OM- Dysplasia+Oral Cancer Flashcards
2 distinct disease patterns of oral cancer
Oral cavity cancer
Oral pharyngeal cancer
Risk factors for oral cancer
Smokers who don’t drink- 2x
Drinkers(3-4 daily)- 2x
Smoke and drink- 5x
Paan- 3x
SES- 2x- low educational attainment/low income
FH
Oral health
Sexual activity- HPV
Is there a higher cancer risk with erythroplakia or leukoplakia
Erythroplakia
What is dysplasia
Disordered cell maturation in a tissue
Categorisation of dysplasia
Low grade
High grade
Carcinoma-in-situ
What causes the cytological features for histological grading of dysplasia
Abnormal DNA content in nucleus, failure to mature or keratinise correctly, increased proliferation
Cytological grading for histological grading
Abnormal variation in nucleus or cell shape/size
Increased number and size of nucleoli
Atypical mitosis figures
What causes the architectural features for histological grading of oral mucosa dysplasia
Abnormal structure of maturation or abnormal layering of epithelium
Architectural features for histological grading of dysplasia
Abnormal and increased mitoses
Abnormal keratinisation
Irregular epithelial stratification
Drop-shaped rete ridges
Histological prognostic factors of dysplasia- help to inform MDT on management of cancer
Pattern of invasion
Depth of invasion
Perineural invasion
Vessels invasion
Low grade dysplasia
Considerable Keratin production
Stratification
Well formed basal cell layer
Tumour islands well defined and continuous with surface epithelium
High grade dysplasia
Little resemblance to normal squamous epithelium
Considerable atypia
Mitotic figures prominent
What is carncinoma-in-situ grading
Abnormal architectural changes
Pronounced cellular atypia+frequent generalised mitoses
Cytologically malignant but not invading
What is field cancerisation concept
Increased risk of cancer in 5cm radius around mucosa affected by dysplasia
High risk sites for mouth cancer
FoM
Lateral border of tongue
Retromolar regions
Gingivae
Buccal mucosa
Which virus is strongly linked to rapid increase in oro-pharyngeal cancer rates
HPV
Oral cancer staging
T=primary tumour size
N=regional lymph node
M=distant metastasis
Lip cancer presentation
Non healing ulcer 2W+
Exophytic
Crusted
Rarely metastises to nodes
Lip cancer risk factors
UV exposure
Smoking
Oral cancer screening methods
HPV16 screening
Toluidene blue- false positives
VELscope- nonspecific to just cancer
Clinical judgment of experienced clinician
Oral cancer in primary care
Primary prevention- smoking cessation, alcohol reduction/diet advice
Monitor lesions with photos
Remove local factors which may be causing ulcer then review
2W rule for referral to hospital
Potentially malignant conditions-oral types
Lichen planus
Oral submucous fibrosis
Iron deficiency
Tertiary syphilis
Potentially malignant lesions- oral types
Leukoplakia
Erythroplakia
Chronic hyperplastic candidosis
Oral submucous fibrosis
Which stain is needed to demonstrate candida albicans hyphae clearly in chronic hyperplastic candidosis
Periodic Schiff Stain
Tx of chronic hyperplastic candidosis
Systemic antigungal- fluconazole
Biopsy
Stop smoking
Observe
Risk factors for malignant change in leukoplakia
Age and gender- females>males
Idiopathic
Site- FoM,tongue
Type of leukoplakia- homogenous/non-homogeneous
Methods of predicting malignant change- leukoplakia
Histopathology- signs of dysplasia/atrophy/candida infection
Biological markers- DNA content in leukoplakia
Histological signs of cellular atypia?
Pleomorphism
Hyperchromatism
Carcinogenesis steps
Initiation
Promotion-mutation in gene involved in DNA repair
Transformation
Progression
Carcinogens types of gene changes
Mutations
Deletions
Translocations
Amplifications
Epigenetic changes
Most important gene involved in carcinogenesis
Tp53 mutation or inactivation
Hallmarks of cancer
Evading apoptosis
Sustained angiogenesis
Self-sufficiency in growth signals
Insensitivity to anti-growth signals
Tissue invasion and metastasis
Limitless replicative potential
Sign of potential malignancy despite no intra-oral manifestation of suspected lesion
Unexplained mobility of tooth
What is TNM system used for
Clinical staging
