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Dentistry Module 4 > Oral Cancer > Flashcards

Oral Cancer Flashcards

1
Q

What three key ways can cell numbers be altered?

A
  1. Increased or decrease rates of stem cell input
  2. Apoptosis
  3. Changes in the rate of proliferation or differentiation
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2
Q

What controls the cell cycle?

A

Chemical factors in the micro-environment of the cell ( i.e. stimulators and inhibitors)

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3
Q

Describe what is meant by “terminally differentiated” cells

A

Cells that are not capable of replicating

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4
Q

Give an example of terminally differentiated cells

A

Epithelial cells of oral cavity

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5
Q

What is the difference between dysplasia and neoplasia?

A

Dysplasia is reversible, neoplasia is irreversible

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6
Q

Define hypertrophy

A

An increase in cell size ( usually muscle)

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7
Q

Define hyperplasia

A

An increase in cell number (proliferation)

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8
Q

What is an example of hyperplasia in the oral cavity?

A

Gingival hyperplasia

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9
Q

Define atrophy

A

Reduction in cell size by loss of cell substance (decrease in size of body tissue)

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10
Q

Define hypoplasia

A

Reduced size of an organ that never fully developed to normal size (a developmental defect)

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11
Q

Define metaplasia

A

Reversible change in which one adult cell type is replaced by another adult cells type
(cells change to a form that is not normally found in specific tissue)

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12
Q

Which disorder of growth is irreversible?

A

Hypoplasia

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13
Q

define dysplasia

A

Abnormal growth of cells

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14
Q

What is a pre-malignant process?

A

Dysplasia

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15
Q

what are the three different grades of pre-invasive dysplasia?

A
  • mild
  • moderate
  • severe
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16
Q

What does a severe grade of dysplasia indicate?

A

A higher risk of progressing to invasive malignancy

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17
Q

Define neoplasia

A

Uncontrolled abnormal growth of cells or tissues in the body

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18
Q

What are the two main classification of tumours?

A
  1. Behaviour
  2. Histogenesis
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19
Q

What are the two factors of behaviour classification that need to be considered when diagnosing a tumour?

A
  1. Benign
    OR
  2. Malignant
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20
Q

What type of tumour remains localised, is often encapsulated, has a slow growth rate and can be treated through local excision?

A

Benign tumours

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21
Q

What is a common type of benign salivary gland tumour, often presenting in the parotid salivary ducts?

A

Pleomorphic adenoma

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22
Q

What type of tumour metastasises, has a fast growth rate and may require additional therapy alongside excision for treatment?

A

Malignant tumour

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23
Q

What are pleomorphic cells?

A

Cells that grow in multiple shapes and sizes

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24
Q

What type of malignant oral cell shows clear pleomorphic nuclei histologically?

A

Oral squamous cell carcinoma

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25
Q

Give an example of progression of a benign tumour to a malignant one

A

Pleomorphic adenoma progresses to carcinoma ex pleomorphic adenoma

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26
Q

How would tumours be classified histogenetically?

A

According to the cell type they resemble (i.e. their differentiation)

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27
Q

If a tumour presents in covering epithelia, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. Papilloma
  2. Carcinoma
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28
Q

If a tumour presents in glandular epithelia, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. Adenoma
  2. Adenocarcinoma
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29
Q

If a tumour presents in smooth muscle, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. Leiomyoma
  2. Leiomyosarcoma
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30
Q

If a tumour presents in skeletal muscle, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. Rhabdomyoma
  2. Rhabdomyosarcoma
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31
Q

If a tumour presents in bone forming connective tissue, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. Osteoma
  2. Osteosarcoma
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32
Q

If a tumour presents in cartilage, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. Chondroma
  2. Chondromasarcoma
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33
Q

If a tumour presents in fibrous tissue, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. Fibroma
  2. Fibromasarcoma
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34
Q

If a tumour presents in blood vessels, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. (Haem) angioma
  2. Angiosarcoma
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35
Q

If a tumour presents in adipose tissue, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. Lipoma
  2. Liposarcoma
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36
Q

If a tumour presents in melanocytes, what is it referred to if it’s:

  1. Benign
  2. Malignant
A
  1. Melanocytic naevi
  2. Malignant melanoma
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37
Q

What type of tumours may be undifferentiated, showing no definite form of differentiation?

A

Highly malignant tumours

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38
Q

The prediction of the probable course and outcome of disease

A

Prognosis

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39
Q

What is prognosis important for?

A

Appropriate treatment and estimation of survival

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40
Q

Give an example of an odd tumour with unpredictable behaviour

A

Malignant melanoma

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41
Q

What aids in the diagnosis, staging and treatment of tumours?

A

Knowing the patterns of spread of tumour types

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42
Q

What does a histological assessment determine?

A

How well differentiated the tumour cells are

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43
Q

What tumours have better prognosis, well differentiated or undifferentiated tumours?

A

Well differentiated

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44
Q

What does tumour staging describe?

A

The anatomical extent of disease

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45
Q

what type of classification is used to stage cancer?

A

TNM classifications of malignant tumours

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46
Q

What does each letter component of “TNM” describe?

A

T- extent of primary tumour
N- absence or presence and extent of regional lymph node metastasis
M- absence or presence of distant metastasis

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47
Q

When staging, what does a higher number given to TNM indicate?

A

A more extensive disease

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48
Q

What does a higher tumour stage indicate in regards to prognosis?

A

Poorer prognosis

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49
Q

What causes cancer?

A

Mutations in genes resulting in a cell which grows and proliferates at an uncontrolled rate, and is unable to repair DNA within itself or undergo apoptosis

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50
Q

What are the common causes of genetic errors?

A
  1. Inherited
  2. Viruses
  3. Exposure to chemicals and radiation
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51
Q

Define mouth cancer

A

A variety of malignant tumours that develop in the mouth, affecting the lips, salivary glands, tongue, gums, palate and inside of cheeks

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52
Q

What type of cancer is commonly associated with mouth cancer?

A

Squamous cell carcinoma

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53
Q

What age group does oral cancer often present in?

A

Older age group ( approx over 55 years old)

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54
Q

In the UK, how often does death associated with mouth cancer occur?

A

1 person every 3 hours

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55
Q

What are the two largest risk factors of oral cancer?

A
  1. Tobacco
  2. Alcohol
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56
Q

What are less common risk factors for oral cancer?

A
  • poor diet/obesity
  • immunological defect
  • sunlight ( UV)
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57
Q

If a patient smokes tobacco and drinks alcohol, how much more likely are they to develop oral cancer than a patient who doesn’t smoke or drink?

A

24 times more likely

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58
Q

In what area of the oral cavity is mouth cancer most common?

A

In the sublingual gutter ( space between tongue and FOM)

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59
Q

Why is oral cancer most likely to present in the sublingual gutter?

A

Due to pooling of carcinogens from tobacco and/or alcohol in this area

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60
Q

Describe the consequence of alcohols thinning effect on the oral mucosa

A

It makes mucosa more permeable to carcinogens, which can enter through the epithelial cell barrier

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61
Q

What mutagen and carcinogen is alcohol metabolised to?

A

Acetaldehyde

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62
Q

How is ethanol broken down into acetaldehyde in the oral cavity?

A

By bacteria in oral cavity and salivary glands

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63
Q

What is the daily recommendation of alcohol for both females and males?

A

2 units

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64
Q

What is the weekly recommendation of alcohol for females and males?

A

14 units

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65
Q

How many days are recommended to be taken as ‘alcohol free’ in a week?

A

2 days

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66
Q

What type of food is affective in preventing oral cancer and why?

A

Fruits and vegetables as they provide vitamins and supplements

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67
Q

Cancer in what location is most likely to present due to UV light exposure?

A

Lip cancer

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68
Q

What are the three main viruses associated with oral cancer?

A
  • human papillomavirus (HPV)
  • Epstein-barr virus (EBV)
  • Human immunodeficiency virus (HIV)
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69
Q

Which infectious virus has the largest predisposition for milignant change in the oral cavity?

A

HPV

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70
Q

What type of HPV is associated with oral mucosa?

A

Beta type

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71
Q

What are the two high risk HPV types associated with the oral cavity?

A

HPV 16 and HPV 18

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72
Q

Which HPV type has oncogenes properties ( tumour development)?

A

HPV 16

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73
Q

What type of cell does HPV infect?

A

Undifferentiated proliferative basal cells

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74
Q

Interactions between what proteins cause HPV infection to result in latency and malignant transformation?

A

Interactions of viral (E6 and E7) proteins with p53 and pRB

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75
Q

What are the two types of benign oral HPV lesions?

A
  1. Papilloma
  2. Condylomata
76
Q

What is similar to a papilloma but instead is a multiple lesion phenomena?

A

Condylomata

77
Q

Define exophytic

A

Growth of a tumour outwards

78
Q

What are the two main risk factors for HPV?

A
  • number of sexual partners
  • weakened immune system
79
Q

What virus causes infectious mononucleosis ( glandular fever)?

A

EBV

80
Q

What rare cancer is associated with EBV?

A

Burkitt’s lymphoma

81
Q

Which virus causes an increased risk of kaposi sarcoma?

A

HIV

82
Q

What are oral symptoms of HIV?

A

Candidiasis, hairy leukoplakia, accelerated perio disease, kaposi sarcoma, salivary gland disease and oral ulcers

83
Q

How is HIV treated?

A

Highly affective antiviral treatment (HAART)

84
Q

What is kaposi Sarcoma- associated herpesvirus (KSHV) also known as?

A

Human herpesvirus-8 (HHV-8)

85
Q

What are the first symptoms of kaposi sarcoma?

A

Red, purple or brown patches/nodules on the skin/mucosa

86
Q

Abnormal thickening of the epithelium

A

Hyperkeratosis

87
Q

What are squamous cell papilloma’s pedunculated to?

A

A stalk

88
Q

Atypical epithelial alterations limited to the surface squamous epithelium

A

Epithelial dysplasia

89
Q

What characterises epithelial dysplasia?

A

Cytological and architectural alterations with a loss of normal maturation and differentiation. It is a premalignant process.

90
Q

A benign histologic finding characterised by the proliferation of the basal cells

A

Basal cell hyperplasia

91
Q

Abnormal keratinisation occurring prematurely within individual cells or groups of cells

A

Dyskeratotic cells

92
Q

Define pleomorphism

A

Cells or their nucleus having variation in size and shape

93
Q

What is the key feature of identifying oral squamous cell carcinoma histologically?

A

Invasion of adjacent normal tissues

94
Q

A keratinised structure found in regions where abnormal squamous cells form concentric layers

A

Keratin pearl

95
Q

If squamous carcinoma cells are better differentiated (more like normal epithelium), how would this effect tumour grade and prognosis?

A

Lower tumour grade and better prognosis

96
Q

If squamous carcinoma cells are poorly differentiated, how would this effect tumour grade and prognosis?

A

Higher tumour grade and lower prognosis

97
Q

The application of a test to people who are apparently free of disease to identify those who may have the disease from those who may not

A

Screening

98
Q

Define primary prevention and give an example

A

Prevents a disease from developing ( e.g. risk factor education to patients)

99
Q

Define secondary prevention and give an example

A

To detect disease while it is localised or ‘early’ (e.g. screening oral cavity)

100
Q

Define tertiary prevention and give an example

A

To mitigate the morbidity from established disease and to improve quality of life (e.g. programs and support groups for people living with disease)

101
Q

What are the three types of population screening programmes?

A
  1. Mass screening
  2. Selective screening
  3. Opportunistic screening
102
Q

What type of screening are dentists involved in?

A

Opportunistic screening, as patients present voluntarily to dentists to be assessed.

103
Q

For any screening programme to be successful, what are the two qualities it must possess?

A

High sensitivity and specificity

104
Q

What is meant by the term ‘sensitivity’ in regards to screening?

A

The proportion of the population who are correctly classified as having a disease

105
Q

What is meant by the term ‘specificity’ in regards to screening?

A

The proportion of the population correctly classifies as disease-free

106
Q

What order of sensitivity and specificity do screening tests aim to have in order for them to be usefully applied to the population?

A

80% or more

107
Q

What did the one properly conducted study (randomised controlled trial carried out over 15 year period) on mouth cancer screening evaluate?

A

Clinical or cost efficacy of mouth cancer screening

108
Q

What does OPMD stand for?

A

Oral potentially malignant disorders

109
Q

What is an important example of OPMD?

A

Lichen planus

110
Q

How can lichen planus manifest?

A
  • white patches
  • reticular patches
  • rows of patches
  • ulcerated patches
  • plaques
111
Q

What does OPML stand for?

A

Oral potentially malignant lesions

112
Q

When would size of a lesion be concerning in terms of potential for malignancy?

A

If a lesion is above 20cm in size

113
Q

When would texture of a lesion be concerning in terms of potential for malignancy?

A

If the lesion is irregular in texture, more non-homogenous

114
Q

When would colour of a lesion be concerning in terms of potential for malignancy?

A

Red lesions are more worrying, followed by speckled, then white lesions

115
Q

What sites in the mouth are highest risk for malignancy?

A

Tongue and FOM

116
Q

Which sex are at greater risk of developing malignancy?

A

Females

117
Q

At what age is it most common to develop malignancy?

A

> 50 years

118
Q

A white patch of unknown cause is known as?

A

Leukoplakia

119
Q

A red patch of unknown cause is known as?

A

Erythroplakia

120
Q

What is meant by indurated margins?

A

Heaped, thick and rubbery texture to touch
AND
is a sign of cancer invading underlying mucosal margin

121
Q

Define endophytic lesion

A

Inwards growing lesion

122
Q

Define exophytic lesion

A

Outwards growing lesion

123
Q

In what scenario would cancers become painful?

A

When they are secondary infected or when they invade nerves (perineural spread)

124
Q

How is tumour/lesion size classified?

A

By T classifications ( T1, T2, T3, T4)

125
Q

What size would a T1 lesion be?

A

<2cm

126
Q

What size would a T2 lesion be?

A

2-4cm

127
Q

What size would a T3 lesion be?

A

4-6cm

128
Q

What size would a T4 lesion be?

A

> 6cm or any lesion that involves the underlying bone

129
Q

When should you refer a patient presenting with an unusual ulcer?

A

If the ulcer does not heal within 2-3 weeks

130
Q

Who should you refer a patient with an unusual lesion to?

A

Nearest Maxillofacial department on urgent 2 week referral;

131
Q

What sort of imaging will the Maxillofacial department take to assess patient for potential malignancy?

A

Head/neck MRI scan and CT of chest

132
Q

What is ‘geographic’ tongue also known as?

A

Benign migratory glossitis

133
Q

What is the key characteristic of geographic tongue?

A

Appearance of red or white patches that comes and goes- hence ‘migratory’

134
Q

What is geographic tongue a result of?

A

Deviation in natural turnover in cells, where some cells turnover fast and are evolved and other turn over slowly, heaping up and forming the patches we see

135
Q

Why does ‘black hairy tongue’ occur?

A

Where mastication cannot clean dorsum of tongue, elongation of the papilla occurs which becomes infected by pigmented bacteria causing the black appearance

136
Q

How can ‘black hairy tongue’ be treated?

A

Simply with OH, by focusing cleaning to the tongue

137
Q

Define ‘papillary hyperplasia’

A

Benign lesion of the oral mucosa which is characterised by enlarged papillae

138
Q

What may a slight white appearance along the occlusal plane of lateral tongue indicate about a patient?

A

That they may grind their teeth or clench

139
Q

What is a blister in the oral cavity also known as?

A

Bullae

140
Q

What benign features can normally be seen when assessing the buccal mucosa?

A
  • linea alba
  • chewing of cheek
  • small white spots
141
Q

What is linea alba?

A

Linear white line at the level of occlusal plane (indicates clenching habit)

142
Q

Why can benign small white spots appear in buccal mucosa?

A

Caused by ectopic sebaceous glands

143
Q

Give 9 common examples of benign oral lesions

A
  1. Aphthous ulceration
    2.lipoma
  2. Mucoceole
  3. Epulis
  4. Leaf fibroma
  5. Denture induced hyperplasia
  6. Papillary hyperplasia
  7. Papilloma
  8. Tori palatinus or mandibularis
144
Q

What is a mucocoele?

A

A benign mucous containing cystic lesion of the minor salivary gland.

145
Q

What often causes mucocoele’s to form?

A

Trauma to the area

146
Q

What is an epulis?

A

A benign mass-like growth in the mouth that typically grows over or around a tooth

147
Q

What is a pyogenic granuloma?

A

A harmless overgrowth of tiny blood vessels on the skin

148
Q

What is leaf fibroma and why does it occur?

A

A fibrous epulis forms underneath the palatal base of a denture.

149
Q

What are examples of benign lesions caused by ill-fitting dentures?

A
  • leaf fibroma
  • denture induce hyperplasia
  • papillary hyperplasia
150
Q

What is torus palatinus?

A

A harmless, painless bony growth located on the roof of the mouth

151
Q

Why can torus become easily traumatised by mastication to dentures?

A

As they have thin mucosal layer

152
Q

What is torus mandibularis and where does it occur most often?

A

A benign bony outgrowth normally located on lingual aspect of alveolus bilaterally

153
Q

When doing an extra-oral exam as part of cancer screening, what are you looking for?

A

Lymphadenopathy (enlargement of the lymph nodes)

154
Q

How cancerous lymph nodes present ?

A

Firm, rubbery and non-tender

155
Q

What are features of oral malignancy?

A
  • red/white/speckled lesion
  • ulcerated areas
  • high risk sites
  • asymptomatic
  • unknown duration
  • risk factor history
156
Q

What is a ‘mapping biopsy’?

A

Incisional biopsies are carried out at multiple sites

157
Q

What structures does ‘ head and neck cancer’ encompass?

A

Cancers of the:
- mouth
- oropharynx
- nasopharynx
- hypopharynx
- nose
- paransal sinuses
- larynx
- salivary glands
- ear

158
Q

What type of mucosa do squamous cell carcinomas typically arise from?

A

Lining mucosa

159
Q

What is an example of cancer of the salivary glands?

A

Polymorphous adenocarcinoma

160
Q

What is an example of cancer of Odontogenic epithelium?

A

Ameloblastic carcinoma

161
Q

What is an example of malignant skeletal muscle tumour?

A

Rhabdomyosarcoma

162
Q

What does aneuploidy mean? And where is it common?

A

Altered DNA content, common in tumour cells

163
Q

What very simplified stages are involved in the ‘multi step theory of carcinogenesis?

A
  1. Initiation
  2. Promotion
164
Q

What happens in the initiation stage of the ‘multi step theory of carcinogenesis?

A

DNA damage and mutation

165
Q

What happens in the promotion stage of the ‘multi step theory of carcinogenesis?

A

Clonal expansion of abnormal cells leading to cancer

166
Q

What are the four key elements of tumour growth?

A
  • replication
  • escape from senescence (deterioration with age)
  • evasion of apoptosis
  • limitless replicative potential
167
Q

What are the four key elements in cancer development?

A
  1. Tumour growth
  2. Invasive growth
  3. Angiogenesis
  4. Metastasis
168
Q

What are the three key factors involved in invasive growth of a tumour?

A
  1. Reduction in cell-cell adhesion
  2. Invasion of basement membrane and stroma
  3. Tumour cell motility
169
Q

What is ‘the angiogenic switch’?

A

Development of rich blood supply around a tumour

170
Q

What is a critical step in progression of a small localised tumour to a bigger one with metastatic potential?

A

Angiogenesis

171
Q

What is another term used to describe metastasis?

A

Secondaries

172
Q

What are tumour implants that are discontinuous with the primary lesion?

A

Metastasis

173
Q

What organs are very effective at arresting circulating cancer cells?

A

Lung and liver

174
Q

What is epithelial dysplasia?

A

A premalignant process- atypical epithelial alterations limited to the surface squamous epithelium

175
Q

Dysplasia involves the invasion of adjacent normal tissues. True or false?

A

False, limited to the surface squamous epithelium

176
Q

How does WHO grade epithelial dysplasia?

A

Mild
Moderate
Severe

177
Q

What is the binary system for grading epithelial dysplasia?

A

Low grade
High grade

178
Q

What grade of epithelial dysplasia is described:

Disorganisation, increase proliferation and atypia of basal cells

A

Mild dysplasia

179
Q

What grade of epithelial dysplasia is described:

Very abnormal, affects full thickness of epithelium

A

Severe dysplasia

180
Q

What grade of epithelial dysplasia is described:

More layers of disorganised basaloid cells, atypia, suprabasal mitosis

A

Moderate dysplasia

181
Q

Define oral potentially malignant disorders

A

Oral mucosal lesions that have a potential risk of developing into oral SCC

182
Q

Give three examples of oral potentially malignant disorders

A
  1. Oral sub-mucous fibrosis
    2.lichen planus
    3.chronic hyperplastic candidosis
183
Q

How long is follow up treatment after surgical excision of SCC?

A

5 years

184
Q

what is the gold stands tool for excisions of potentially malignant lesions?

A

Carbon dioxide laser

185
Q

What are lichenoid reactions often triggered by?

A

A long-standing chromic irritation to amalgam or metal-based restorations

186
Q

what is an indolent tumour?

A

A tumour that causes little or no pain

187
Q

What do groups of cells that display invasive growth have high levels of?

A

Autocrine pro-migratory factors and proteolytic enzymes

Dentistry Module 4 (20 decks)

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