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Module 4 > Oral Cancer > Flashcards

Oral Cancer Flashcards

1
Q

What does hypertrophy mean?

A

Increase in cell size

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2
Q

What does hyperplasia mean?

A

Increase in cell number

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3
Q

What does atrophy mean?

A

Reduction in cell size by loss of cell substance

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4
Q

What does hypoplasia mean?

A

Reduced size of an organ that never fully developed to normal size

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5
Q

What does metplasia mean?

A

Reversible change in which one adult cell type is replaced by another adult cell type

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6
Q

What does dysplasia mean?

A

Abnormal growth

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7
Q

What does neoplasia mean?

A

New growth

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8
Q

In adult tissues what is the size of cell population determined by?

A

The rates of cell proliferation, differentiation and death by apoptosis

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9
Q

What is meant by the term apoptosis?

A

Programmed cell death

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10
Q

What are the 2 main classifications of tumours?

A

Behaviour
Histogenesis

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11
Q

What are the 2 types of behaviour tumours?

A

Benign
Malignant

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12
Q

What is a prognosis?

A

Prediction of the probable course and outcome of a disease.
Appropriate treatment and estimated survival

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13
Q

What does a cancer prognosis involve?

A

Tumour type
Tumour grade
Tumour stage

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14
Q

What classification is used for staging malignant tumours?

A

TNM

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15
Q

What does TNM classification stand for?

A

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

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16
Q

What is distant metastasis?

A

Cancer that has spread from the original (primary) tumour to distant organs or distant lymph nodes

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17
Q

Define the term oral cancer

A

The general term given to the variety of malignant tumours that develop in the mouth

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18
Q

What is the most common tumour that counts for 90% of all cancers of the mouth?

A

Squamous cell carcinoma

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19
Q

What area of the mouth is concerned when talking about mouth cancer?

A

Anterior (2/3) of the tongue

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20
Q

What area of the mouth is concerned when talking about oropharyngeal cancer?

A

Posterior (1/3) of the tongue

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21
Q

What is the largest risk factor for mouth cancer?

A

Tobacco

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22
Q

What is the second largest risk factor for mouth cancer?

A

Alcohol

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23
Q

What age group does oral cancer mostly effect?

A

> 55

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24
Q

If you smoke >21 cigarettes and consume over 7 ounces of alcohol per day how much does your risk of developing mouth cancer increase by?

A

24%

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25
Q

How does alcohol contribute to mouth cancer?

A

It causes thinning of the overlying mucosa making it more permeable for the carcinogens to enter the epithelial cells

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26
Q

If you smoke <10 cigarettes a day what is your risk compared to a non smoker of developing cancer?

A

2.5 x

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27
Q

If you smoke <20 cigarettes a day what is your risk compared to a non smoker of developing cancer?

A

5.0 x

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28
Q

If you smoke >20 cigarettes a day what is your risk compared to a non smoker of developing cancer?

A

5.5 x

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29
Q

If you quit smoking how long does it take for your relative risk to fall down to the same as someone who has never smoked?

A

20 years

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30
Q

Why does smoking cause cancer?

A

Contains the chemicals nitrosamines and acrolein (mutagen, carcinogen?

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31
Q

What is an example of a cultural habit associated with an increased risk of mouth cancer?

A

In Asia a lot of the population use betel nuts

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32
Q

What is oral submucous fibrosis?

A

abnormal collagen deposition

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33
Q

What does excessive alcohol consumption do to the metabolic pathway for oxidation of ethanol?

A

Slows it down, preventing acetaldehyde from converting to acetate

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34
Q

What is the recommended alcohol consumption per week in units?

A

14

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35
Q

How long does it take the body to eliminate 1 unit of alcohol?

A

1 hour

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36
Q

How can a poor diet contribute to mouth cancer?

A

Insufficient levels of supplements such as iron can cause the mucosa to become thinner making it more permeable for carcinogens

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37
Q

What is the known carcinogen in alcohol?

A

Ethanol is broken down into acetaldehyde

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38
Q

What is the third largest risk factor for mouth cancer?

A

Infection of HPV (Human Papilloma Virus)

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39
Q

What are the 5 types of HPV?

A

Alpha
Beta
Gamma
Mu
Nu

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40
Q

Which type of HPV most commonly effects the oral mucosa?

A

Beta

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41
Q

Which high risk HPVs are associated with mouth cancer?

A

HPV16 abd HPV18

42
Q

What group does HPV belong to?

A

Papovavirus group

43
Q

What does oncogenic mean?

A

causing development of a tumour or tumours

44
Q

What early genes does HPV consist of?

A

E1-E7

45
Q

What late genes does HPV consist of?

A

L1 and L2

46
Q

What early genes give HPV its ocogenic properties and why?

A

E6 and E7 because they target the tumour suppressor genes and knockout their function

47
Q

Why does HPV target cells which are capable of dividing?

A

Because the virus wants to take over the genetic regulation and production of proteins of the cell

48
Q

Which protein does E7 interact with to inactivate the human tumour suppressor gene product?

A

The retinoblastoma protein (pRB)

49
Q

Which protein does E6 bind to for the destruction by the ubiquitin pathway?

A

p53

50
Q

What are the 2 main benign oral HPV lesions?

A

Papilloma
Condylomata

51
Q

What is the most common malignant oral HPV lesion?

A

Cancer - Squamous Cell Carcinoma (SCC)

52
Q

Does mouth cancer generally give patients symptomatic or asymptomatic lesions?

A

Asymptomatic

53
Q

What can happen to the teeth within a cancerous lesion?

A

They can become mobile

54
Q

What does it mean for an area of the mouth to be indurated?

A

Hard and rubbery to touch

55
Q

What percentage of oropharyngeal cancers are HPV related?

A

Up to 80%

56
Q

What are the 2 main risk factors behind HPV?

A

Number of sexual partners
Weakened immune system

57
Q

What are the 3 HPV vaccines?

A

Quadrivalent Gardasil
Bivalent Cervarix
Nonvalent Gardasil

58
Q

What is the Epstein-Barr Virus (EBV)?

A

A type of Herpes virus

59
Q

What does EBV most commonly cause?

A

Infectious mononucleosis

60
Q

What is infectious mononucleosis more commonly known as?

A

Glandular fever (kissing disease)

61
Q

What is a common oral symptom of a HIV positive patient?

A

Oral candidiasis

62
Q

What is Kaposi’s sarcoma?

A

A rare type of cancer that affects the skin, mouth and occasionally the internal organs

63
Q

What are usually the first symptoms of Kaposi’s sarcoma?

A

Red, purple or brown patches, plaques or nodules on the skin

64
Q

Where is commonly effected by UV Light as a risk of mouth cancer?

A

Lower lip

65
Q

Approximately 20% of mouth cancers have HPV within tumour cells, which HPV does this tend to be?

A

HPV16

66
Q

What is the commonest oral lesion with a viral aetiology?

A

Papilloma

67
Q

What is the known national screening programme for oral cancer?

A

There isnt one

68
Q

What are the 3 types of prevention classified into?

A

Primary
Secondary
Tertiary

69
Q

Define primary prevention and what is the role of the clinician here?

A

Prevents a disease from developing
Giving risk factor education - e.g. smoking/alcohol consumption

70
Q

Define secondary prevention and what is the role of the clinician here?

A

To detect disease while it is localised or ‘early’
Screening the oral cavity - looking for what is normal/abnormal

71
Q

Define tertiary prevention and what is the role of the clinician here?

A

to mitigate the morbidity from established disease and to improve quality of life
maintaining oral health and remaining dentition after patients have been treated/undergoing treatment. Also giving advice regarding risk factors

72
Q

What are the 3 screening programme types?

A

Mass
Selective
Opportunistic

73
Q

What screening programme is used in dentistry?

A

Opportunistic

74
Q

For a screening programme to be successful what must it be high in?

A

Sensitivity and Specificity

75
Q

How is sensitivity calculated?

A

True Positive/TP+False Negative

76
Q

How is specificity calculated?

A

True Negative/TN+FP

77
Q

What % of specify and sensitivity in a screening programme is acceptable

A

80 or more

78
Q

What is the best way to screen for oral cancer?

A

Conventional oral examination

79
Q

What is the name of the only study to have shown benefit of screening oral cancer?

A

Cochrane Review

80
Q

What does OPMD stand for?

A

Oral potentially malignant disorders

81
Q

Name a common OPMD

A

Lichen planus

82
Q

What is meant if something is homogeneous?

A

uniform/normal in colour, content, texture

83
Q

Are white or red lesions more worrying?

A

Red

84
Q

what sites in the mouth are at the highest risk for developing mouth cancer?

A

FOM and lateral borders of tongue

85
Q

What does leukoplakia mean?

A

clinical term that means a white patch, isn’t easily removed with gauze, no obvious risk factors (a white patch of unknown cause)

86
Q

What is the clinical term used to describe red lesions of an unknown cause

A

Erythroplakia

87
Q

What is meant by endophytic?

A

Inwards growing

88
Q

What is meant by exophytic?

A

Outwards growing

89
Q

When can cancers become painful?

A

When they are secondarily infected or when they invade nerves

90
Q

What is meant by a perineurial spread?

A

Cancerous cells that have invaded the nerves

91
Q

What is meant by a vascular invasion?

A

When cancerous cells have invaded the blood supply

92
Q

How is the size of a lesion recorded?

A

In T sizes

93
Q

How big is a T1 lesion?

A

<2cm

94
Q

How big is a T2 lesion?

A

2-4cm

95
Q

How big is a T3 lesion?

A

4-6cm

96
Q

How big is a T4 lesion?

A

> 6cm or if it involves bone

97
Q

What should you do if you spot a suspicious lesion?

A

Photograph /document in notes
Eliminate trauma
Review
Refer using urgent pathways

98
Q

What is sensitivity of a screening programme telling you?

A

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

99
Q

What is the specificity of a screening programme telling you?

A

The proportion of the population correctly classified as disease-free

100
Q

When examining a patients lymph nodes what are you looking for?

A

Symmetry
Soft non tender lymph nodes
Palpate all anatomical sites of lymph nodes
Skin moves freely over the nodes they are not attached
think about anatomical drainage from the mouth to the nodes of the neck
Symmetrical salivary glands

Module 4 (9 decks)

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