Oral Cancer (from dr macks lectures) Flashcards
What are features of cancer (6)
- red patch (erythroplakia - far more worrying) /white (hyperkeratotic - thick)/speckled lesion (combo of two) - should arouse suspicion but remember most worrying is red colours (half red patches are cancerous lesions)
- ulcerated areas - if painful then fine, if not then alarm bells should be ringing - doesnt matter what size.
- high risk sites - fom, lateral/ventral border of tongue, retro-molar area - area of mouth which the saliva will naturally pool. carcinogens are in contact with oral epithelium for long periods of time in these areas.
- symptom free - pts arent aware and then late presentation. this is directly related to high stage disease with poor clinical outcomes
- unknown duration - due to asymptomatic pts are never exactly aware of how long lesion has been there
- risk factor history
What sites can oral cancer affect in the mouth?
affects the LIPS, SALIVARY GLANDS, TONGUE, GUMS, PALATE, AND INSIDE OF THE CHEEKS
- squamous cell carcinoma - 90%
what are the RISK FACTORS of developing oral cancer - LEARN THIS WELL - COULD BE EXAM QUESTION (9)
- tobacco
- alcohol
- poor diet
- obesity
- immunological defects
- sunlight
- previous cancer
- genetic conditions
- potentially malignant conditions ie homo/heterogenous leukoplakia, erythroplakia
How can alcohol combined with smoking make u at a higher risk for developing oral cancer?
alcohol acts as a solvent for the carcinogens to lie and dissolve into ie lat border of tongue and fom (lingual gutter)
what is an aphthous ulceration?
an ULCER - most common type of lesion
they are small, VERY painful and resolve very quickly (within a 2 week period)
cream colour sometimes, marked red rim.
approx 20% of pop suffer from them
what is a lipoma
BALL OF FAT
yellow hue , soft and very sguidgy , not painful, v mobile, can get larger… pts may require removal, BENIGN
What is a mucocoele
often caused by TRAUMA
causes a small rupture in a duct that drains the salivary gland
what is an epulis
term which means swelling of gum
what is a leaf fibroma
lesion that grows underneath dentures, due to it being compressed it becomes flattened. v simple to treat - just incision of the fibroma off
what is denture induced hyperplasia
caused by ill fitting dentures worn 24/7.
what is a papilloma
caused by LOW RISK HPV TYPES, benign overgrowth caused by contact with virus particles that then invade the underlying epithelial cells
characterised by having finger-like growth/projections
HT OVERGROWTH - tori palatinus, describe it
hard tissue overgrowth, entirely harmless and get larger over time. tends to occur midline on the hardpalate. if gets big then can impede mastication or if pt wears a denture can lead to denture instability. not common that we remove these lesions.
What is the growth PATTERN of a MALIGNANT tumour
infiltrate LOCALLY and they metastasize (spread to different sites in the body, would usually be the head and neck)
What is the growth RATE of a malignant tumour compared to a benign
FASTER
What are the CLINICAL EFFECTS of a malignant tumour
LOCAL pressure and destruction
Inappropriate hormone secretion
what is usually the general treatment of a malignant tumour?
Excision and sometimes additional therapy
What is the definition of PROGNOSIS
- this is the PREDICTION of the PROBABLE OUTCOME of disease
- appropriate treatment and estimate survival
What does the tumour stage (ie how far on has the tumour been there) mean in relation to the outcome for the patient?
tumour stage related well with the outcome in most tumour types
in general, higher stage = poorer prognosis
When do you do an extra-oral exam (4)
- all new patients
- all review patients 3/6month review patients
- when the patient reports any CHANGES even when an IO seems sinister, we do an EO TOO
- when you notice any changes regardless if it has been 3/6 months or not
What are we looking for when doing an EO exam? (7)
- SYMMETRY
- soft non tender lymph nodes
- palpate/rolling movement all anatomical sites of lymph nodes
- skin moves freely over the nodes they are not attached
- think about the anatomical drainage from the mouth to the nodes of the neck
- symmetrical salivary glands
- symmetrical TMJ and movements
Typically where do we find 7 landmarks for lymph nodes within the neck region? anatomically **
- preauricular (infront of the ear)
- Tonsilar
- submandibular
- anterior cervical
- posterior cervical
- supraclavicular (near clavicle/collar bone)
- submental
THESE ARE ALL SUPERFICIAL NODES
What (as primary care practitioners) should we do in identification of a potentially malignant lesion?
- REFER ON THE URGENT PATHWAY for the patient to be seen by the appropriate specialist department/maxillofacial team within two weeks.
- this is known as the fast track urgent pathway
What is field cancerisation?
this is when ALL of the mucosa is genetically altered to the point where it is pre-programmed to undergo malignant change
Describe the meaning of dysplasia
a POTENTIALLY MALIGNANT DISORDER
What are some worrying clinical features of an oral cancer presentation?
- injurated
- hard/firm
- rubbery texture
What are 5 common normal conditions that we can see in Oral Cavity
- deep fissured tongue
- geographic tongue
- black hairy tongue
- papillary hyperplasia
- Blister/Bullae
What sort of conditions are BENIGN? (8)
- Aphthous ulcers
- a lipoma (ball of fat)
- a mucocele
- an epulis
- a leaf fibroma/denture induced hyperplasia
- papillary hyperplasia
- papilloma
- tori mandibularis
what are the HR types of HPV?
HR HPVs are associated with carcinogenesis 16, 18 (main ones) - HPV 16 is of interest due to its oncogenic properties
What are the benign oral HPV lesions?
PAPILLOMA (HPV aetiology)
CONDYLOMATA
What is the name of the malignant Oral HPV lesion?
Cancer- SCC
What are some risk factors of developing HPV
- no of sexual partners
- weakened immune system
Who can get the HPV vaccine?
In the UK (from 2019) girls and boys ages 11/12
from april 2018 - MSM up to and including the age of 45 became eligible for free HPV vaccination on NHS
What is the epstein barr virus? (EBV)
- a type of herpes virus
- infection is lifelong
- infects b lymphocytes
what condition can arise from EBV?
Burkitt’s Lymphoma
Infectious mononucleosis
OPMDs - 5
chronic (long term) candida
leukoplakia
lichen planus
erythroplakia
erthroleukoplakia
