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BDS4 > Oral cancer > Flashcards

Oral cancer Flashcards

1
Q

What are the risk factors for oral cancer?

A
  • Smoking
  • Drinking
  • HPV and EBV (oropharyngeal cancer)
  • Poor OH
  • Poor diet
  • Immunosuppression
  • History of oral cancer
  • Socioeconomical background
  • Chewing betel nut
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2
Q

What are the main risk sites for oral cancer?

A
  • lateral border and ventral surface of the tongue
  • FOM
  • Oropharynx
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3
Q

What are some key signs and symptoms of OC?

A

Signs
- Persistant ulcer for >3weeks after removal of any cause
- Rolled margins with central necrosis
- Endulated (hard to touch)
- Unilateral
- Persistent unexplained head and neck swelling/lump
- unexplained White or red patches

Symptoms
- Pain is symptom in later stages, bleeding and numbness
- Hoarsness in voice
- pain of swollowing

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4
Q

How does cancer spread?

A
  • Locally via the blood and lymphatics
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5
Q

What is this?

A

Oral leukoplakia

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6
Q

what this is an example of

A

Erythroplakia

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7
Q

What is this an example of?

A

Lichen planus of the right buccal mucosa

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8
Q

What are some potential malignant lesions which should be closely monitored and potentially referred?

A

Leukoplakia
Erthyroplakia
Submucous fibrosis
Lichen planus
Ulcers

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9
Q

What are the stages of the metastatic cascade?

A

Local invasion
intravasation
Survival in circulation
Arrest in distant organ/tissue
Extravasion
Survival or cells after extravasion
Intial growth/ proliferation of cells after extravastion (micro metasisis)
Establish growth/persistent of growth (marco metastic growth)

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10
Q

What does TNM stand for?

A

Tumour
Node
metastisis

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11
Q

How are tumours graded?

A

Tumour is graded T0-T4
- This is depending on the size of the tumour and then if it is locally invasive.
* Tumour size graded; Tx- no info, Tis- carcinoma in situ, T0- no evidence of primary T1-<2cm, T2- 2-4cm, T3- >4cm, T4->4cm with gross local invasion (antrum, muscles, base of tongue or skin)

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12
Q

How are the nodes graded?

A

number of nodes involved and size
* Lymph node involvement graded; Nx- can’t be assessed, N0- no positive nodes, N1- single ipsilateral <3cm, N2- single ipsilateral 3-6cm or multiple ipsilateral <6cm, bilateral <6cm, N3- <6cm

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13
Q

How is metastisis graded?

A

has the cancer spread of not.
* Metastasis graded; Mx- not assessed, M0- no metastasis, M1- metastasis

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14
Q

How is the final cancer stage formed?

A

Combine the TNM score to give final cancer grading.
* Scores are then combined to give an overall stage of cancer 1-4 increasing in severity; stage 1- T1, stage 2- T2, stage 3- T3 or T1/2 w/ N1, stage 4- T4, ant T w/ N>1, any T any N w/ M1

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15
Q

A patient attends with a squamous cell carcinoma on the lateral border of the tongue which is 5cm in width. There are bilateral ipsilateral lymph nodes palpated >2cm in size. The presurgical examination shows that cancer has not spread to any other structures.
1. List 2 risk factors for oral squamous cell carcinomas? (2)

A

Smoking
drinking
OH
Diet
Socioeconomic background
History of SSC
Immunocomprimised

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16
Q

A patient attends with a squamous cell carcinoma on the lateral border of the tongue which is 5cm in width. There are bilateral ipsilateral lymph nodes palpated >2cm in size. The presurgical examination shows that cancer has not spread to any other structures.
2. What is the stage of this tumour with the TNM system? (1)

A
  • T3, N2, M0= Stage 4
    As there is more than one node involed then automatically becomes a stage 4 diagnosis
17
Q
  1. How would you grade the dysplasia histopathologically? (3)
A

WHO 2017 grading system.
dysplasia, mild, moderate, severe

18
Q
  1. What intervention (medical) other than surgery could the patient have to treat there SSC? (3)
A

Radiotherapy
Chemotherapy
Immunotherapy

19
Q
  1. After removal of the lesion, how could you restore the function of the tongue? (1)
A

Soft tissue graft to rebuild the tongue

20
Q

What is this an example of? If this is a pathological cell change.

A

Hyperchromatism

21
Q

What is pleomorphism?

A

Change in the size and shape of the cell +/ or the nuceli

22
Q

What are drop shaped rete pegs?

A

Rete pegs that are wider in the deeper portions than they are more superficially.

23
Q

What does loss of basal cell polarity mean?

A

It is the loss of the organisation of the basal cells. Become disorgansied.

Loss of polarity, the orientation of apical and basolateral surfaces of the epithelial cells that line most internal organs and body cavities, usually occurs early in cancer and is considered a consequence of malignant transformation.

24
Q

Describe the histopathological grading of hyperplasia?

A
  • Increased number of cells
  • No cellular atypia
  • Regualr stratification or layer
  • basal cell layer is larger
25
Q

Describe mild dysplasia for histopathological grading.

A
  • Changes in the lower third of epithelium
  • Mild atypia (pleomorphism, hyperchromastism, basal cell hyperplasia, drop shaped rete pegs not in all areas)
  • May regress is you remove the cause (inflammatory cause e.g smoking or infection)
26
Q

Describe moderate dysplasia for histopathological grading.

A
  • Spread into the middle 1/3 of epithelium
  • Moderate signs of atypia pleomorphism, hyperchromatism, loss of basal cell polarity, basal cell hyperplasia, increased area/vol ratio of nucleus to cytoplasm.
27
Q

Describe severe dysplasia in histopathological grading?

A
  • Changes in the upper 1/3 of epithelium
  • Severe cellular atypia (pleomorphism, hydrochronism, loss of basal cell polarity (disorganised), loss of intracellular adhesion, enlarged nucleus.
  • *numerous mitosis abnormally high (mitosis occurs in all layers), abnormal stratification and keratinisation requires surgical removal ** LOTS of cell division, uncontrolled.
28
Q

Describe carcinoma in situ? histopathologcally

A

malignant but invasive, tissue no longer characteristic appearance of epithelium, abnormal architecture with full thickness of viable cell layers affected, pronounced cytological atypia (mitotic abnormalities frequent, huge clearly stained nuclei), surgical removal required

29
Q

You have biopsied a potentially malignant lesion.
1. List 11 histological signs of epithelial dysplasia?

A
  • Pleomorphism
  • Hyperchromatism
  • Basal cell hyperplasia
  • Increased mitosis
  • Drop shaped rete pegs
  • Disorganised ( loss of basal cell polarity)
  • Increased area to volume ratio of nuceli to cytoplasm
  • Enlarged nuclei
  • Loss of intracellular adhesion
  • Abnormal stratification
  • Abnormal keratinisation
30
Q

How is dysplasia graded?

A

Basal cell hyperplasia
* Mild dysplasia (lower 1/3, mild atypia and architectural changes)
* Moderate dysplasia (middle 1/3, moderate atypia and architectural changes)
* Severe dysplasia (upper 1/3, sever atypia and architectural changes)
Carcinoma in situ

31
Q

Squamous Cell Carcinoma Pathology-
1. What is the pathology of a squamous cell carcinoma?

A
  • May be well, moderately or poorly differentiated - 80% moderately well differentiated (Nb. Anaplastic where you cannot tell what the original tissue is)
  • Pattern of invasion front related to nodal spread. may be cohesive with one broad tumour front pushing forward or non-cohesive with multiple strands/lumps pushing through the LP
  • Local extension of the disease
  • Abnormal keratinisation (keratin pearls)
  • Signs of cellular atypia - Abnormal/increased mitotic activity, hyper-chromatic nuclei cellular pleomorphism/ ansiocytosis, basal cell hyperplasia, distrubed polarity of the basal cells.
  • irrgular epithelium stratification
  • Drop shaped rete pegs
  • Connective tissue stroma with chromic inflammation (histocytes, lymphocytes
32
Q

Oral Cancer & MDT-
1. What does dentally fit mean?

A

Free from any active disease prior to the start of cancer therapy

33
Q

What is the MDT for oral cancer

A

Team of individuals from various disciplines/specialities who work together to provide the best hollistic care and decide on the best tx options for the patient collectively

34
Q

List 4 members of the MDT for oral cancer?

A
  • restorative specialist
  • MAXFAX surgeon
  • Pathologsit
  • Oncologist
  • Radiologist
  • Clinical nurse specialist
  • Speech therapist
  • Palliative care physician
  • Special care dentist
35
Q

What is the patient at risk of the following following radiotherapy apart from mucositis?

A
  • Dry mouth
  • ORN
  • Caries (radiation)
  • Taste disturbance
  • Increased infection incidence - candidosis or viral infection reactivation
  • Poor wound healing
  • Trismus
  • Erosion
  • Periodontal disease
36
Q

What are the grades of mucositis?

A

0 - none
1 - (mild) soreness +/- erythema
2 - (moderate) - Erythematous ulcers - patient can swollow solid food
3 - Severe - Ulcers with extensive erthyema - patient cannot swollow food, liquid tolerance only
4 - life threatening - mucositis to the extent the oral alimentation is impossible (can’t tolerate food or liquids)

37
Q

How is mucositis managed?

A
  • Avoidance of triggers! - Avoid smoking, alcohol (spirits), spicey foods, tea and coffee (as dehydrating), alcoholic mouthwash.
  • SLS free toothpaste
  • Analgesic. Narcotic analgesics often indicated for pain relief
  • Topical preperations - topical lidocaine, sodium bicardonate to break up mucous saliva, benzydamine hydrochloride, gelclair and caphosol to create covering over ulcers to allow patient to eat, tea tree oil mouthwash
  • Smooth teeth and dentures to prevent further traumatic ulceration
  • Low level light therapy
  • In non H&N cancer cases can use ice cubes for a cooling effect but otherwise dont as can vasconstrict and favour the tumour

What are Narcotic Analgesic Drugs? Narcotic analgesics are prescription pain relievers ordered for treatment of moderate pain to severe pain. like opiods!

The main medical applications of LLLT are reducing pain and inflammation, augmenting tissue repair and promoting regeneration of different tissues and nerves, and preventing tissue damage in situations where it is likely to occur.

38
Q

What are the oral side effect of chemotherapy?

A
  • Higher risk of infection as immunosuppression
  • Mucositis
  • Xerostomia
  • Mouth ulcers
  • Reduced sense of taste
  • Halitosis
  • Increased bleeding and brusing risk

BDS4 (24 decks)

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