Oral Cancer

Question 1

What is oral cancer?

Answer 1

Malignant neoplasm of upper aerodigestive tract
Squamous cell carcinoma
Differentiation
Metastasise

Question 2

How does cancer arise?

Answer 2

Mutation
Oncogenes
Tumour suppressor genes

Question 3

What are the risk factors for oral cancer?

Answer 3

Smoking 
Alcohol 
Infection (HPV)
UV light (sun exposure)
Immunosuppression 
Other cancer diagnosis 
Potentially pre malignant tumour oral epithelial lesions 
Previous oral cancer

Question 4

What are some potentially premalignant oral epithelial lesions (PPOEL)?

Answer 4

Oral lichen planus
Leukoplakia
Erythroplakia
Actinic keratosis

Question 5

What is oral lichen planus?

Answer 5

A chronic inflammatory autoimmune mucocutaneous condition that affects the stratified squamous epithelium

Question 6

What is erosive oral lichen planus?

Answer 6

Irregular areas of ulceration

Question 7

What is OLP classified into?

Answer 7

Atypical OLP and unilateral lichenoid lesions
Oral lichenoid contact reaction
Lichenoid drug reactions
Oral lesions related to food or other substance
Chronic graft vs host disease

Question 8

What is leukoplakia?

Answer 8

Condition in which one or more white patches or lesions form inside the mouth

Question 9

What are the types of leukoplakia?

Answer 9

Homogenous- asymptomatic- thin, flat, smooth surface, shallow cracks
Non-homogenous- symptomatic- speckled, modular, verrucous

Question 10

What is proliferation verrucous leukoplakia?

Answer 10

Rare 
Multifocal sites 
Warty, exophytic appearance 
Spread 
Recur following removal 
Malignant transformation

Question 11

What are some indicators that the leukoplakia has had malignant transformation?

Answer 11

Female 
>60 years 
Long duration 
>2cm 
Site
Non-homogenous 
Candida 
Degree of dysplasia

Question 12

What is erythroplakias?

Answer 12

Fiery red patch
Bright red velvety surface
Irregular outline 
Solitary lesion 
Soft palate most common site
Diagnostic biopsy essential

Question 13

What is actinic cheilitis?

Answer 13

Produced by the effect of actinic radiation to exposed areas of the face and therefore predominately the skin and vermillion of the lower lip
Localised or diffuse lesions
White lesions, crusting, flaking, dryness
Scaly lesions with interspersed red areas (mottled)

Question 14

What is graft vs host disease?

Answer 14

Complication of stem cell or bone marrow transplant
Systemic condition
Keratotic striations, white plaques, ulcerative areas
Buccal mucosa and lateral/dorsum tongue
Xerostomia, recurrent mucoceles
Risk of malignancy
Increases with time since transplant

Question 15

What is discoid lupus erythematous?

Answer 15

Affects the skin and may involve the oral mucosa
Central zone of erythema/ulceration with white striations
Resembles lichen planus
Buccal mucosa, palate, lips
Lower lip malignant transformation, rare

Question 16

What signs and symptoms should raise suspicion of SCC?

Answer 16

Ulceration of oral mucosa 
Oral swelling 
Red/white patch of oral mucosa
Hoarseness 
Dysphagia 
Unilateral nasal obstruction 
Unexplained tooth mobility 
Non-resolving neck masses 
Cranial neuropathies 
Orbital masses

Question 17

How is a lesion described?

Answer 17

Location
Size (length and width)
Colour (white, red, speckled, homogenous, non-homogenous)
Outline (discrete vs diffuse)
Fixed vs mobile
Texture (smooth, flat, raised, dome-shaped, granular, verrucous, ulcerated, indurated)