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Bds4 Oral Med > Oral Cancer > Flashcards

Oral Cancer Flashcards

1
Q

What are some potentially malignant conditions?

A

Lichen planus (erosive)
Oral sub mucous fibrosis
Iron deficiency
Tertiary syphilis

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2
Q

What are potentially malignant lesions?

A

Leukoplakia
Erythroplakia

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3
Q

What is leukoplakia?

A

A white patch which cannot be rubbed off with no identifiable cause

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4
Q

What is the term given to a white patch which can be rubbed off?

A

Pseudomembranous candidiasis

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5
Q

What is most common for malignant change- erythroplakia or leukoplakia?

A

Erythroplakia
50% are already a carcinoma

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6
Q

What are common causes of white patches in the mouth (differential diagnosis)?

A

Traumatic lesion (frictional keratosis, chemical burn, cheek/ tongue biting)
Infection (chronic/ acute hyperplastic candidosis)
Lichen planus (or lichenoid reaction)
Smokers keratosis
Squamous cell carcinoma
Leukoplakia (unknown cause)

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7
Q

what is sublingual keratosis and its malignancy potential?

A

Refers to a white patch on floor of mouth or ventral surface of tongue
Usually bilateral
Site is high risk of malignancy

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8
Q

What is smokers keratosis?

A

A white patch of no known cause found in the mouth of a smoker
Flat, homogenous white patch on non-keratinised mucosa

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9
Q

What is frictional keratosis?

A

White patch along occlusal line/ lateral tongue due to trauma - from sharp teeth/ restorations/ tongue or cheek biting.
These lesions are gradual and often have a shredded surface.
Resolve on removing the cause.

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10
Q

What is chronic hyperplastic candidosis?

A

Candidato leukoplakia
Commonly on bucal mucosa and dorsal of tongue
May be associated with red areas
Biopsy and resolution following anti viral treatment

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11
Q

What are the common features of lichen planus?

A

Usually bilateral white patches
Common on bucal mucosa
Skin involvement
Desquamative gingivitis

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12
Q

What is the clinical appearance of an aspirin burn?

A

Application of aspirin directly to mucosa in bucal sulcus which affects both sides of the the site where the tablet was placed.

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13
Q

Why are biopsy’s performed

A

White lesions require biopsy (except typical keratotic leukoplakia and typical LP).
- To exclude/ confirm SCC
- If not malignant, to determine whether dysplasia is present
- To identify chronic candida infection if present
- To help identify specific conditions and causes of lesion

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14
Q

What is the ideal biopsy sample?

A

For a white patch:
10mm long and 4-5mm wide width sufficient depth to support the epithelial sample.
Should extend to muscle and contain mostly the lesion but with part of the margin and normal surrounding mucosa

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15
Q

What is dysplasia?

A

Disordered maturation in tissue (histopathological finding, not clinical diagnosis)

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16
Q

What is the grade of dysplasia based on?

A

Cellular atypia and epithelial architectural organisation

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17
Q

What are signs of high risk of malignancy (from histological sample)

A

Dysplasia
Atrophy
Candida

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18
Q

What are the histological features of dysplasia?

A

Failure to form organised epithelial layer
Disordered maturation and differentiation of single cells
Abnormalities of cell nuclei
Abnormal growth regulation

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19
Q

What are the grades of dysplasia?

A

Hyperplasia
Mild
Moderate
Severe
Carcinoma in situ

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20
Q

What are the high risk sites for malignant transformation?

A

Floor of mouth and ventral tongue

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21
Q

What is field cancerisation

A

There is a high cancer risk in a 5cm radius of the original primary
(Therefore, most of the mouth and pharynx)

  • risk of development of abnormal area of epithelium in area close to area of transformation
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22
Q

what are the hallmarks of cancer? (6)

A
  1. Evading apoptosis
  2. Self sufficiency in growth signals
  3. Insensitivity to anti growth signals
  4. Tissue invasion and metastasis
  5. Limitless replicative potential
  6. Sustained angiogenesis
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23
Q

What is angiogenesis?

A

Formation of new blood vessels

24
Q

How is cancer staged?

A

T - tumour size
N - lymph node involvement
M - distance metastasis

25
Q

What are risk factors for oral cancer?

A

Smoking
Alcohol
Socioeconomic status
FH
Poor OH
Sexual activity

26
Q

What should be included when describing a red/ white patch (lesion)?

A

Size
Site
Shape
Colour
Surface

What it feels like (firm/ attached etc)
If it can be rubbed off

27
Q

What are the main features of a malignant lesion?

A

Red/ speckled areas
Non-healing ulceration
Rolled everted ulcer margin
Induration of surrounding tissue
Bleeding from surface
Fixation of tissues
Destruction of adjacent bone
Enlarged lymph nodes

28
Q

What is the grading of oral cancer? And what does this tell us?

A

Grading predicts how quickly the cancer will spread and is based on the degree of differentiation under the microscope

◦ GX- grade cannot be evaluated
◦ G1- the cells look more like normal tissues and are well differentiated (low grade)
◦ G2- the cells are only moderately differentiated
◦ G3 and G4- the cells do not resemble normal tissue and are poorly differentiated

29
Q

What are the margins for biopsy of OPMD? And how does this differ to biopsy margins for SCC?

A

1mm (very narrow) for OPMD
Thicker and deeper for SCC eg 1cm

30
Q

What is the aim of treatment of OPMDs?

A

To eliminate infection and inflammation

31
Q

What is the best way to test malignancy risk of OPMD?

A

H&E staining to assess degree of dysplasia

32
Q

What is the oral cancer urgent referral pathway?

A

3 weeks

33
Q

What is the malignant transformation rate of erythroplakia?

A

40-50% (3x higher than leukoplakia)

34
Q

What are some acute oral side effects of radiation therapy to head and neck?

A

Mucositis
Taste loss/ alteration
Candidosis
Trismus
Radiation dermatitis
Dysphagia

35
Q

What are the long term side effects of radiation to head and neck?

A

Long term - loss of salivary gland function, trismus due to muscle fibrosis, radiation caries and ORN

36
Q

What is Mucositis?

A

A severely debilitating condition characterized by erythema, edema, and ulcerations of the oral mucosa
Extremely painful and self limiting

37
Q

What is the management for Mucositis?

A

Local analgesics - benzydamine mouthwash/ spray, lidocaine gel.
Ice cooling
Hydration
Saliva replacements

38
Q

What is the prevention for Mucositis?

A

Good OH
Alcohol free mouthwash
Hydration
Avoid oral irritants (alcohol, tobacco, spicy foods)
Leave out dentures

39
Q

When does Mucositis usually begin?

A

1-2 weeks after treatment starts

40
Q

When does Mucositis usually resolve

A

Around 6 weeks after treatment has finished

41
Q

How is caries prevented in patients with oral Mucositis who struggle to brush?

A

Tooth mouse
Fluoride gel in mouth guard

42
Q

Why does the oral cavity suffer so many side effects from radiation/ chemotherapy?

A

Chemo/ RT targets cells with high turnover (oral cavity)

43
Q

Why does RT cause xerostomia?

A

Damage to the salivary glands results in dysfunction through cell death and fibrosis

44
Q

What are the local measures for management of xerostomia?

A

Advice - frequent sips tap water, ice, sugar free gum

Glandosane spray (for edentulous as acidic)
Salivez spray
BioXtra gel

45
Q

What is ORN?

A

Osteoradionecrosis of the jaw

An area of exposed bone of at least 3 months duration in an irradiated site and not due to tumour recurrence

46
Q

What is a complication of ORN?

A

Pathological fracture

47
Q

In what cases should patients who have undergone radiation therapy be referred for extractions?

A

Refer to OMFS department if tooth to be extracted is in a field of >50 gray.
Otherwise, a traumatic technique and primary closure of socket

48
Q

When would a non healing extraction socket be os ORN suspicion?

A

8 weeks non healing post XLA

49
Q

What does ‘dentally fit’ mean?

A

No possible source of dental infection.

50
Q

When should teeth be extracted in terms of starting cancer treatment?

A

10 days

51
Q

What antifungals can be prescribed for candida infections?

A

Chlorohexidine mouthwash
Miconazole (topical)
Fluconazole (systemic) - be careful with interaction
Nystatin

52
Q

What virus can be reactivated during cancer treatment?

A

Herpes simplex virus
Causes painful ulceration with sudden onset

53
Q

What is radiation induced caries?

A

Indirect effect of non surgical cancer treatment
Reduced salivary flow and altered saliva function in combination with high protein and calorie diet = caries
Often circumferential around teeth- cervical margins and incisal edges.

54
Q

How is ORN prevented?

A

Remove teeth of doubtful prognosis in radiation field.
Extractions completed 10 days prior to treatment starting.
Encourage healing by primary closure/ sutures

55
Q

What technique can reduce ORN risk when extractions need to be carried out?

A

Extractions in combination with hyperbaric oxygen therapy - increased oxygen supply to damaged tissue to stimulate healing.

56
Q

What puts patients at increased risk of ORN?

A

Radiation dose >60 grays
Dose fraction was large with high number of fractions
Local trauma
Immunodeficiency
Malnutrition

57
Q

Why is the mandible more at risk of ORN?

A

Less vascular than maxilla

Bds4 Oral Med (13 decks)

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