Oral and Oesophageal Pathology

Question 1

What are the main two inflammatory disorders of the oesophagus?

Answer 1

Acute Oesophagitis (rare) and Chronic oesophagitis (common)

Question 2

What can cause acute oesophagitis?

Answer 2

Corrosive following chemical ingestion

Infective in immunocompromised patients e.g. candidiasis, herpes, CMV

Question 3

What can cause chronic oesophagitis?

Answer 3

Reflux disease (reflux oesophagitis) 
Rare causes include Crohn's disease

Question 4

What causes reflux in pregnant women

Answer 4

Increased abdominal pressure

Question 5

Define reflux oesophagitis

Answer 5

Inflammation of the oesophagus due to refluxed low pH gastric contents

Question 6

Microscopically, what can be seen in the oesophagus of reflux oesophagitis?

Answer 6

Basal zone epithelial expansion

Intraepithelial neutrophils, lymphocytes and oesinophils

Question 7

List some complications of reflux

Answer 7

Ulceration (bleeding)
Stricture
Barrett’s oesophagus

Question 8

What is Barrett’s oesophagus

Answer 8

Replacement of stratified squamous epithelium by columnar epithelium

Question 9

Describe the epidemiology of allergic oesophagitis

Answer 9

Eosinphillic oesophagitis 
Personal or family history of allergy 
Asthma 
Young 
Males > Females

Question 10

What is the treatment for allergic oesophagitis

Answer 10

Steroids / chromoglycate / montelukast

Question 11

What are the two different types of oesophageal tumours

Answer 11

Benign and Malignant

Question 12

What is the most common type of benign tumour

Answer 12

Squamous papilloma

Question 13

What are the 2 main types of malignant tumours and which one is most common?

Answer 13

Squamous cell carinoma

Adenocarcinoma (more common)

Question 14

Describe the epidemiology of squamous cell carincoma

Answer 14

Commoner in males
Declining
Probably something to do with diet and culture

Question 15

Describe the aetiology of squamous cell carcinoma

Answer 15

Vit. A, zinc deficiency
Tannic acid/ strong tea
Smoking, alcohol
HPV
Oesophagitis
Genetic

Question 16

Describe the aetiology of adenocarcinoma of the oesophagus

Answer 16

Commoner in caucasians (white person with European origin)
Increasing in Europe and USA
Commoner in males and obesity
Commonest in the lower 1/3rd of the oesophagus

Question 17

What is the pathway to Barrett’s oesophagus

Answer 17

Inflammation, metaplasia, dysplasia, adenocarcinoma

Question 18

Name the 3 mechanisms of metastases

Answer 18

Direct invasion
Lymphatic permeation
Vascular invasion

Question 19

How would patients present with oesophageal carcinoma

Answer 19

Dysphagia
Anaemia
Weight loss
Loss of energy

Question 20

What are the symptoms of oral squamous cell carcinoma

Answer 20

White, red, speckled, ulcer, lump

Question 21

Where are the high risk sites

Answer 21

Floor of the mouth 
Lateral border of tongue 
Ventral tongue 
Soft palate 
Retromolar pad / tonsillar pillars

Question 22

What is the aetiology of oral cancer

Answer 22

Tobacco
Alcohol
Betel quid
?Chronic infections 
Nutritional deficiencies 
? Genetics
History of primary oral squamous cell carcinoma have increased risk for 2nd primary

Question 23

What is the reason for no improved survival in the last few decades

Answer 23

Late detection