Oral Cancer and Diagnostic Techniques

Question 1

Male to female ratio for SCC?

Answer 1

Male 2.5 to female 1

Question 2

Site distribution of Oral Cancer (5 sites)

Answer 2

1. Lip (23%)
2. Salivary glands (11%)
3. Floor of mouth (16%)
4. Tongue (28%)
5. Other (22%)

Question 3

How long to follow up?

Answer 3

7-10 days (biopsy if indicated) and provide oral cancer risk education

Question 4

Difference between lymphadenopathy and malignancy?

Answer 4

Lymphadenopathy - Soft, tender, movable

Malignancy - Firm, non-tender, fixed (though sometimes can move)

Question 5

Five year survival rate for SCC?

Answer 5

64.5%

Question 6

List three high risk sites for Oral SCC?

Answer 6

Tongue, lip, floor of mouth

Question 7

T/F: Reactive cervical nodes always indicate pathology of odontogenic origin

Answer 7

F

Question 8

Metastatic enlarged lymph nodes should exhibit what characteristics?

Answer 8

Indurated
Fixed
Non-tender

Question 9

Verrucous carcinoma is linked to what risk factor?

Answer 9

Smokeless tobacco

Question 10

Four indications for a biopsy

Answer 10

1. Lesions which fail to resolve 10-14 days
2. Unusual appearance / uncommon location
3. Confirm diagnosis of systemic diseases
4. Excised tissue (e.g. teeth)

Question 11

Specs for excision biopsy

• Removal of part/entire lesion
• Lesion > or < 1 cm
• Requires how much of normal tissue with adequate depth
• Remove at least #x the size of lesion
• What shape wedge for primary closure?

Answer 11

1. Remove entire lesion
2. Lesions less than or equal to 1 cm in diameter
3. Requires 3-5 mm margin of normal tissue
4. Remove 3x size of lesion
5. Elliptical shape wedge

Question 12

Specs - Incisional biopsy

• Removal of part/whole lesion
• What shape wedge for primary closure
• Specimen should be #x width with 5 mm margin

Answer 12

1. Remove part
2. Elliptical wedge
3. 3x width with 5 mm margin normal tissue

Question 13

Oral Brush Biopsy - Pros

Answer 13

1. Excellent correlation with results of scape biopsy
2. Easy & non-invasive
3. Great for private practitioner unaccustomed to biopsy

Question 14

Oral Brush Biopsy - Cons

Answer 14

1. Screens for but doesn’t diagnose cancer
2. Extra step necessary for definitive dx
3. Utility and cost effectiveness questionable for military

Question 15

Tzanck Smear - Great for screening of what three diseases

Answer 15

1/2 - Viral disease (HSV, VZV)
3. Pemphigus

(Sampling from base of vesicle)

Question 16

Toluidine Blue

• Vital stain that binds to what three structures?
• These items are found in high amounts of what?

Answer 16

1. DNA
2. Mitochondria
3. Sulfated mucopolysaccharides

• Founding malignant/dysplastic cells (cell division and DNA synthesis)

Question 17

Toluidine Blue - Procedure process (five steps)

Answer 17

1. Rinse mouth w/ tap water
2. Apply stain with cotton-tipped applicator
3. Rinse mouth w/ tap water
4. Apply acetic acid with cotton tipped applicator
5. Rinse w/ tap water

Question 18

False positives of Toluidine Blue (two)

Answer 18

1. Ulcers

2. Filiform papillae

Question 19

What info to accompany a biopsy tissue exam report? (five)

Answer 19

1. Personal patient information
2. Specimen description (clinical appearance, location, number)
3. Past medical history
4. Diagnosis
5. Radiographs, lab values, clinical photos

Question 20

What solution preferred for vesiculobullous diseases? (Pemphigus and pemphigoiid)

Answer 20

Michel’s solution