Oral Cancer - clinical and pathology

Question 1

When would you use a PET scan for a patient?

PET – Positron Emission tomography

Answer 1

Used when patients present with enlarged lymp nodes but don’t know where the tumour is coming from

Question 2

What can be seen in this image?

Answer 2

Tumour invasion into lymph node

Question 3

When would you use CT scans as a part of your special invetsigations for tumours?

Answer 3

Soft and hard tissue involvement used for staging and planning surgery

CT Scan = Computer aided tomography

Question 4

In terms of where in the cell pathologically, what type of malignancy are oral cancers?

Answer 4

Oral cancer is a epithelial malignancy

Question 5

What can be seen in this image?

Answer 5

Tumour invasion into lymph node

Question 6

What is an Increased nuclear to cytoplasmic ratio?

Answer 6

Nucleus looks bigger than it should for its cell

Question 7

This image is very pink what does this suggest about the invasive carcinoma?

Answer 7

Epithelieum is trying to keratinise itself
(abnormal attempt of keratinisation)

Question 8

How do oral cancers spread?

Answer 8

Invade and spread via lymphatics to regional lymph nodes

Question 9

What lymph nodes are commonly involved with oral cancers?

Answer 9

Lymph nodes of;

submental
submandibular region
cervical chain

may all be affected

Question 10

Comment about the malignancy of this image on the RHS

Answer 10

RHS:
Epithelieum is still held by basement membrane
Epithelieum looks messy and disorganised
Nuclie are very prominent
Dysplasia but not invasive malignany

Question 11

When surgically removing tumours why are margins taken?

Answer 11

To ensure the tumour hasnt spread past this point

Question 12

What are the 3 grades we give for oral cancer?

Answer 12

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

Question 13

Label this diagram

Answer 13

Question 14

Pathologically how can we differentiate between dysplasia and a carcinoma?

Answer 14

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

Question 15

What special investigation would you use if you believe there is bony involvement in a tumour?

Answer 15

Radiographs

Question 16

What would you grade this tumour?

Answer 16

Poorly differentiated

As you can tell what is tumour and what is cell

Question 17

What scan is this? What can be observed?

Answer 17

MRI

Tumour on lateral border of tongue

Question 18

What are the different types of atypia you may see pathologically in a carcinoma?

Answer 18

Nuclear hyperchromasia
Nuclear and cellular pleomorphism
Increased nuclear to cytoplasmic ratio
Raised mitotic rate
Abnormal Mitoses

Question 19

How do malignant epithelial cells interact with underlying connective tissue?

Answer 19

Malignant epithelial cells invade and destroy the underlying
connective tissue

Question 20

What is Nuclear and cellular pleomorphism

Answer 20

Nuclei/cells look very different from eachother

Question 21

Why is MRI chosen over CT scans for some tumours?

CT = Computer aided tomography, MRI = Magnetic Resonance Imaging

Answer 21

MRI used for soft tissue involvement better resolution than CT

Question 22

Comment on prognosis of tumours with nodal metastasis

Answer 22

Worse if nodal metastasis.

Further spread down inferior axis of cervical nodes worsens prognosis

Question 23

Comment on this malignancy

Answer 23

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

Question 24

Generally what are treatment options for oral tumours?

Answer 24

• Surgery +/- radiotherapy
• Radiotherapy only (when surgery not an option)
• Chemoradiotherapy plays a role in HPV associated oropharyngeal carcinoma
• Palliative care

Question 25

What types of tumour will radiotherapy not work?

Answer 25

When tumour is in bone

Surgery only option

Question 26

If a lump is in the patients neck what special invetsogation would you carry out to confirm your diagnosis?

Answer 26

Biopsy - Fine needle aspirate

Question 27

Histopathologically, what would you expect to see when a oral cancer tumour has formed?

Answer 27

Invasion of epithelial islands into underlying connective tissue, skeletal muscle, salivary gland and bone

Epethial cells will show atypia

Question 28

When a malignancy is suspected in the mouth what is the first sepcial investigation you would carry out?

Answer 28

Incisional biopsy of lesion to confirm diagnosis

Question 29

What atypical feature can be obserevd here?

Answer 29

Nucleur hyperchromasia

(potentially cellular pleomorphism)

Question 30

What would you grade this tumour?

Answer 30

Moderately differentiated

As you can just about make out the tumour islands

Question 31

What is nuclear hyperchromasia?

Answer 31

When nuclei look very dark

Question 32

Where may vascular spreads of oral cancers end up?

These are rare

Answer 32

Vascular spread to distant sites particularly lung may occur

Question 33

What are the purple structures in this image?

Answer 33

Lymph nodes
(loads of lymphatic cells which are purple)