Oral cancer Flashcards
What is the pathophysiology of oral cancer development?
Oral squamous cell carcinoma is the end product of an unregulated proliferation of mucous basal cells. A single precursor cell is transformed into a clone with accumulation of oncogenes which can then metastasise.
What is the histology of dysplasia?
- pleomorphic cells with irregular nuclei
- epithelial dysplasia
- architectural changes with abnormal maturation and stratification
- cellular atypia
- hyperplasia
- hyperchromatism
- infiltration unto muscle fibres
What are the 3 methods of spread of cancer?
Local extension
Lymphatic spread
Haematogenous spread
What are the 3 main sites affected by oral cancer?
Lateral border of tongue 80%
Floor of mouth 45%
Soft palate 25%
Retromolar pad region
What is the increased risk of smokers vs non smokers for getting oral cancer?
7-10x increased risk for smokers
What is the risk of oral cancer from smoking and drinking?
15-38x increase due to synergistic effect
What is the increased risk from betel nut chewing than smokeless tobacco?
11-12x risk for smokeless tobacco
What are the main risk factors for oral cancer?
Tobacco - smokeless/smoking Alcohol Betel nut Viruses - HPV, HSV1, EBV, HPV16, HHV8 Sun exposure Malnourishment Poor oral hygiene Immunocompromised Genetics Previous oral cancer Pre malignant lesions/chronic infections
What is the increased risk and timing for leukoplakia to become malignant?
Leukoplakia lesions have 2.5% in 10yrs of becoming malignant and 4% In 20yrs
50-100x more likely to progress to cancer than normal mucosa
What are the common pre malignant conditions of the oral cavity?
Leukoplakia Erythroplakia Chronic hyperplastic candidiasis (<2% risk) Oral lichen planus (1-3% risk) Discoid lupus erythematous
What are the diagnostic signs for suspected oral cancer?
- hoarseness persistent for >6wks
- unexplained ulceration or oral swelling for >3wks
- unexplained white/red patches >3wks
- dysphagia persisting for >3wks
- unilateral nasal obstruction, particularly when associated with discharge
- unexplained tooth mobility not associated with periodontal disease
- unresolving neck mass >3wks
What is the process of diagnosis at OMFS for suspected oral cancer?
- biopsy of lesion for histology
- OPT +/- MRI +/- CBCT +/- PET
- chest xray and US to exclude distant metastasis
- FNA of enlarged lymph nodes
- staging and grading to determine success of Tx
What are the 4 stages relating to TNM grading?
Stage 1: T1 N0 M0
Stage 2: T2 N0 M0
Stage 3: T3 N0 M0 or T1-3 N1 M0
Stage 4: any tumour T4, N2/N3, or M1
What are the 3 options for oral cancer tx?
- Attempted cure
- multimodality Tx: excision surgery +/- radiotherapy (within 6wks post surgery and with 5mm excision margins) +/- chemotherapy - Active palliative care
- Supportive care only pending death
Who is part of the oral cancer MDT?
Radiologist MaxFacs consultant Restorative specialist dentist Radio therapist Chemo therapist Palliative care consultant