumour boundaries
CECT
accurately determine LN metastases
what can’t CT do?
differentiate between recurrences, surgical scars and adverse reactions after radio
imaging without ionising radiation
MRI
US
MRI
good for STs, bone marrow, vessels and nerves
can detect local LN and distant metastases
US
evaluate superficial lesions, LNs and to guide FNAB
with colour doppler can use US to determine type of blood vascularity in a lesion, often increasing the specificity of diagnosis
PET-CT
can use to look for primary tumour site when metastases are found earlier (CUP)
may detect malignancy in structures which appear normal/difficult to assess on CT/MRI e.g. small vol LN metastases
routinely used to detect recurrence and distant metastasis of known primary tumours, as well as 2nd primary tumours
recommended in advanced cancer stages and the whole body imaging improves analysis of TMN
cTMN
estimate of cancer based on results of physical exams, imaging, endoscopy, biopsy, done before tx starts
pTNM
relies on results of exams and tests before surgery, as well as what is learned about cancer during surgery
gives more precise info, can be used to help determine what other txs might be needed, as well as to help predict tx response and outcomes (prognosis)
first stage before imaging
establish primary site and any neck metastases clinically and have histological diagnosis
role of radiology
accurately stage full extent and distant spread with TNM
T groupings
TX Tis T1 T2 T3 T4a T4b
N groupings
NX N0 N1 N2a N2b N2c N3a N3b