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
What are the oral side effects of radiotherapy?
- mucositis
- xerostomia
- osteoradionecrosis
- increased risk of infection and poor wound healing
- caries
- candidiasis
- oral ulceration
What are the Oral side effects of chemotherapy?
- increased bleeding and bruising
- increased risk of infections
- mucositis
- mouth ulcers
- xerostomia
- reduced sense of taste
- halitosis
What is mucositis?
Condition characterised by painful inflammation and ulceration of the mucosa membranes lining the digestive tract, usually adverse effect from chemo and radiotherapy.
What are the 4 grades of mucositis?
Grade 0: nothing to note
Grade 1: oral soreness, erythema
Grade 2: oral erythema, ulcers and solid diet tolerated
Grade 3: Oral ulcers on liquid diet only
Grade 4: oral alimentation Impossible
What is the management of mucositis?
- sook on ice cubes for cooling
- morphine lollipops for pain management
- LLLLT - UVB light
- calcium and phosphate MW to create lining of mouth
- use of gelclair, sodium bicarbonate
- ensure good OH and avoid smoking, alcohol, spicy food and caffeine.
What structures are removed during block dissection of the neck?
Entire sternomastoid muscle (sacrifices accessory nerve causing shoulder droop) Internal and external jugular veins Submandibular and submental triangles Submandibular gland Lymph nodes along internal jugular vein
