Oral cancer - aetiology & epidemiology

Question 1

Why can lymphadenopathy be a sign of oral cancer?

Answer 1

Metastatic deposits cause enlargement of the node, firm texture

Question 2

What virus is associated with Oropharyngeal cancer?

Answer 2

HPV - Human papillomavirus

Question 3

What % of oral cancer patients are drinkers?

Answer 3

60-80%

Question 4

Which sex is affected more by oral cancer?

At what age is the peak incidence?

Answer 4

Elderly males

60-70 years

Question 5

If a tumour has a perinueral or vascular spread, comment on its prognosis

Answer 5

Perineural and vascular spread poor prognostic feature

Question 6

What are common symptoms of oral cancer?

Answer 6

• Sore mouth ulcers that don’t heal within several weeks
• Unexplained, persistent lumps in the mouth that don’t go away
• Unexplained, persistent lumps in the lymph glands in the neck that don’t go away
• Pain or difficulty when swallowing (dysphagia)
• Changes in your voice or speech problems
• Unexplained weight loss
• Bleeding or numbness in the mouth
• A tooth, or teeth, that becomes loose for no obvious reason, or a tooth socket that doesn’t heal
• Difficulty moving your jaw
• Red or white patches on the lining of your mouth

Question 7

What infection is asscociated with malignant changes in leukoplakias?

Answer 7

Candida

Question 8

What does incidence mean?

And what is the relative frequency of oral cancer;
- UK
- India

Answer 8

Incidence = Rate of new disease per 100,000/year

Uk - 4 cases/100,000/year
India - 20-30 cases/100,000/year

Question 9

How is iron deficiency linked to oral cancer?

Answer 9

Iron Deficiency links to mucosal atrophy which may render mucosa more susceptible to carcinogens

Question 10

How are viruses linked with oral cancer?

Answer 10

Viruses act by activating cellular oncogenes either by initiation of mutations or inserting own genome close to oncogene

Question 11

Comment on a size of a tumour in relation to its metastatic potential

Answer 11

Larger tumour greater risk metastatic spread and worse prognosis

Question 12

What the link between Oral Cancer and Oral Squamous Cell Carcinoma?

Answer 12

Oral Cancer often used synonymously with Oral Squamous Cell Carcinoma

Question 13

What are the common sites for Oral cancer?

Answer 13

Tongue 30%
FOM 15%
Mandible/alveolus 20%
Retromolar 15%

Question 14

Ethanol is not a carcinogen but how can it be involved in oral cancer development?

Answer 14

Increases permeability of oral mucosa to carcinogens

Question 15

What is the prognosis of Oral cancer?

Answer 15

Poor 50% die of disease

Question 16

What does relative frequency mean?

And what is the relative frequency of oral cancer;
- Worldwide
- UK
- India

Answer 16

Relative Frequency = % of all malignant disease

Worldwide 10%
UK 1-2%
India 30-50%

Question 17

How may Vitamin A be linked to oral cancer?

Answer 17

Vit A important for normal epithelial differentiation
Lack of Vit A may be a factor in neoplasia

Treatment with retinoids (Vit A ) can remit white lesions

Question 18

What do the TMN gradings mean and what are the five year survival rates for the different grades for oral cancer?

Answer 18

5 year survival
Stage 1 - Small lesion no nodal mets 77%
Stage 2 - Larger no nodal mets 76%
Stage 3 - Very large no nodal mets or small with mets 44%
Stage 4 - Any size with bilateral nodal or distant mets 20%

mets = metastasis

Question 19

What does prevalence mean?

What is the prevalence of oral cancer in the UK?

Answer 19

Number cases within population at given time point

0.05-0.1% (1 in 1000) patients will have oral cancer

Question 20

Describe how an infected lymph node may seem to a patient

Answer 20

Infected nodes are painful soft or firm but not fixed

Question 21

What are clinical features observed in oral cancer?

Answer 21

• White patch-leukoplakia excessive keratin
• Speckled white patch – speckled leukoplakia due to hyperkeratosis and atrophy
• Red patch erythroplakia epithelial atrophy abnormal epithelial differentiation
• Ulceration loss of intact epithelium due to invasion
• Excessive proliferation of epithelium leads to a exophytic tumour

Question 22

What % of oral cancer patients are long term smokers?

Answer 22

80-90%

Question 23

Where in the world is oral cancer most prevalent?

Answer 23

Particularly problem in South East Asia single most common cancer between 30-50% of all cancers