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ORAL CANCER/MEDICINE > Oral Cancer (from dr macks lectures) > Flashcards

Oral Cancer (from dr macks lectures) Flashcards

1
Q

What are features of cancer (6)

A
  • 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
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2
Q

What sites can oral cancer affect in the mouth?

A

affects the LIPS, SALIVARY GLANDS, TONGUE, GUMS, PALATE, AND INSIDE OF THE CHEEKS
- squamous cell carcinoma - 90%

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3
Q

what are the RISK FACTORS of developing oral cancer - LEARN THIS WELL - COULD BE EXAM QUESTION (9)

A
  • tobacco
  • alcohol
  • poor diet
  • obesity
  • immunological defects
  • sunlight
  • previous cancer
  • genetic conditions
  • potentially malignant conditions ie homo/heterogenous leukoplakia, erythroplakia
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4
Q

How can alcohol combined with smoking make u at a higher risk for developing oral cancer?

A

alcohol acts as a solvent for the carcinogens to lie and dissolve into ie lat border of tongue and fom (lingual gutter)

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5
Q

what is an aphthous ulceration?

A

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

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6
Q

what is a lipoma

A

BALL OF FAT
yellow hue , soft and very sguidgy , not painful, v mobile, can get larger… pts may require removal, BENIGN

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7
Q

What is a mucocoele

A

often caused by TRAUMA
causes a small rupture in a duct that drains the salivary gland

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8
Q

what is an epulis

A

term which means swelling of gum

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9
Q

what is a leaf fibroma

A

lesion that grows underneath dentures, due to it being compressed it becomes flattened. v simple to treat - just incision of the fibroma off

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10
Q

what is denture induced hyperplasia

A

caused by ill fitting dentures worn 24/7.

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11
Q

what is a papilloma

A

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

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12
Q

HT OVERGROWTH - tori palatinus, describe it

A

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.

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13
Q

What is the growth PATTERN of a MALIGNANT tumour

A

infiltrate LOCALLY and they metastasize (spread to different sites in the body, would usually be the head and neck)

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14
Q

What is the growth RATE of a malignant tumour compared to a benign

A

FASTER

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15
Q

What are the CLINICAL EFFECTS of a malignant tumour

A

LOCAL pressure and destruction
Inappropriate hormone secretion

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16
Q

what is usually the general treatment of a malignant tumour?

A

Excision and sometimes additional therapy

17
Q

What is the definition of PROGNOSIS

A
  • this is the PREDICTION of the PROBABLE OUTCOME of disease
  • appropriate treatment and estimate survival
18
Q

What does the tumour stage (ie how far on has the tumour been there) mean in relation to the outcome for the patient?

A

tumour stage related well with the outcome in most tumour types
in general, higher stage = poorer prognosis

19
Q

When do you do an extra-oral exam (4)

A
  • 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
20
Q

What are we looking for when doing an EO exam? (7)

A
  • 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
21
Q

Typically where do we find 7 landmarks for lymph nodes within the neck region? anatomically **

A
  • preauricular (infront of the ear)
  • Tonsilar
  • submandibular
  • anterior cervical
  • posterior cervical
  • supraclavicular (near clavicle/collar bone)
  • submental
    THESE ARE ALL SUPERFICIAL NODES
22
Q

What (as primary care practitioners) should we do in identification of a potentially malignant lesion?

A
  • 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
23
Q

What is field cancerisation?

A

this is when ALL of the mucosa is genetically altered to the point where it is pre-programmed to undergo malignant change

24
Q

Describe the meaning of dysplasia

A

a POTENTIALLY MALIGNANT DISORDER

25
Q

What are some worrying clinical features of an oral cancer presentation?

A
  • injurated
  • hard/firm
  • rubbery texture
26
Q

What are 5 common normal conditions that we can see in Oral Cavity

A
  • deep fissured tongue
  • geographic tongue
  • black hairy tongue
  • papillary hyperplasia
  • Blister/Bullae
27
Q

What sort of conditions are BENIGN? (8)

A
  • Aphthous ulcers
  • a lipoma (ball of fat)
  • a mucocele
  • an epulis
  • a leaf fibroma/denture induced hyperplasia
  • papillary hyperplasia
  • papilloma
  • tori mandibularis
28
Q

what are the HR types of HPV?

A

HR HPVs are associated with carcinogenesis 16, 18 (main ones) - HPV 16 is of interest due to its oncogenic properties

29
Q

What are the benign oral HPV lesions?

A

PAPILLOMA (HPV aetiology)
CONDYLOMATA

30
Q

What is the name of the malignant Oral HPV lesion?

A

Cancer- SCC

31
Q

What are some risk factors of developing HPV

A
  • no of sexual partners
  • weakened immune system
32
Q

Who can get the HPV vaccine?

A

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

33
Q

What is the epstein barr virus? (EBV)

A
  • a type of herpes virus
  • infection is lifelong
  • infects b lymphocytes
34
Q

what condition can arise from EBV?

A

Burkitt’s Lymphoma
Infectious mononucleosis

35
Q

OPMDs - 5

A

chronic (long term) candida
leukoplakia
lichen planus
erythroplakia
erthroleukoplakia

ORAL CANCER/MEDICINE (3 decks)

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