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Finals > Oral Cancer > Flashcards

Oral Cancer Flashcards

1
Q

What is the 5 yr survival for mouth cancer?

A

<50%

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2
Q

What is the commonest cancer of the mouth?

A

Squamous cell carcinoma

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3
Q

What are the risk factors of oral cancer?

A
  • Tobacco
  • alcohol
  • HPV (OPC)
  • age
  • deprivation
  • genetics
  • diet
  • M>F
  • previous cancer
  • potentially malignant conditions
  • immunocompromised
  • sunlight/UV light - lip cancer
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4
Q

what is dysplasia?

A

abnormal growth

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5
Q

how does a cell become cancerous?

A

cancer results from a mutation in genes resulting in a cell that grows and proliferates at an uncontrolled rate, is unable to repair DNA damage within itself, or refuses to die

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6
Q

what is a prognosis?

A

prediction of the probable course and outcome of a disease. Appropriate tx and estimated survival

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7
Q

what classification is used for staging malignant tumours?

A

TNM

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8
Q

What cancers fall under the umbrella of head and neck cancers?

A
  • mouth
  • oropharynx
  • nasopharynx
  • hypopharynx
  • ear
  • nose
  • paranasal sinuses
  • larynx
  • salivary glands
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9
Q

what area of the mouth are we concerned about when talking about mouth cancer?

A

anterior 2/3 of tongue

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10
Q

what area of the mouth are we concerned about when talking about oropharyngeal cancer?

A

posterior 1/3 of tongue

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11
Q

what is the largest risk factor of oral cancer?

A

tobacco

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12
Q

what is the second largest risk factor of oral cancer?

A

alcohol

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13
Q

what age group does oral cancer mostly effect?

A

> 55

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14
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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15
Q

what are the different forms of consuming tobacco?

A
  • roll ups
  • cigarettes
  • chews
  • cigars/pipes
  • snuff
  • betal nut/quid
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16
Q

what is oral submucous fibrosis?

A

abnormal collagen deposition

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17
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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18
Q

what is the recommended alcohol consumption per week in units?

A

14

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19
Q

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

A

1 hr

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20
Q

how can a poor diet contribute to oral cancer?

A

low fruit and veg increases risk
insufficient levels of supplements such as iron can cause the mucosa to become thinner making it more permeable for carcinogens

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21
Q

what is the known carcinogen in alcohol?

A

ethanol is broken down into acetaldehyde

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22
Q

where is alcohol metabolised in the mouth?

A

salivary glands
mucosa
oral bacteria

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23
Q

what is the metabolic pathway for oxidation of ethanol?

A

ethanol > acetaldehyde > acetate > CO2 > H2O

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24
Q

what is the third biggest risk factor for mouth cancer?

A

Human Papilloma Virus

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25
Q

which high risk HPVs are associated with mouth cancer?

A

HPV 16 and 18

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26
Q

what are the low risk HPVs?

A

HPV 6 and 11

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27
Q

what are the 2 main benign oral HPV lesions?

A

papilloma
condylomata

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28
Q

does mouth cancer generally give patients symptomatic or asymptomatic lesions?

A

asymptomatic

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29
Q

what does it mean for an area of the mouth do be indurated?

A

hard and rubbery

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30
Q

what are the 2 main risk factors behind HPV?

A

number of sexual partners
weakened immune system

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31
Q

what is the epstein-barr virus (EBV)?

A

a type of herpes virus

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32
Q

what does EBV most commonly cause?

A

glandular fever

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33
Q

what is the most common oral symptom of a HIV positive patient?

A

oral candidiasis
hairy leukoplakia
accelerated periodontal disease
kaposi’s sarcoma
salivary gland disease
oral ulcers

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34
Q

what is kaposi’s sarcoma?

A

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

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35
Q

what are usually the first symptoms of kaposi’s sarcoma?

A

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

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36
Q

where is commonly effected by UV light as a risk of mouth cancer?

A

lower lip

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37
Q

what is the most common lesion with a viral aetiology?

A

papilloma

38
Q

what are the 3 types of prevention?

A

primary
secondary
tertiary

39
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

40
Q

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

A

to detect disease while it is localised or ‘early’
screening oral cavity - looking for what is normal/abnormal

41
Q

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

A

to mitigate 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

42
Q

what does OPMD stand for?

A

Oral Potentially Malignant Disorder

43
Q

name a common OPMD

A

lichen planus

44
Q

what is meant if something is homogenous?

A

uniform/normal in colour, texture

45
Q

are white or red lesions more worrying?

A

red

46
Q

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

A

Lat border of tongue
FOM
retromolar region

47
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)

48
Q

what is the clinical term to describe red lesions of an unknown cause?

A

erythroplakia

49
Q

what is meant by endophytic?

A

inwards growing

50
Q

what is meant by exophytic?

A

outwards growing

51
Q

when can cancers become painful?

A

when they are secondarily infected or when they invade nerves

52
Q

what is meant by a perineural spread?

A

cancerous cells that have invaded the nerves

53
Q

what is meant by a vascular invasion?

A

when there is a presence of cancerous cells in the blood

54
Q

how is the sizes of a lesion recorded?

A

T sizes

55
Q

how big is a T1 lesion?

A

<2cm

56
Q

How big is a T2 lesion?

A

4-6cm

57
Q

How big is a T4 lesion?

A

> 6cm or if it involves bone

58
Q

what should you do if you spot a suspicious lesion?

A

photograph/document in notes
eliminate trauma
review
refer using urgent pathways (2wks)
get another opinion?

59
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
60
Q

what are papillomas caused by?

A

Low risk HPVs (6 and 11)

61
Q

what are the features of cancer?

A
  • red/white/speckled lesion
  • ulcerated areas (often pain free)
  • high risk sites
  • symptom free (usually)
  • unknown duration
  • RF history
62
Q

Buckman (2005) proposes the communication protocol…to break bad news

A

SPIKES

63
Q

what does SPIKES stand for?

A

SETTING and listening skills
patients PERCEPTION of condition and seriousness
INVITATION from the patient to give information
KNOWLEDGE - giving the facts
explore emotions and EMPATHISE as patients responds STRATEGY and summary

64
Q

what is the overview for overall oral health assessment and review?

A
  • assessment of patients history
  • assessment of oral health status
  • diagnosis and risk assessment
  • personal care plan
65
Q

what is frictional keratosis?

A

type of white patch
position of lesion corresponds to cause and disappears when cause is removed
common on lat border of tongue and cheeks

66
Q

what is lichen planus?

A

a type of white patch
autoimmune disease
bilateral reticular lesions, affecting the cheeks, lat tongue, gingivae, skin, scalp and nails

67
Q

what is a lichenoid reaction?

A

a type of white patch
resembles lichen planus
can be due to drugs or amalgam
if amalgam it will be unilateral on tongue or on cheeks adjacent to restoration

68
Q

what are the clinical features of a traumatic ulcer

A

position of ulceration corresponds to suspected cause and disappears when removed

69
Q

what are the clinical features of minor aphthous ulcer?

A

recurrent, young individuals, painful, small lesions, lips FOM. last 10-14 days

70
Q

what are the clinical features of a squamous cell carcinoma ulcer?

A

long duration, non healing ulcer, no obvious cause, raised rolled margins, firm/hard to touch
high risk sites include FOM lat border of tongue, retromolar area

71
Q

what does a herpes ulcer look like?

A

on gingivae and palate
patients systemically unwell
lasts 10-14 days

72
Q

what do pemphigus vulgaris ulcers look like?

A

blisters which break down to give ulcers and erosions
affects older individuals
skin lesions

73
Q

what is a list of benign lesions?

A
  • leaf fibrosis
  • denture induced hyperplasia
  • papillary hyperplasia
  • papilloma
  • condylomata
  • toris mandibularis palatinus
  • apthous ulcers
  • lipoma
  • mucocele
  • epulis
74
Q

what is an epulis?

A

chronic area of irritation - overhang
gum swelling
preg hormones

75
Q

what causes a mucocele?

A

trauma to salivary gland

76
Q

what is an apthous ulcer?

A

clusters
pain
resolve in two weeks

77
Q

what causes papilloma or codylomata?

A

low risk HPV (6,11)

78
Q

When do you screen patients for oral cancer?

A

recalls
new patients
concerns
review

79
Q

what are you feeling for lymph nodes?

A
  • not ewnlarged
  • not tender
  • freely moving
  • symmetry
  • not firm/indurated
80
Q

what is the prevalence of cancer?

A

90% = SSC
high prevalance - most deprived
6th common cancer in scotland
males >55
56% year survival

81
Q

what carcinogens does tobacco contain?

A
  • arsenic
  • tar
  • acetylaldehyde
  • Carbon monoxide
82
Q

what effects the diagnosis?

A
  • proliferation rate
  • aggressive nature
  • deprivation
  • education
  • delayed professionals - low confidence, lack of time, fear of inducing anxiety
83
Q

what are the features of cancer?

A
  • unknown duration
  • non-wipeable
  • RFs
  • ulcerated
  • risk sites
  • size >200mm
  • heterogenous
  • speckled patch
  • erythroplakia
  • leukoplakia
  • no pain
84
Q

what to include in a refferal?

A
  • document details
  • photographs
  • referral - biopsy
  • size
  • colour
  • location
  • time
  • photographs
85
Q

whats normal?

A

dorsum of tongue:
- black hairy tongue
- geographical tongue
- fissured tongue
Ventral tongue:
- frenum
- veins
- glands
- bullae (blister)
lateral tongue:
- keratosis - clenching bruxism

86
Q

what is routine or urgent referral?

A
  • 2 weeks
  • unexplained lesion
  • unknown duration
  • severe pain
  • RFs
  • painless
  • immunosupressed
  • leukoplakia
  • red/speckled
  • > 3 weeks
87
Q

what viruses can cause oral cancer?

A

HPV
low risk 6,11
high risk 16, 18
EBV - burkitts lymohoma
HIV - AIDS - weak immune s

88
Q

what is kaposi sarcoma?

A

HHV8 or HIV
oral patches/nodules - red, brown, purple

89
Q

what are the symptoms of lichen planus?

A

pain/burning
associated with auto - immune disease
buccal
tongue
bilateral
white
red
pain/burning

90
Q

what are OPMDs?

A

oral potentially malignant disorders
- leukoplakia
- lichen planus
- chronic candidiasis
- erthroplakia
- erythroleukoplakia
- leukoplakia

Finals (9 decks)

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