Oral Cancer/PML Flashcards
Histopathological features of epithelial dyplasia
- Increase and abnormal mitoses
- Basal cell hyperplasia
- drop shaped rete pegs
- disturbed polarity of basal cells/loss of cellular orientation
- Alteration (increase) in nuclear/cytoplasm ratio
- Nuclear hyperchromatism
- Irregular epithelial stratification/disturbed maturation
- Nuclear/cellular pleomorphism (shape/size difference)
- Abnormal keratinisation (keratin pearls)
- Loss/reduction of intercellular adhesion
Staging of oral cancer
Tx - Main tumour not be measured T1 - tumour<2cm T2 - Tumour 2-4cm T3 - >4cm T4 - >4cm and involves base of tongue/skin/pterygoid muscles
Nx - can't be assessed N0 - no clinically positive nodes N1 - single ipsilateral <3cm N2a - " 3-6cm N2b - Multiple ipsilateral <6cm N3a - single/multiple ipsilateral node >6cm N3b - Bilateral N3c - contralateral
Mx - not assesses
M0 - no evidence
M1 - distant metasteses present
Potentially malignant disorders
Leukoplakia 2.5% in 10 yrs Erythroplakia - greater dysplasia, greater risk Lichen Planus (1%) Oral submucous fibrosis Iron deficiency Tertiary syphyllis Chronic hyperplastic leukoplakia
Predictors of malignancy in leukoplakia
Age/gender
Idiopathic
Site - lat of tongue/FoM/SP HIGH RISK
Clinical appearance - clinically normal mucosa - most carcinomas (homogenous/Non Homogenous)
Histology - dysplasia (grading), atrophy,
invaasion/growth of new vessels/candidal inf
Epithelial dysplasia - what does this affect
Architechtura change - abnormal maturation/stratification
Cytological abnormalities - cellular atypia
Mild dysplasia features
Architecture: affecting lower third
Cytology: Mild atypia (Pleomorphism/hyperchromatism)
Moderate dysplasia features
Architecture: affecting middle third
Cytology: Moderate atypia (pleomorphism/hyperchromatism/loss of polarity)
Severe dysplasia
Architecture: change in Upper third
Cytology: Severe atypia and numerous mitoses
(Loss of polarity/stratification/odd apearance)
Carcinoma in situ features
Theoretical - malignant but NOT invasive
Abnormal architecture - full thickness of viable cell layers
Pronounced cytological atypia - abnormal mitoses
Aetiology of oral cancer
- tobacco - smoke/smokeless
- betel quid chewing
- alcohol
- diet and nutrition
- OH
- virus - HPV, Ep barr, HHV-8
- immunodeficiency
- socioeconomic factors
leukoplakia chance of malignancy
0.2-4%
predictors of malignancy in leukoplakia
age and gender idiopathic site: buccal mucosa: low risk floor of mouth, tongue: high risk clinical appearance: homogeneous non-homogeneous: verrucous, ulcerated leuko-erythroplakia histology: dysplasia atrophy candida infection Biological markers : DNA content in leukoplakia –future prognostic indicator?
basal hyperplasia feautures
increased cell numbers architecture regular stratification basal compartment is larger no cellular atypia
points found on a oral cancer pathology report
Diagnosis: squamous cell carcinoma
- differentiation and grading .80% are moderately well differentiated
- pattern of invasive front related to nodal spread
- local extension of the disease
Oral cancer referral guidance criteria
- Persistent unexplained head and neck lumps for >3 weeks
- Unexplained ulceration or unexplained swelling/induration of the oral mucosa persisting for >3 weeks
- All unexplained red or mixed red and white patches of the oral mucosa persisting for >3 weeks
- Persistent (not intermittent) hoarseness lasting for >3 weeks. If other symptoms are present to suggest suspicion of lung cancer, refer via lung cancer guideline
- Persistent pain in the throat or pain on swallowing lasting for >3 weeks
