Oral Cancer - clinical and pathology Flashcards
When would you use a PET scan for a patient?
PET – Positron Emission tomography
Used when patients present with enlarged lymp nodes but don’t know where the tumour is coming from
What can be seen in this image?
Tumour invasion into lymph node
When would you use CT scans as a part of your special invetsigations for tumours?
Soft and hard tissue involvement used for staging and planning surgery
CT Scan = Computer aided tomography
In terms of where in the cell pathologically, what type of malignancy are oral cancers?
Oral cancer is a epithelial malignancy
What can be seen in this image?
Tumour invasion into lymph node
What is an Increased nuclear to cytoplasmic ratio?
Nucleus looks bigger than it should for its cell
This image is very pink what does this suggest about the invasive carcinoma?
Epithelieum is trying to keratinise itself
(abnormal attempt of keratinisation)
How do oral cancers spread?
Invade and spread via lymphatics to regional lymph nodes
What lymph nodes are commonly involved with oral cancers?
Lymph nodes of;
submental
submandibular region
cervical chain
may all be affected
Comment about the malignancy of this image on the RHS
RHS:
Epithelieum is still held by basement membrane
Epithelieum looks messy and disorganised
Nuclie are very prominent
Dysplasia but not invasive malignany
When surgically removing tumours why are margins taken?
To ensure the tumour hasnt spread past this point
What are the 3 grades we give for oral cancer?
Well, Moderately and Poorly differentiated.
Well differentiated tend to have large tumour islands with abundant keratin, little atypia and few mitosis.
Poorly differentiated smaller islands, frequent mitosis and marked cellular atypia
Label this diagram
Pathologically how can we differentiate between dysplasia and a carcinoma?
If atypia is confined to the basment membrane (in epethelium) it is dysplasia.
The moment it breaks free of the basement membrane and invades underlying connective tissue it is a carcinoma
What special investigation would you use if you believe there is bony involvement in a tumour?
Radiographs
What would you grade this tumour?
Poorly differentiated
As you can tell what is tumour and what is cell
What scan is this? What can be observed?
MRI
Tumour on lateral border of tongue
What are the different types of atypia you may see pathologically in a carcinoma?
Nuclear hyperchromasia
Nuclear and cellular pleomorphism
Increased nuclear to cytoplasmic ratio
Raised mitotic rate
Abnormal Mitoses
How do malignant epithelial cells interact with underlying connective tissue?
Malignant epithelial cells invade and destroy the underlying
connective tissue
What is Nuclear and cellular pleomorphism
Nuclei/cells look very different from eachother
Why is MRI chosen over CT scans for some tumours?
CT = Computer aided tomography, MRI = Magnetic Resonance Imaging
MRI used for soft tissue involvement better resolution than CT
Comment on prognosis of tumours with nodal metastasis
Worse if nodal metastasis.
Further spread down inferior axis of cervical nodes worsens prognosis
Comment on this malignancy
You can see tumour islands invading the connective tissue
Cannot clearly distinguish layers in normal tissue
Well differntiated (as tumour looks like epithieum)
Invasive squamous cell carcinoma
Generally what are treatment options for oral tumours?
- Surgery +/- radiotherapy
- Radiotherapy only (when surgery not an option)
- Chemoradiotherapy plays a role in HPV associated oropharyngeal carcinoma
- Palliative care
What types of tumour will radiotherapy not work?
When tumour is in bone
Surgery only option
If a lump is in the patients neck what special invetsogation would you carry out to confirm your diagnosis?
Biopsy - Fine needle aspirate
Histopathologically, what would you expect to see when a oral cancer tumour has formed?
Invasion of epithelial islands into underlying connective tissue, skeletal muscle, salivary gland and bone
Epethial cells will show atypia
When a malignancy is suspected in the mouth what is the first sepcial investigation you would carry out?
Incisional biopsy of lesion to confirm diagnosis
What atypical feature can be obserevd here?
Nucleur hyperchromasia
(potentially cellular pleomorphism)
What would you grade this tumour?
Moderately differentiated
As you can just about make out the tumour islands
What is nuclear hyperchromasia?
When nuclei look very dark
Where may vascular spreads of oral cancers end up?
These are rare
Vascular spread to distant sites particularly lung may occur
What are the purple structures in this image?
Lymph nodes
(loads of lymphatic cells which are purple)
