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BDS4 > Oral cancer > Flashcards

Oral cancer Flashcards

1
Q

What are the 2 distinct disease patterns in oral cancer?

A
  • Oral cavity cancer
  • Oro-pharyngeal cancer
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2
Q

What are 4 high risk sites in the oral cavity for oral cancer?

A
  • FoM
  • Lateral border of the tongue
  • Soft palate
  • Retromolar regions
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3
Q

In most cases of oral cancer which 2 sites have the highest incidence?

A
  • Tongue
  • Tonsils
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4
Q

Why are the rated of oropharyngeal cancer rapidly rising in high income areas?

A

Lined to the rising HPV pandemic

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5
Q

How many times more likely does a person who smokes will get cancer ?

A

x2

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6
Q

How many times more likely does a person who drinks will get cancer ?

A

x2

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7
Q

How many times more likely does a person who smokes and drinks will get cancer ?

A

x5

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8
Q

In drinking, which will increase the risk of cancer more , the duration or the frequency?

A

Frequency

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9
Q

In smoking, which will increase the risk of cancer more frequency or duration?

A

duration

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10
Q

How many times more likely does a person who uses betel quid will get cancer ?

A

x2

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11
Q

How many times more likely does a person who is from a low socioeconomic background will get cancer ?

A

x2 , especially low income and low education level

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12
Q

What part of the family history is important to acquire to assess the risk of head and neck cancer?

A

1st degree relative

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13
Q

What other risk factors can be associated with oral cancer other than socioeconomic status, gender, smoking, drinking , paan and family history?

A
  • Poor oral hygiene
  • Sexual activity
  • Poor diet
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14
Q

Give 4 potentially malignant lesions?

A
  • Leukoplakia
  • Erythroplakia
  • Lichen planus - candidal leukoplakia, chronic hyperplastic candidiasis
  • Oral submucous fibrosis
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15
Q

What is dysplasia grading based on?

A
  • Cellular atypia
  • Epithelial architectural organisation
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16
Q

What is the catagories of dysplasia?

A
  • Low grade
  • High grade
  • Carcinoma in situ
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17
Q

What are cytological changes?

A

Changes in individual cells

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18
Q

Give 4 examples of cytological changes?

A
  • Abnormal nuclear size
  • Abnormal nuclear shape
  • Abnormal cell shape
  • Abnormal cell size
  • nuclear hyperchromatism
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19
Q

What are architectural changes?

A

changes in organisation of maturation and layering of the epithelium

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20
Q

4 examples of architectural changes?

A
  • irregular epithelial stratification
  • loss of basal cells polarity
  • drop shaped rete pegs
  • Abnormal keratinisation
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21
Q

How does low grade dysplasia appear? Give 5 signs?

A

Squamous epithelium can be distinguished
* Architectural change in lower third
* increased keratin production
* Stratification
* well defined tumour islands
* well formed basal cell layer

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22
Q

How does high grade dysplasia appear? Give 4 signs?

A

Show little resemblance to a normal sqaumous epithelium
* Architectural change in upper third
* increased atypia
* non-cohesive invasion pattern
* Prominent mitotic figures

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23
Q

What can be a predictor of cancer prognosis?

A

Degree of differentiation

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24
Q

What is cacinoma in situ?

A
  • Abnormal archteccture involving the full thickness of epithelium with severe cytological atypia
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25
Q

What are the histological prognostic factors of cancer? (4)

A
  • Pattern of invasion
  • Depth of invasion
  • Perineural invasion
  • Invasion of vessels
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26
Q

What does the field cancerisation concept suggest?

A

large tissue areas (>5cm) are more likely to develop multiple cancers due to widespread genetic damage from carcinogens

27
Q

Which system is oral cancer staged on?

A

TNM

28
Q

What are 2 risk factors for lip cancer?

A

Smoking and sunlight

29
Q

Why does lip cancer have good prognosis in the early stages ?

A
  • slow growth
  • local invasion
  • rarely metastasise to nodes
30
Q

How can lip cancer present ?

A

non healing ulcers or swelling on the lower lip

31
Q

Which tool can be used for oral cancer screening?

A

Oral cancer recognition toolkit

32
Q

4 examples of screening aids for oral cancer other than the oral cancer recognition toolkit?

A
  • HPV 16 screening
  • Toluidene blue
  • VELscope
  • Photodynamic diagnosis
33
Q

What is the disadvantage of toluidine blue?

A

50% false negatives

34
Q

How does VELscope work?

A

Autofluorescence of tissue with light blue , loss of fluorescence equate to change which may be cancer

35
Q

According to WHO what does a potentially malignant lesion mean?

A
  • altered tissue in which cancer is more likely to form
36
Q

According to WHO what does a potentially malignant condition mean?

A

A generalised state with increased cancer risk

37
Q

What 4 systemic conditions are considered as potentially malignant?

A
  • Lichen planus
  • Oral submucous fibrosis
  • Iron deficiency
  • Tertiary syphilis
38
Q

What 2 types of leukoplakia can be considered to have a high malignant potential?

A
  • Chronic hyperplastic candidiasis
  • Proliferative verrucous leukoplakia
39
Q

What area of the mouth does chronic hyperplastic candidiosis can affect?

A

Commissures , in smokers

40
Q

What 3 histological features in chronic hyperplastic candidosis?

A
  • Dysplasia in lower third
  • Mitotic figures
  • collection of neutrophils in the epithelium
41
Q

What stain is used to demonstrate candida albicans hyphae?

A

Periodic Schiff stain

42
Q

What are 3 managements for chronic hyperplastic candidosis?

A
  • Systemic antifungals - Fluconazole
  • Biopsy
  • Smoking advice
43
Q

Which area in the world might be considered as high incidence?

A

India

44
Q

How many times does leukoplakia more likely to progress into cancer than normal mucosa?

A

50 to 100

45
Q

From what does most oral carcinomas rise in the UK?

A

Clinically normal mucosa

46
Q

What is this?

A

Proliferative verrucous leukoplakia

47
Q

What are 4 predictors factors of leukoplakia malignancy?

A
  • Age and gender
  • Idiopathic
  • Site
  • Clinical appearance - non homogenous
48
Q

Which site is considered high risk for leukoplakia malignancy?

A

FoM and tongue

49
Q

Which white lesion has the most malignancy transformation?

A
  • Proliferative verrucous leukoplakia
50
Q

What 3 things histologically are a predictor of malignancy in leukoplakia?

A
  • Dysplasia
  • Atrophy
  • Candida infection
51
Q

What is dysplasia?

A

disordered maturation in a tissue

52
Q

What is atypia ?

A

Changes in cells

53
Q

What are the criteria for diagnosing malignancy?

A
  • Architectural changes
  • Cytological abnormalities
54
Q

According to WHO classification 2005 , how is epithelial dysplasia graded?

A
  • Hyperplasia
  • Mild
  • Moderate
  • Severe
  • Carcinoma in situ
55
Q

What is involved in hyperplasia (4) ?

A
  • increased basal cell numbers
  • basal compartment is larger
  • no cellular atypia
56
Q

What is involved in mild dysplasia? (2)

A
  • architectural changes in lower third
  • Mild atypia ; hyperchromatism, pleomorphism
57
Q

What is involved in moderate dysplasia? (2)

A
  • Archtectural change in middle third
  • Moderate atypia
58
Q

What is involved in severe dysplasia?

A
  • Architectural changes extend to upper third
  • Severe atypia and numerous mitoses
59
Q

What is the gold standard for confirming a malignancy?

A

Histopathology

60
Q

What are the two main factors in carcinogenesis?

A
  • Genetic
  • Environmental
61
Q

What is the molecular basis of cancer?

A

Damage leads to altered gene expression leads to altered cell function

62
Q

List 3 genetics involved in oral cancer?

A
  • Genes that regulate apoptosis
  • Genes involved in DNA repair
  • Oncogenes
  • Tumour suppressor genes
63
Q

80% cancers are considered what in case of differentiation?

A

Moderately differentiated

64
Q

What are 3 subtypes of OSCC?

A
  • Verrucous carcinoma
  • Spindle cell
  • Basaloid squamous

BDS4 (63 decks)

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