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ORAL CANCER/MEDICINE > Oral cancer (from book) > Flashcards

Oral cancer (from book) Flashcards

1
Q

List the 5 different types of ulcers we can get

A

Traumatic (eg mechanical)
Idiopathic (eg minor ulceration cause can be unknown)
Neoplastic (squamous cell carcinoma)
Infective (herpes simplex)
Autoimmune conditions

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2
Q

List the 4 different types of white patches we can get in the oral mucosa

A
  • frictional keratosis
  • lichen planus
  • lichenoid reactions to drugs
  • leukoplakia - homo/non homogenous
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3
Q

What are some clinical features of a traumatic ulcer?

A

position of the ulceration corresponds to the suspected cause (dentures, teeth, ortho appliance) and DISSAPPEARS when the cause is removed.

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4
Q

What are some clinical features of a neoplastic (uncontrolled/abnormal growth) ulcer eg squamous cell carcinoma(5)

A

LONG duration, non-healing ulcer, no obvious cause, raised rolled margins, firm/hard to touch

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5
Q

where are the HIGH risk sites for a squamous cell carcinoma? (malignant lesion!)

A
  • FOM
  • lateral border of the tongue, - retromolar area (where pterygomandibular raphe is located)
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6
Q

Describe some clinical features of an infective ulcer eg herpes simplex (4)

A
  • preceded by vesicles
  • found on gingivae and palate
  • pts can feel systemically unwell
  • usually lasts 10-14 days
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7
Q

What are some clinical features of frictional keratosis

A

position of lesion corresponds to cause - if not further investigation required and CANT BE DX! - dentures, teeth, ortho apps
- common areas of frictional keratosis are on the buccal mucosa in A LINEAR PATTERN adjacent to the teeth which is known as the occlusal line. they may also be seen on the tongue

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8
Q

clinical features of lichen planus(3)

A
  • very common disorder, affecting the skin as well as the oral mucosa
  • some patients may complain of roughness or discomfort when eating spicy foods
  • typically characterised by white interlacing lines which occur bilaterally on the buccal mucosa and tongue.
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9
Q

what are some features of lichenoid reactions to amalgam restorations?

A

uni-lateral (one side of the mouth usually affected) of tongue/cheeks, adjacent to large amalgam restoration
resembles lichen planus
REMOVAL OF AMALGAM RESTORATION USUALLY FIXES THIS CONDITION

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10
Q

clinical features of leukoplakia - HOMOGENOUS

A

SMOOTH or undulating white patch, any site. not associated with trauma
- PRE-MALIGNANT LESION - identification of ‘high risk’ leukoplakias is important for both the therapist and pt - has a negligible risk of turning malignant

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11
Q

clinical features of leukoplakia - NON-HOMOGENOUS/HETEROGENOUS

A

these lesions may show variations in the surface contour - they may be nodular or spiky.
- may show variation in colour with red areas interspersed with white areas.
- IT IS WITHIN THIS GROUP THAT THE HIGHEST RISK OF MALIGNANT TRANSFORMATION OCCURS - some may even be malignant from the onset!

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12
Q

What are the high risk areas of the mouth that we should watch out for regarding leukoplakia?

A
  • Lateral border of the tongue
  • Floor of the mouth
  • retro-molar area
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13
Q

What can also make someone at high risk of oral cancer along with site of the mouth risk

A

aspects of the patients SOCIAL HISTORY are also important - risk of malignancy increases in patients who smoke and drink alcohol due to carcinogens in tobacco and solvent. there is also an increased risk in patients who take betel liquid and in these patients leukoplakia is often found on the buccal mucosa.

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14
Q

What is oral cancer?

A

Oral cancer starts when cells in the mouth begin to grow out of control and form a tumor. These tumors can be either benign (non-cancerous) or malignant (cancerous). Malignant tumors are the ones that can spread to other parts of the body, making them dangerous, hence why we want to catch these early in a patient to gain a more favourable outcome.

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15
Q

where are the most commonly affected sites in finding oral cancer

A

lateral border of the tongue, floor of mouth and retro-molar area

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16
Q

what are the 2 MOST important risk factors that have a huge relation to developing oral cancer

A

TOBACCO
ALCOHOL CONSUMPTION

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17
Q

How does alcohol/smoking actually increase the risk?

A

the CARCINOGENS(chemicals that cause cancer) which are present in tobacco dissolve in saliva and POOL in the high risk regions of the mouth as already stated. - alcohol sort of acts as a solvent for the carcinogens in tobacco smoke to dissolve into high risk sites where the saliva pools/sits.

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18
Q

how is cancer on the lower lip caused?

A

caused by sunlight and is prevalent in fair-skinned individuals with outdoor occupations/lifestyles

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19
Q

what are some clinical features of oral cancer ?(8)

A
  • some ocs arise in existing leukoplakia lesions which have a raised nodular appearance and speckled red - heterogenous leukoplakia - more concerning/white areas which look sus
  • some cancers present as ERYTHROPLAKIA (erythro - red) - velvety red patches which may be raised above surrounding tissues
  • LONG standing ulcers with raised/rolled margins
  • some cancers grow out into the oral cavity as well as invade into the underlying tissues
  • tissues affected by OC are hard to touch and there may be destruction leading to loss of function
  • lesions are usually PAINLESS in the early stages and pts are usually unaware of the lesions until they are quite large (more severe)
  • if the cancer has spread to the cervical lymph nodes, these will feel rock hard and painless.
  • in ADVANCED stage disease, the patient may appear very thin and pale
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20
Q

What does a monoclonal tumour mean

A

all the cells in the tumour appear to arise from ONE SINGLE parent cell which has undergone a genetic change.

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21
Q

What are the 2 classifications of tumours

A
  • behaviour (benign or malignant)
  • histogenesis (how it divides)
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22
Q

What does METASTASIS involve within oral cancer?

A

this is when tumour cells also invade lymphatic vessels and spread into the cervical lymph nodes in the neck

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23
Q

describe (briefly) the pathogenesis of oral cancer (4)

A
  • in health, the oral epithelium forms a CONTINUOUS layer on the surface mucosa
  • BUT, in OC, the epithelium proliferates excessively due to genetic changes and eventually epithelial cells will grow into underlying tissue
  • this is known as an INVASION and is a characteristic feature of malignancy.
  • tumour cells will continue to divide and divide and will spread into and destroy the underlying tissues - may feel hard and not function properly.
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24
Q

Describe how an ulcer in the oral cavity can occur

A

an ulcer is formed when there is a break or defect in the epithelial covering and the UNDERLYING TISSUE is exposed to saliva and micro-organisms from the oral cavity.

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25
Q

what is an apthous ulceration

A
  • v common
  • mostly affects young generation
  • can get MINOR and MAJOR apathae ulcers!
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26
Q

what is a minor apathae ulcer? (6)

A
  • most common type
  • small ulcers
  • surrounding mucosa is erythromatous (red)
  • ulcer may be multiple around
  • last usually 10-14 days
  • v painful, pain can increase towards end of ulcer.
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27
Q

what is a major apathae (4)

A
  • not as common as minor apathae and differ from minor
  • they are LARGER
  • can last up to 4-6 weeks, v painful
  • may heal along with scarring
28
Q

what are some features of a fibrous hyperplasia (2)

A
  • these swellings are caused by an overgrowth of fibrous connective tissue in response to CHRONIC TRAUMA from:
  • plaque or calculus (ie poor OH)
  • ortho appliances
  • dentures
  • malocclusion
  • fibrous hyperplasias are covered by mucosa and appear pale and the SAME COLOUR AS THE SURROUNDING MUCOSA
29
Q

Describe some features of a pyogenic granuloma (4)

A
  • these are also formed in response to trauma and are the result of overgrowth of immature, vascular connective tissue
  • these are ulcerated and not covered by epithelium
  • they are very vascular therefore may appear clinically red-blue and bleed easily.
  • pyogenic grans sometimes form in response to calculus particularly in pregnant women sometimes referred to as pregnancy epulis - tx is usually to remove the cause ie improve OH
30
Q

Describe some features of a giant cell granuloma(4)

A
  • occur exclusively on the gingivae - usually anterior parts of the mouth
  • they may become quite large
  • red-blue in colour and clinically difficult to distinguish from pyogenic granulomas (clinically look the same)
  • DIFF IS IS ITS NOT RELATED TO POOR OH
31
Q

What is a squamous cell papilloma

A
  • these are formed as a result of over-growth of the epithelium which becomes keratinised and fold into themselves
  • This results in lesions which have a white spiky or cauliflower appearence
  • common sites = lips and palate
32
Q

What infection can cause a squamous papilloma

A

some papillomas are the result of infection by the human papilloma virus HPV can put us at a high risk of developing oral cancer form a squamous papilloma

33
Q

What is the name given to a salivary gland swelling affecting the MINOR salivary glands

A

a mucocele

34
Q

What are the clinical signs of a mucocele

A

they are common and usually occur on the lower lip and cheeks of younger individuals
-they appear as sessile(do not move) blue swellings which may be fluctuant (can be unstable)
- pts often give a history of a rapid increase in size following trauma!

35
Q

What is sjogrens syndrome

A

an auto-immune disease which affects the salivary glands - can get primary and secondary

36
Q

what are the 5 clinical features of xerostomia

A
  • pts have trouble eating and swallowing and tasting there food
  • increased incidence of cervical and smooth surface caries. Due to lack and saliva and increased sugar in diet due to lack of taste
  • greater incidence of perio disease
  • mucosa appears smooth and red, may suffer from fungal infections
  • ulceration is also common
37
Q

What tumour suppressor protein is involved in oral cancer?

A

p53 protein - its over expression is involved in survival and response treatment in square cell carcinoma of oral cancers

38
Q

What is the communication protocol used when breaking bad news to patients?

A

SPIKES acronym
S - Setting and Listening skills
P - Patients PERCEPTION of condition and seriousness (ask them to gage their knowledge on condition)
I - INVITATION from the patient to give information - find out if they want to know the details of the oral or dental condition
K - KNOWLEDGE - giving the facts - avoid jargon!
E - EXPLORE - emotions and empathise as patient responds. important to identify the emotion eg shocked, anger?
S - STRATEGY and SUMMARY - important to assess the patients expectations of the condition treatment and outcome.

39
Q

What does SCC stand for?

A

Squamous Cell Carcinoma

40
Q

What are the 4 most common viral infections affecting the oral cavity?

A

herpes simplex
herpes zoster
hand foot and mouth
herpangina

41
Q

What are the 3 most common types of EPULIS (swelling of the gingivae)

A

Fibrous Hyperplasia
Pyogenic Granuloma (can get a pregnancy epulis from this due to hormonal changes etc)
Giant Cell Granuloma

42
Q

What/how is thrush formed ?

A

AKA = pseudomembranous candidosis caused by the FUNGUS CANDIDA ALBICANS
- characterised by thick, creamy white patches which may occur on any part of the oral mucosa and may be wiped off , leaving a raw reddened surface.

43
Q

What can mostly affect peoples risk of developing OC/what are the risk factors

A

Age, Deprivation category, Genetics, Smoking, Smokeless tobacco - betel liquid, excessive alcohol consumption, poor diet, poor OH, HPV (human papilloma virus)

44
Q

When should a SUSPECTED cancer pathway referral be carried out?

A

for people with :
- an unexplained ulceration in the oral cavity lasting for more than 3 weeks
- a persistent and unexplained lump in the neck

45
Q

When should we consider an URGENT referral for assessment of oral cancer

A
  • a lump on the lip or in the oral cavity
  • a RED or RED/WHITE patch in the oral cavity consistent with ERYTHROPLAKIA or erythroleukoplakia
46
Q

what key points should we include in an oral cancer referral? (8)

A
  • include all patient details
  • describe the problem and include a succinct relevant history
  • if a lesion, describe appearence, location, size and history
  • provide a prov dx
  • if think its cancer… say so
  • include special investigations and photographs of suspected lesion
  • DH depending on nature of referral
  • SH is important reg risk factors re alcohol consumption, smoking.
47
Q

What is the definition of health inequalities?

A
  • difference in health status or in the distribution of health determinants between population groups
48
Q

What is the definition of healthy inequity

A

presence of avoidable, unfair or remediable differences among groups of people

HEALTHY INEQUITY LEADS TO HEALTH INEQUALITY

49
Q

how does it matter when it comes to the risk factor of smoking and oral cancer in the mouth?

A

DURATION over FREQUENCY with smoking - how long has the patient been smoking for

50
Q

In terms of alcohol, how can this affect the oral cavity? in terms of it being a risk factor how can we measure the risk in a patient

A

Alcohol - FREQUENCY over DURATION

51
Q

What is a protective factor of potentially developing mouth cancer?

A

a diet high in fruit and non-starchy veg is protective for cancer

52
Q

What could risk reduction mean for our patients mean in regards of oral cancer?

A

risk reduction = EARLY DETECTION!

53
Q

what is the most important prognostic factors of oral cancer?

A

THE STAGE AT DIAGNOSIS - early detection = better prognosis

54
Q

What can diagnostic delay be because of?

A

Patient delay and professional delay

55
Q

what are the barriers for patient delay in terms of presenting to the dentist?

A
  • knowledge of cancer
  • deprivation
  • significant life events
56
Q

What can cause professional delay in terms of diagnosis

A
  • low in confidence
  • lack of time in surgery
  • fear of inducing undue anxiety!
57
Q

What is involved in an oral health assessment?

A
  1. assessment of patient histories (personal details, social history, dental history, medical history, anxiety level)
  2. assessment of OH status (head/neck, oral mucosal tissue, perio tissues, teeth, other eg dentures)
  3. diagnosis and risk assessment (diagnose disease eg caries, perio, oral cancer)
  4. form a personal care plan - specific for the patient
    * important to note - risk based recalls can also be done but it is specific elements only of the oral health assessment - not comprehensive*
58
Q

where has the highest rates of head and neck cancer?

A

Those from the most deprived areas consistently have the highest rates of head and neck cancer

59
Q

What do we do for ALL patients regarding the early detection and prevention of oral cancers?

A
  1. ASK - explore risk factors, esp tobacco use, record advice given and patients response in clinical notes
  2. EXAMINE - E/O - lips, neck, nodes (visual and tactile), I/O - soft tissues (visual and tactile)
60
Q

what do we do for HIGH RISK patients regarding the early detection of oral cancer

A
  1. ADVISE - share the best approaches to changing modifiable risk factors in line with tobacco and alcohol pathways
  2. ACT - if a patient is interested in quitting smoking/reducing drinking, act to assist them to address these risk factors , if they are not keep asking and advising - it can make a difference
61
Q

what are the 7 main signs and symptoms of oral potentially malignant disorders?

A
  • unexplained oral ulceration or swelling/induration in the oral cavity lasting for more than 3 weeks
  • a persistent and unexplained lump in the head or neck
  • a lump in the lip or the oral cavity
  • a red patch in the oral cavity consistent eryhtroleukoplakia (speckled leukoplakia)
  • persistent hoarsness lasting for more than 3 weeks
  • persistent pain in the throat or pain on swallowing lasting for more than 3 weeks
62
Q

when should we provide an URGENT referral

A
  • for adults with a clinically evident suspicious oral lesion/ symptoms suggestive of oral malignancy
  • we should use an ‘urgant suspected cancer pathway referral’ (appt within 2 weeks)
63
Q

What is the gold standard for oral cancer diagnosis

A

scalpel biopsy and histological assessment

64
Q

what are the prevention methods in place for patients POST-TREATMENT for oral cancer?

A
  • it is important patients who have recieved surgery, radiotherapy, chemotherapy in the head/neck area make regular visits for dental care
  • they are now at higher risk of developing dental caries, perio, peri-implantitis due to reduced salivary flow. - PREVENTITIVE OPTIONS ARE IMPORTANT HERE!
65
Q

How often should oral health assessments be carried out on adults/children

A

every 24 months for adults
every 12 for children

66
Q

what is the key aim of oral health assessment /review

A

to facilitate the move from a restorative approach to patient care to a preventive and long term approach that is risk based and meets the specific needs of individual patients.
it also aims to encourage the involvement of patients managing there own oral health

67
Q
A

ORAL CANCER/MEDICINE (3 decks)

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