ORAL CANCER - FROM NINAS NOTES Flashcards
Where can mouth cancer (oral cancer) occur in the mouth ? 6
- lips
- cheeks
- palate
- tongue
- salivary glands
- gingivae
what is the PREVELENCE of oral cancer
- 90 % turn into square cell carcinoma
- 56% are 5yr survuval rate
- Males more common in more than 55
- increased prev in more deprived areas
what is the most important PROGNOSTIC factor for oral cancer
- STAGING AT DIAGNOSIS
List the risk factors of oral cancer
- tobacco
- diet/obesity
- alcohol
- sunlight
- previous cancer
- genetics/family history
- hpv (high risk - 16,18)
Describe how tobacco can cause risk to development to oral cancer
tobacco contains acetaldehyde which contains CARCINOGENS
describe how alcohol can cause or increase our risk of developing oral cancer
- 14 units/week which works out 2 units a day, we should be having 2 days off
- acts as a solvent, pools in FOM which is a high risk site
- metabolised to acetylaldehyde
- atrophy of mucosa - means more permeable for chemicals eg tobacco
List some features of oral cancer (9)
- leukoplakia
- erythroplakia
- speckled patch
- heterogenous
- size is more then 200mm
- high risk sites - retremolar area, lat border, fom
- ulcerated
- non wipeable
- unknown duration/no pain
What’s clinically normal in the mouth?
DORSUM of tongue - black hairy tongue, geographical tongue, deep fissure tongue
VENTRAL of the tongue - frenum, veins, glands, bullae (blister)
LATERAL BORDER of tongue - papillae, keratosis from clenching/bruxism
List some BENIGN lesions? 9
- apthous ulcers
- toris mandubularis/palatinus
- papilloma/condylomata - low risk HPV 6/8
- papillary hyperplasia
- denture induced hyperplasia
- leaf fibrosis
- epulis - gum swelling
- mucocele - trauma to salivary glands
- lipoma - mobile/ball of fat
where to we typically check in the mouth for oral cancer?
lingual/buccal/labial sulcus
mucosa
fom
hp/sp
lat/vent border of tongue
oropharynx
who do we screen for oral cancer?
CONCERNS of a lesion
REVIEW
recalls
NEW patients
what do we do when referring a patient of concern
document the details
photographs
referral of the biopsy
size
colour
location
time
what should we include in a referral letter - 7
- provisional diagnosis
- sh
- photos
- appearence - size, history, location, colour, ulcerated margins
- pt history - dh, mh, sh
- dh attendance
- pt details
when would we do a ROUTINE referral or oc
leukoplakia
when should we carry out an urgent referral? (7)
- unexplained lesion
- red/speckled
- unknown duration
- painless
- has been there for up to 2 weeks/more than 3 weeks
- immunosuppressed
- OPMDs !!!
list some oral potentially malignant disorders
- risk of development into a SCC:
- erythroplakia - v concerning lesions
- leukoplakia
- erythroleukoplakia
what are the most common lesions that progress onto oral cancer? - 4
- red speckled areas
- high risk areas
- heterogenous
- over 200mm
describe some features of lichen planus (opmd) - 7
- pain/burning
- red
- bi-lateral
- white
- buccal
- tongue
- can be associated with AUTO-IMMUNE DISEASES
what are the 3 different viruses associated with oral cancer
HPV, EBV - burkitt’s lymphoma AND hairy leukoplakia HIV - weaken immune os oral ulcers, candida, hairy leukoplakia, kaposi sarcoma - purple lesions
what are the LOW risk hpv types?
6, 11
what are the high risk hpv types
16, 18
what are some features of oral candidiasis 7
- dentures
- fungal infections
- wipeable white patches
- inhaler (ccorticosteroids)
- immunosupp (ebv, hiv)
- xerostomia
- long term abs
what are the opmds
erythro
erythroleuko
leuko = SCC most likely
more than 200mm
high risk site
heterogenous
lichen planus
leukoplakia
erythroplakia
erythroleukoplakia
