L23 Oral cancer: clinical presentation and importance of early diagnosis Flashcards
Name some promoters of malignancy.
- Cigarettes, cigars, pipes
- Chew/spit tobacco
- Snuff (very low risk)
- Paan
- Alcohol
What are the effects of Paan on the oral mucosa?
- Paan contains betel/areca nut and tobacco
- Can cause oral submucous fibrosis: tissues become hard and stuff with a mottled marbling appearace
- Seen on the buccal mucosa and palate
What is snus?
- Small sachets of tobacco held in the labial sulcus
- Low risk of malignant transformation orally, but has been linked to other malignancy (stomach cancer)
- Causes a hyperkeratotic lesion aka tobacco pouch keratosis
Is alcohol associated with oral cancer?
- Alcohol is implicated in oral squamous cell carcinoma
- Can be challenging to isolate the independent effects of alcohol on oral cancer separate to those of tobacco as they are often consumed together
- Greatest effect may be in the pharynx/oropharynx
- Alcohol and tobacco combined is extremely high risk
What are the effects of alcohol on the mucosa?
- Alcohol increases mucosal permeability
- Theorised that this permeability allows carcinogens through the epithelium
Why are younger people getting oral and oropharyngeal cancer?
HPV infection
What has caused these palatal lesions?
Reverse smoking
What are the 2 different types of biopsy?
- Incisional biopsy: sampling the lesion for investigation and diagnosis
- Excisional biopsy: excising the lesion entirely
NB: biopsy is the gold standard for diagnosis
What are the features of dysplasia?
- Basal cell crowding
- Drop-shaped rete ridges
- Loss of basal cell polarity
- Nuclear hyperchromatism
- Nuclear polymorphism
- Increased nuclear-cytoplasmic ratio
- Suprabasal mitoses
- Bizarre mitoses
- Inflammatory reaction
How are dyplasias categorised?
- Mild
- Moderate
- Severe
One system classifies according to the amount of dysplastic features evident, another classifies according to the distribution of the altered cells.
How should dysplastic lesions be managed?
Clinicians are not 100% certain about how to manage dysplasias, but current recommendations are:
- Stop any associated habits
- Treat infections/deficiency where applicable
- Biopsy to assess degree of dysplasia
- Assess risk of change of clinical & histological grounds
- Maintain regular observation & review
- Consider ablation of lesions : Evidence is poor in relation to management of dysplasia, most surgeons would recommend excision and outcomes may/may not be affected
What guidelines are followed for suspected oral cancer?
NICE (2015)
Why is an early diagnosis important?
Improves chances of survival.
Once cancer spreads to lymph nodes chance of survival is signifcantly decreased.
How do patient related factors impact prognosis?
How do tumour related factors impact prognosis?
- Site: further back in the oropharynx = worse prognosis
- Stage
- Tumour thickness: >5mm strong predictor of nodal metastasis
- Extracapsular (extranodal spread) lymph node spread: associated with higher local recurrence rates, distant metastases, lower survival rate
- Histologic differentiation: poorer differentiation of tumour correlated with poorer prognosis (not always)
