Oral cancer - aetiology & epidemiology Flashcards
Why can lymphadenopathy be a sign of oral cancer?
Metastatic deposits cause enlargement of the node, firm texture
What virus is associated with Oropharyngeal cancer?
HPV - Human papillomavirus
What % of oral cancer patients are drinkers?
60-80%
Which sex is affected more by oral cancer?
At what age is the peak incidence?
Elderly males
60-70 years
If a tumour has a perinueral or vascular spread, comment on its prognosis
Perineural and vascular spread poor prognostic feature
What are common symptoms of oral cancer?
- 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
What infection is asscociated with malignant changes in leukoplakias?
Candida
What does incidence mean?
And what is the relative frequency of oral cancer;
- UK
- India
Incidence = Rate of new disease per 100,000/year
Uk - 4 cases/100,000/year
India - 20-30 cases/100,000/year
How is iron deficiency linked to oral cancer?
Iron Deficiency links to mucosal atrophy which may render mucosa more susceptible to carcinogens
How are viruses linked with oral cancer?
Viruses act by activating cellular oncogenes either by initiation of mutations or inserting own genome close to oncogene
Comment on a size of a tumour in relation to its metastatic potential
Larger tumour greater risk metastatic spread and worse prognosis
What the link between Oral Cancer and Oral Squamous Cell Carcinoma?
Oral Cancer often used synonymously with Oral Squamous Cell Carcinoma
What are the common sites for Oral cancer?
Tongue 30%
FOM 15%
Mandible/alveolus 20%
Retromolar 15%
Ethanol is not a carcinogen but how can it be involved in oral cancer development?
Increases permeability of oral mucosa to carcinogens
What is the prognosis of Oral cancer?
Poor 50% die of disease
What does relative frequency mean?
And what is the relative frequency of oral cancer;
- Worldwide
- UK
- India
Relative Frequency = % of all malignant disease
Worldwide 10%
UK 1-2%
India 30-50%
How may Vitamin A be linked to oral cancer?
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
What do the TMN gradings mean and what are the five year survival rates for the different grades for oral cancer?
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
What does prevalence mean?
What is the prevalence of oral cancer in the UK?
Number cases within population at given time point
0.05-0.1% (1 in 1000) patients will have oral cancer
Describe how an infected lymph node may seem to a patient
Infected nodes are painful soft or firm but not fixed
What are clinical features observed in oral cancer?
- 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
What % of oral cancer patients are long term smokers?
80-90%
Where in the world is oral cancer most prevalent?
Particularly problem in South East Asia single most common cancer between 30-50% of all cancers
