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Neoplasia > Lectures 5-6 > Flashcards

Lectures 5-6 Flashcards

1
Q

HPV16 is strongly associated with what type of cancer?

A

Oropharyngeal

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2
Q

Which cancers are the oncogenic subtypes?

A

16,18,21,33

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3
Q

What are the 4 sites where H&N cancer is found?

A

Oral cavity, oropharynx, hypo pharynx, larynx.

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4
Q

What triples the odds of development oropharyngeal SCC?

A

6+ oral sex partners or a high lifetime number of vaginal sex partners (>26) triples the odds of developing oropharygneal SCC.

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5
Q

What is the trend of HPV and incidence of oral cancer?

A

Incidence of HPV related oral SCC increased significantly, HPV unrelated cancers decreased. Virus related cancers diagnosed earlier.

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6
Q

What is the greatest risk factor of HPV and oral cancer?

A

Sexual contact with HPV+ person.

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7
Q

Who tends to get HPV+ oropharyngeal cancer?

A

White, male, non-smoker, non-drinkers.

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8
Q

SCC Clinical features

A
  • Exophytic (fumigating, papillary, verruciform)
  • Endophytic (invasive, ulcerated, burrowing)
  • Leukoplakia
  • Erythroplakia
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9
Q

SCC Clinical features

A

SCC Clinical features

  • Older males
  • Vermillion of lip
  • Intraoral sites: tongue PL and V, floor of mouth (more common in men), soft palate, gingiva, buccal mucosa, labial mucosa, hard palate.
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10
Q

Lip vermillion SCC affects who? Why? Appearance? Typical location? Growth rate?

A

Light skinned. Long term or sudden severe exposure to UV. Crusted, oozing, non tender, indurated ulcer, <1cm. 90% located on the lower lip. Slow growth rate; metastasis occurs late.

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11
Q

Where does tongue intraoral SCC occur?

A

Intraoral SCC mostly occurs on the tongue (50% of all intraoral SCC). Usually painless, indurated masses or ulcer in PL tongue. 20% anterior lateral or ventral. Dorsum rare 4%. Young patients.

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12
Q

Level of danger of where SCC occurs intraorally?

A

Tongue —> floor of mouth —> gingiva

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13
Q

True or False. Floor of the mouth intraoral SCC Comprises 35% of all intramural SCC. More common in males. Most likely to arise from pre-existing leukoplakia, erythroplakia.

A

True

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14
Q

Intraoral gingival SCC

A
  • Mimic inflammatory/reactive lesions
  • May resemble inflammatory fibrous hyperplasia if edentulous
  • May resemble periodontal disease or pyogenic granuloma
  • Female predilection
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15
Q

Verrucous carcinoma

A
  • Malignancy of older individuals
  • Unlike SCC: low metastatic potential, exophytic, slow growing
  • Etiology: tobacco, linked to HPV 16,18
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16
Q

What are the clinical features of verrucous carcinoma and what is the treatment?

A

Exophytic papillary proliferation. Location: mandibular vestibule, buccal mucosa, and hard palate. Treatment: excision and radiation.

17
Q

Specificity and Sensittivity definitions..

A

Specificity: false negative and false positive results do not occur
Sensitivity: if cancer is present it will be detected

18
Q

What are the high risk sites for a clinical exam?

A

VL tongue, lips, floor of the mouth, soft palate

19
Q

What is a disadvantage of the clinical exam?

A

It does not tell you what the lesion is, only whether further investigation is warranted.

20
Q

Oral Cdx Brush Biopsy Indications:

A
  • assessment of “minimally suspicious” white lesions in low risk sites
  • NOT for submucosal, pigmented, suspected inflammatory or ulcerated lesions
  • Severely medically compromised pt who may be at risk for a conventional biopsy
  • Monitor suspicious areas in pt with previous oral cancer
  • Non-compliant pt who may not return for follow-up
  • Pt with multiple lesions
21
Q

Oral Cdx Brush Biopsy

A
  • Uses a special barb brush to take sample of disaggregated cells from all layers of epithelium including basal cell layer
22
Q

Which results of Cdx require surgical biopsy?

A

Atypical (abnormal epithelial cells of uncertain significance) and Positive (unequivocal evidence of dysplasia or carcinoma)

23
Q

What are the brush biopsy disadvantages?

A
  • Does NOT tell you what the lesion is
  • NO 2D eval of epithelial architecture
  • Trauma, inflammation can produce “reactive epithelial atypia” (not sure dysplasia)
  • Cost to the pt
  • All “negative” lesions require same careful clinical follow up.
24
Q

Toluidine Blue (Oratest)

A
  • Screening test to assess clinically suspicious lesions and used to help map biopsy sites
  • NOT a diagnostic test; will not tell you what “lesion” is
  • FDA approved in conjunction with Vizilite
25
Q

Indications for Toluidine Blue:

A
  • Monitoring of suspicious lesions that have baseline histopathological valuation
  • Screening in high risk individuals
  • Routine follow-up of pt with history of oral cancer
  • Determining optimal biopsy site for large, heterogenous lesions
26
Q

What is the mechanism of toluidine blue?

A
  • Selectively binds free anionic groups like phosphate groups of DNA
  • Actively dividing cells have more free phosphate groups
  • 1% toluidine stains epithelial surfaces blue
  • Stain is lost after treatment with 1% acetic acid solution
  • Premalignant and malignant lesions are not decolorized by acetic acid!!!!!
  • Blue = bad
27
Q

What are the disadvantages of Toluidine Blue?

A

Areas of inflammation, irritation, ulceration, and dorsum of tongue —> stain blue
Screening low risk populations with no clinically suspicious areas NOT recommended.
Retest areas that stain in 14 days to allow transient inflammatory lesions to heal.
ONLY for epithelial lesions
Negative staining does NOT: r/o presence of a cancerous lesion, preclude need for scalpel Bx if clinical presentation warrants
Works well on erythroplakias but NOT leukoplakia. May be better than visual acuity but does not identify true margins of the lesion/field.

28
Q

What is Vizilite?

A

screening test “whether Bx needed”, “where to do Bx”, Detect lesions not seen under visible light?, not a diagnostic test.

29
Q

Vizilite background:

A
  • Similar to colposcopy (acetowhite test): used in detection of uterine cervical dysplasias and carcinoma
  • Tells you which areas to Bx
  • May help better define areas populated by cells with increased amounts of DNA
  • FDA approved
30
Q

Vizilite Procedure:

A
  • Examination of oral cavity with single use “chemiluminescent” light
  • Rinse with acetic acid solution for 1 minute (disrupts glycoprotein barrier present on mucosal surfaces)
  • Turn operators lights off
  • Activate chemiluminescent light
  • Examine oral cavity
  • Epithelium with increased keratinization and/or higher N:C ratio reflects the light!!!!
  • Lesions appear white “acetowhite”
31
Q

Vizlite Disadvantages

A
  • Efficacy in oral cavity unknown
    • readings can be caused by minor epithelial abnormalities e.g. inflammation, irritation, ulceration, linea albea.
    • test does not mean that dysplasia or SCC is not present
  • Cost
32
Q

VELscope: fluorescence visualization in oral cavity

A
  • Takes 1-2 min
  • Adjunct to clinical exam. Good baseline of understanding of normal is essential
  • For surgeon to help identify margins (clinically)
  • No rinses or stains
  • FDA approved
33
Q

VELscope procedure:

A
  • Conduct thorough oral exam
  • Repeat oral exam with VELscope handpiece 2 inches from tissue
  • Normal tissue is green. Abnormal dark.
  • Re-evaluate suspicious areas under white light
  • Follow up after two weeks or refer
34
Q

VELscope Results:

A

Suspicious areas are

  • Very dark
  • High risk location
  • Unilateral presentation
  • Asymmetry, irregular shape
35
Q

VELScope Disadvantages:

A
  • Inflammation/irritation - appears dark due to blood. Try blanching while viewing
  • Buccal mucosa, lateral tongue, hard palate, anterior tonsillar pillars, attached gingiva
  • Hyperkeratosis
  • Pigmented areas

Neoplasia (3 decks)

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