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MFDS > Oral cancer > Flashcards

Oral cancer Flashcards

1
Q

What is the pathophysiology of oral cancer development?

A

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.

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2
Q

What is the histology of dysplasia?

A
  • pleomorphic cells with irregular nuclei
  • epithelial dysplasia
  • architectural changes with abnormal maturation and stratification
  • cellular atypia
  • hyperplasia
  • hyperchromatism
  • infiltration unto muscle fibres
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3
Q

What are the 3 methods of spread of cancer?

A

Local extension
Lymphatic spread
Haematogenous spread

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4
Q

What are the 3 main sites affected by oral cancer?

A

Lateral border of tongue 80%
Floor of mouth 45%
Soft palate 25%
Retromolar pad region

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5
Q

What is the increased risk of smokers vs non smokers for getting oral cancer?

A

7-10x increased risk for smokers

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6
Q

What is the risk of oral cancer from smoking and drinking?

A

15-38x increase due to synergistic effect

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7
Q

What is the increased risk from betel nut chewing than smokeless tobacco?

A

11-12x risk for smokeless tobacco

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8
Q

What are the main risk factors for oral cancer?

A 
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
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9
Q

What is the increased risk and timing for leukoplakia to become malignant?

A

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

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10
Q

What are the common pre malignant conditions of the oral cavity?

A 
Leukoplakia 
Erythroplakia 
Chronic hyperplastic candidiasis (<2% risk) 
Oral lichen planus (1-3% risk) 
Discoid lupus erythematous
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11
Q

What are the diagnostic signs for suspected oral cancer?

A
  • 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
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12
Q

What is the process of diagnosis at OMFS for suspected oral cancer?

A
  • 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
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13
Q

What are the 4 stages relating to TNM grading?

A

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

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14
Q

What are the 3 options for oral cancer tx?

A
  1. Attempted cure
    - multimodality Tx: excision surgery +/- radiotherapy (within 6wks post surgery and with 5mm excision margins) +/- chemotherapy
  2. Active palliative care
  3. Supportive care only pending death
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15
Q

Who is part of the oral cancer MDT?

A 
Radiologist
MaxFacs consultant
Restorative specialist dentist 
Radio therapist 
Chemo therapist 
Palliative care consultant
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16
Q

What are the oral side effects of radiotherapy?

A
  • mucositis
  • xerostomia
  • osteoradionecrosis
  • increased risk of infection and poor wound healing
  • caries
  • candidiasis
  • oral ulceration
17
Q

What are the Oral side effects of chemotherapy?

A
  • increased bleeding and bruising
  • increased risk of infections
  • mucositis
  • mouth ulcers
  • xerostomia
  • reduced sense of taste
  • halitosis
18
Q

What is mucositis?

A

Condition characterised by painful inflammation and ulceration of the mucosa membranes lining the digestive tract, usually adverse effect from chemo and radiotherapy.

19
Q

What are the 4 grades of mucositis?

A

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

20
Q

What is the management of mucositis?

A
  • 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.
21
Q

What structures are removed during block dissection of the neck?

A 
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

MFDS (37 decks)

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