Neoplasm and cancer Flashcards
Define neoplasm/ cancer, benign and malignant
- Neoplasia literally means “new growth”, and the collection of cells composing new growths are referred to as neoplasms
- Cancerous cells grow and divide uncontrollably, invading local structures. This can occur because of mutagenic events
- Neoplasms may be benign (not cancer) or malignant (cancer)
- A tumor is said to be benign when its microscopic and gross characteristics are considered to be relatively innocent implying that it will remain localized and is amenable to local surgical removal
- Malignant implies that the lesion can invade and destroy adjacent structures or travel to distant sites in the body
Differentiate benign and malignant tumours based on characteristics
Benign • Resemble tissue of original and well differentiated • Grow slowly • Well circumscribed and have a capsule • Remain localised to site of origin
Malignant
• Poorly differentiated
• Grow very fast
• Poorly circumscribed and invade into normal tissues
• Locally invasive and metastasize to distant sites
List 6 architectural dysplastic changes
- Irregular epithelial stratification
- Basal cell hyperplasia
- Drop shaped rete ridges
- Increased mitotic figures
- Premature keratinisation of single cells
- Keratin pearls within rete ridges
List three ways cancers can spread and how cancer can kill people
- Through blood
- Through lymphatics
- Through nerves (perineural)
Kills by:
• Asphyxiation
• Destroying essential organs
• Exsanguination
Understand the nomenclature of benign tumours
- Affects mesenchymal cells
- The suffix “-oma” is attached to the name of the cell type from which the tumor arises. For example, a benign tumor of fibroblast-like cells is called a fibroma, a benign cartilaginous tumor is a chondroma
Describe lipoma
- Benign tumour of adipose tissue
- Rare
- Slow growing, yellowish, semifluctuant, painless mass usually on buccal mucosa
- Investigations: can biopsy to differentiate from other swellings
- Treatment: Excision
Describe benign epithelial tumours and thus describe papillomas
- Adenoma is applied to benign epithelial neoplasms derived from glandular tissues even if the tumor cells fail to form glandular structures
- Benign epithelial neoplasms producing finger-like or warty projections from epithelial surfaces are called papillomas
- Papillomas are HPV associated found in the 20-50yr age group
- Clinical commonly papillated, asymptomatic, pedunculated , can be pink or white if keratinised on palate, tongue and other sites
- Investigations: biopsy to differentiate from other neoplasms, warts
Describe hemangiomas
- Hamartoma or benign tumour made up of blood vessels
- Commonest sites: tongue, vermillion border lip and buccal mucosa
- Clinical: red or blue painless, soft, sometimes fluctuant lesions that usually blanch on pressure. Most appear in infancy
- Investigations: rarely needed, biopsy if feasible
- Treatment: nil, 50% resolve spontaneously, cryotherapy, laser, arterial embolization
Understand the nomenclature surrounding malignant tumours
• Arising in solid mesenchymal tissues are usually called sarcomas (Greek sar = fleshy; e.g., fibrosarcoma and chondrosarcoma)
• Arising from blood-forming cells are designated leukemias (literally, white blood) or lymphomas (tumors of lymphocytes or their precursors).
• Malignant neoplasms of epithelial cell origin are called carcinomas
• In squamous cell carcinoma the tumor cells resemble stratified squamous epithelium
In adenocarcinoma the neoplastic epithelial cells grow in a glandular pattern
Describe submucous fibrosis in terms of appearance, causes, diagnosis and treatment
- Chronic disease that produces scars, tissue fibrosis (excess collagen deposition). This leads to a restricted opening/tongue movement
- Most common in India and associated with diet, habits, and culture.
- Causative factors: chewing betel/areca nut, autoimmunity, vitamin B, C, and iron deficiencies, consumption of spicy foods, human papilloma virus (HPV) infection, and genetic mutations
- Investigations: biopsy of suspicious regions
- Malignant transformation rate 1.5–15%
- Treatment: physical therapy/exercises, medications (steroids), natural remedies
Describe actinic cheilitis in terms of causes, risk factors, appearance, diagnosis and treatment
- Aetiology: chronic sun exposure (solar ultraviolet radiation)
- Risk factors: fair skinned, sunny climates, high altitudes
- Clinical: loss of definition of vermillion border, erythema, oedema, leucoplakia and ulcers
- Investigations: History, clinical features +/- biopsy
- Treatment: topical creams: limit sun exposure, sunscreen, fluorouracil (Efudex, Carac), cryotherapy, laser
List the 6 risk factors for oral cancers
- Male
- > 65
- Alcohol
- Tobacco
- Radiation UVA (UVB)
- Viruses - HPV
List some red flags regarding cancer extra orally and intra-orally
Extra oral
• Unintentional weight loss, fever, night sweats
• Lymphadenopathy (node fixed, indurated)
• Change in voice, usually persistent hoarseness
Intra oral
• Induration (lesion is hard on palpation) , fixation (tethered to underlying tissues), ulceration >2 weeks, fungation
• Unusual/persistent oral bleeding or epistaxis
• Altered sensation
List the 5 classical signs of cancer
- Induration (lesion is hard on palpation)
- Fixation (tethered to underlying tissues)
- Ulceration >2weeks (may be accompanied by tissue replacement and necrosis)
- Fungation (to assume a fungal form or grow rapidly like a fungus)
- Lymphadenopathy (fixed and indurated)
List the high risk regions of the mouth that are most likely to have cancer formation
- Lateral borders of the tongue
- Floor of mouth and ventral tongue
- Retromolar areas
- Pillar and fauces
- Anterior commisures
