Oral and Oesophageal Pathology

Question 1

What is more common acute oesophagitis or chronic oesophagitis (reflux oesophagitis)? Both are inflammation of the oesophagus.

Answer 1

Chronic oesophagitis as acute is usually due to swallowing something chemical that then causes corrosion.

Question 2

What causes reflux oesophagitis?

Answer 2

Defective sphincter mechanism +_ a hiatus hernia.
Increased intra-abdominal pressure (due to pregnancy or being obese).
Abnormal Oesophageal motility.
(All of these are causing reflux of acidic bowl content).

Question 3

What are the complications of reflux oesophagitis?

Answer 3

Ulceration.
Barrett’s oesophagus.
Stricture.

Question 4

Describe how Barrett’s oesophagus occurs and the risks associated with getting it?

Answer 4

Due to constant acid reflux in the lower Oesophageal reagion, stratified squamous epithelium turns into columnar epithelium (metaplasia).
This improves the symptoms of acid reflux but makes you more succeptible to getting an adenocarcinoma.
For this reason, Barrett’s oesophagus is considered a pre-malignant disease.

Question 5

How would you treat Barrett’s oesophagus?

Answer 5

You would give protein pump inhibitors like omeprazole (causes reduced acid secretion in the stomach) and maybe asprin.
If they have dysplasia you might do ablation treatment so that normal cells would grow in their place and preventing the progression to cancer.

Question 6

Describe allergic (eosinophilic) oesophagitis?

Answer 6

Cause is unknown but causes inflammation in the oesophagus, most common in the white males.
Give steroids - chromoglycate and montelukast.

Question 7

Describe the aetiology for getting squamous cell carcinoma in the oesophagus?

Answer 7

Vitiman A/ Zinc deficiency.
Smoking, Alcholol.
HPV.
Oesophagitis. 
(Very hervily associated with diet.

Question 8

Who is more likely to get an adenocarcinoma in the oesophagus?

Answer 8

More common in Caucasians and males.

Question 9

Where are adenocarcinoma and squamous cell carcinomas most likely to occur?

Answer 9

Adenocarcinoma occurs most in the lower third of the oesophagus (45% of tumours).
Squamous cell carcinomas occur in the middle and upper oesophagus (65% of tumours).

Question 10

Why does having Barrett’s oesophagus lead you to have an increased risk of adenocarcinoma in the oesophagus?

Answer 10

The faster regeneration of columnar epithelium (instead of stratified squamous) means that more cells are multiplying which leads to increased risk of developing dysplasia (development of Abnormal cells).

Question 11

Describe the build up from genetic factors/reflux disease to adenocarcinoma?

Answer 11

Genetic factors/reflux disease.
Chronic reflux.
Barrett's oesophagus.
Dysplasia.
Cancer.

Question 12

What are the clinical signs of cancers in the oesophagus?

Answer 12

Dysphagia (due to the blockage caused by the dysplasia).
Weight loss.
Anorexia.
lymphadenopathy.

Question 13

How does the carcinoma of the oesophagus metastasise?

Answer 13

Most commonly through direct invasion of the surrounding structures and lymphatic perrmeation.

Question 14

What type of cancer usually develops in the mouth?

Answer 14

Squamous cell carcinoma.

Question 15

What are sites in the mouth that are least likely to get a SSC?

Answer 15

Dorsum of the tongue and the hard palate.

Question 16

Describe TNM staging is and then everything to do with the T.

Answer 16

TNM staging is used to determine how deadly a tumour is going to be.
T - size and extent of main (primary) tumour.
T0 means that main tumour cannot be found.
TX means that the main tumour cannot be measured.
T1-T4 refers to the size/extent of the tumour, with the higher number being worse.

Question 17

Describe the N in TNM staging?

Answer 17

N refers to the number of nearby lymph nodes that have cancer.
NX means that the cancer in the nearby lymph nodes cannot be measured.
N0 means there is no cancer in the nearby lymph nodes.
N1-N3 refers to the number and location of the cancerous lymph nodes, the higher the number the more lymph nodes that contain cancer.

Question 18

Describe the M in TNM staging?

Answer 18

M refers to where the cancer has metastasised to another location in the body.
MX means that the metastasis cannot be measured.
M0 means that the cancer has not spread to other parts of the body.
M1 means that the cancer has spread to other parts of the body.

Question 19

The general symptom for GORD is dyspepsia, this refers to indigestion and includes what?
What other not too bad symptoms can you get with GORD?

Answer 19

HEAR

Heart burn,
Epigastric pain.
Acid regurgitation.
Retrosternal pain.

Fullness or belching

Question 20

Endoscopy is done to investigate GORD if any of what symptoms are occurring in the patient.

Answer 20

Dysphagia.
If the patient is older than 55.
Weight loss.
Nausea and vomiting. 
Anemia.

Question 21

What are the three aims of management of GORD?

Answer 21

Symptom relief - Antacids (gaviscon/rennie) do not heal or prevent though.
Healing oesophagitis - PPI (Omeprazole) good symptom relief and healing. H2 receptor antagonist (antihistamine) like ranitidine. Both are reducing the amount of stomach acid secretion but PPI better.
Prevent complications - if dysplasia do frequent endoscopy and optimise PPI dose and maybe radio-frequency ablation or endoscopic mucosa resection (EMR).

Question 22

What is gastropareisis and what are the symptoms?

Answer 22

It is when you have delayed gastric emptying. 
Symptoms include:
Feeling of fullness.
Nausea and vomiting.
Weight loss.

Question 23

How would you manage someone with Gastroparesis?

Answer 23

Liquid/sloppy diet.
Eat little and often.
Remove precipitating factor (opiates - thought to be one of the causes).

Question 24

Describe the two types of functional dyspepsia?

Answer 24

Epigastric pain syndrome - pain in the upper abdomen is most predominant symptom.
Postprandial distress syndrome - unpleasant or troublesome, non-painful sensation in the upper abdomen is the main symptom.

Question 25

What is uncomplicated dyspepsia?

Answer 25

It is when you do not have any of the alarm symptoms of dyspepsia.

Question 26

What is the aetiology for oral cancer?

Answer 26

Tobacco (not just smoking, any type of taking tobacco, however especially cigarettes as they contain tar which is carciongenic).
Alcohol.
Tobacco and alcohol (its own combined risk factor due to it being synergistic.
HPV.

Question 27

What is the recommended max amount of alcohol you can take per week?

Answer 27

14 units (half a pint of beer or a glass of wine).

Question 28

How does your diet affect whether you might get oral cancer?

Answer 28

If you are low in Vit A, C, Iron it leads to atrophy of the oral mucosa that makes you more succeptible to oral cancer.

Question 29

How can oral sex increase your risk of oral cancer?

Answer 29

HPV 16 & 18, the prevelence increases with the number of sexual partners.

Question 30

What are the high risk sites of the mouth for oral cancer?

Answer 30

Soft (non keratinizing) sites - ventral tongue, floor of the mouth, lateral tongue.

Question 31

What are the signs and symptoms for someone developing oral cancer?

Answer 31

Red and white lesions. 
Ulcers.
Numb feeling in the face.
Dysphagia. 
Change in voice.
Unexplained pain in the mouth/neck.
Facial palsy.
Double vision.

Question 32

What four questions do you need to ask when looking to diagnose oral cancer?

Answer 32

How long has the lesion been there.
What colour is it.
Is it painful (yes may still just indicate it is an ulcer).
Social factors - how much do they drink/smoke.

Question 33

How common is malignant oesophageal cancer?

Answer 33

Very, It is the 8th most common cancer in the world.