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Oral Path 1 > Oral Cancer & Precursor Lesions > Flashcards

Oral Cancer & Precursor Lesions Flashcards

1
Q

Premalignant lesions

A
  • Leukoplakia
  • Proliferative verrucous leukoplakia
  • Smokeless tobacco keratosis
  • Oral submucosal fibrosis
  • Actinic cheilitis
  • Erythroplakia
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2
Q

Malignant lesions

A
  • Squamous cell carcinoma
  • Verrucous carcinoma
  • Basal cell carcinoma
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3
Q

Leukoplakia

A
  • White patch that cannot be characterized clinically or pathologically as any other disease (strictly clinical, not dx’c term)
  • 80% of pts are smokers
  • Smokers > non-smokers
  • Heavy smokers > light smokers
  • May resolve after cessation
  • Synergistic effect w/ tobacco (oral cancer)
  • Mouth rinses >25% alcohol
  • Grayish plaques (not true leukoplakia)
  • Affect those >40yo
  • 70% found on lip vermillion, buccal mucosa, gingiva
  • Tongue, lip vermillion, floor of mouth: 90% dysplasia or cancer
  • Lesions may have varied appearance and change over time
  • Microscopic dx of leukoplakia would be:
    • Hyperkeratosis = benign callus
      • Increased thickness of keratin layer
      • Uniform maturation of squamous cells
    • Dysplasia = abnormal growth/cells
      • Variation in size, shape, staining of nuclei
      • Can regress or progress
    • Carcinoma in situ
      • Will progress to invasive carcinoma
      • Entire epithelium is dysplastic
    • Superficially invasive carcinoma
    • Squamous cell carcinoma
    • Keratin pearl: Keratin should be towards superficial surface, but it’s towards the basement layer, where it doesn’t belong
  • Many leukoplakias are hyperkeratosis
  • 2-4% of leukoplakias are carcinoma in situ or SCC @ time of discovery
  • Up to 6% of leukoplakias progress to carcinoma
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4
Q

Proliferative Verrucous Leukoplakia

A
  • Special high risk form of leukoplakia
  • Characterized by multiple white plaques w/ rough, warty surface projections
  • Multiple plaques tend to spread slowly
  • Significantly increased tendency to develop into SCC
  • Req’s close follow up
  • Management: Incisional biopsies
  • Microscopic dx: SCC arising in proliferative verrucous leukoplakia
  • Tx: Monitor. Difficult to tx b/c it’ll just keep coming back even though we know it’s on its way to cancer
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5
Q

Smokeless Tobacco Keratosis

A
  • Wide variety of “smokeless tobacco”
    • Moist snuff
    • Dry snuff
    • Chewing tobacco
  • Dry & chewing are declining in popularity, but moist is on the rise
  • Main concern:
    • Gingival recession - characteristic painless loss of gingival tissues in the area of tobacco contact
      • Gingival recession w/o perio recession
      • High sugar content also causes caries
  • Clinical findings:
    • Smokeless tobacco keratosis: gray-white “translucent” plaque w/ border that blends into surrounding area
  • Cancer risk
    • Smokeless tobacco has 1-9% the risk of smoking cigarettes
    • SCC may develop after use of several decades, if at all
      • Higher risk of cancer
  • Dx can often be achieved on clinical basis
  • Biopsy for lesions w/ worrisome presentation (i.e. ulcerated)
  • Tx: Depends on biopsy
    • Habit cessation
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6
Q

Oral Submucous Fibrosis

A
  • Chronic, progressive, high-risk, precancerous condition
  • Asia
  • Placement in mouth of a betel quid or paan
  • Wrap of areca tree nut & slaked lime, usually w/ tobacco
  • Users chew from early age, 16-24hr/day
  • CC: Trismus
  • Buccal mucosa, retromolar pad, soft palate most common sites
  • Betel chewer’s mucosa: Brown-red color (not precancerous)
  • Does not regress w/ habit cessation
  • Surgery & meds can improve fibrosis
  • Freq evaluation for development of cancer
  • Pts are 19x more likely to develop oral cancer
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7
Q

Actinic Cheilitis

A
  • Common premalignant change of lower lip vermillion
  • Due to long-term excessive exposure to UV light
  • Seen in most people w/ fair skin that burn easily
  • Rare in 45yo, 10x more common in males
  • Cancer develops in 6-10% of cases
  • Features:
    • Slow development
    • Atrophy of vermillion border
    • Smooth surface and paleness
    • Blurring of vermillion margin
    • Rough, scaly areas develop
    • Leukoplakia areas appear
    • Scaly material can be peeled off
    • Multifocal ulcers develop
  • Tx:
    • Many changes are reversible
    • Encourage pts to use lip balms to prevent further damage
    • Biopsy req’d for areas of ulceration, induration, or whitening
    • Severe cases, vermilionectomy may be performed
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8
Q

Erythroplakia

A
  • Red patch that cannot be clinically or pathologically dx’d as any other condition
  • AKA erythroplakia of Queyrat: Initially described in male genital
  • Same causes as cancer (esp smoking)
  • Less common than leukoplakia
  • Greater potential for malignancy
  • Disease of middle-aged to older adults
  • Floor of the mouth, tongue, soft palate
  • Well-demarcated macule/plaque, velvety texture
  • Erythroleukoplakia: when associated w/ leukoplakia
  • R/O candidiasis, vascular lesions, psoriasis, mucositis
  • Red lesions should be viewed w/ suspicion & biopsied
  • Floor of mouth and lateral/ventral tongue
  • If trauma is apparent, may wait 2wks to see if it regresses
  • Tx depends on biopsy results (degree of dysplasia)
  • Recurrence and multifocal involvement common: long term follow up
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9
Q

Squamous Cell Carcinoma

A
  • 95% oral cancer
  • ~35K new cases/yr; males > female
  • Px: ~58% of all pts w/ OSCC survive 5yr
    • Only 33% AA pts survive 5yr
    • 5yr survival rate for OC is relatively low, compared to cancer in other locations
    • Why is px so poor?
      • By the time it’s dx’d, usually in advanced stages
  • Risk factors
    • Tobacco
      • 80% pts are smokers
      • 8x increased risk
      • Risk of secondary carcinomas
    • EtOH
      • 30% of pts are drinkers
      • 20% have cirrhosis
      • 15x increased risk
    • Tobacco + EtOH greatly increases risk
    • HPV
      • Oral cancer: 3-5%
    • Genetic mutations & epigenetic events
    • People w/o risk factors CAN & DO still develop OC
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10
Q

Clinical features of OSCC

A
  • Intraoral Locations
    • Tongue: 50%
    • Floor of mouth: 35%
    • OC can happen anywhere in the oral cavity
  • Lips
    • Found in light-skinned persons
    • Due to UV damage
    • 70% pts outdoor occupation
    • 90% lower lip
    • Metastases are rare
  • Clinical features of advanced OC
    • Indurated tumor mass
    • Ulceration/bleeding
    • Pain
    • Cervical lymph node enlargement
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11
Q

Early detection of OSCC

A
  • Challenge: Detecting OSCC in its EARLY stages or as a precancerous lesion
  • Early OSCC
  • Most OSCC arises from clinically visible precursor lesions
  • Evolution from precursor lesion to invasive cancer is often a slow process
  • Most OCs are preventable or curable if detected early in development
  • Common Presentations of Early OSCC
    • Persistent, localized
    • Asymptomatic red lesion (erythroplakia)
    • Asymptomatic white lesion (leukoplakia)
    • Asymptomatic red & white lesion (erythroleukoplakia)
    • Not ulcerated or painful
    • Pt unaware of lesion
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12
Q

Tx for OSCC

A

If a single ulcer shows no sign of healing 14 days after the putative cause is removed, it should be considered malignant until proven otherwise

  • Tx:
    • Smaller lesions tx’d by surgery alone
    • Larger lesions tx’d w/ surgery and/or radiation
    • Neck dissection when lymph nodes involved
    • Chemotherapy usually palliative
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13
Q

TNM staging system for OSCC

A

T: Tumor

N: Nodes

M: Metastasis

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14
Q

Malignancy potential

A
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15
Q

Verrucous Carcinoma

A
  • Slowly growing cancer w/ a writhe, rough, warty surface
  • Low grade malignancy
  • Rarely metastasizes; good Px
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16
Q

Basal Cell Carcinoma

A
  • Smooth, raised, shiny or translucent border w/ telangiectasias
  • AKA “rodent tumor”
  • Assoc w/ chronic sun exposure
  • Slowly growing, may grow to very large size
  • Asymptomatic
  • Clinical findings:
    • Smooth, raised, shiny or translucent border w/ telangiectasias
    • Depressed center, often ulcerated
    • Very infiltrative and destructive, but rarely metastasizes
    • Does not occur in the mouth
17
Q

SCC vs. BCC

A
  • BCC
    • Above lip-tragus line
    • Chronic sun-exposure
    • Does not occur in the mouth
  • SCC
    • Below lip-tragus line
    • Acute sun damage (sunburn)

Oral Path 1 (10 decks)

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