Oral cancers

Question 1

p16

Answer 1

tumour suppressor
protein which acts to regulate the cell cycle by inhibiting enzymes involved in cell division
prevents uncontrolled cell growth

Question 2

p16 positive

Answer 2

indicates over expression of protein which suggests change in cell cycle regulation in response to oncogene activity

Question 3

OSCC
- epidemiology
- risk factors
- clinical features

Answer 3

epi: M>F, south asia and africa, 50+
risks: tobacco, alcohol, areca nut, betel quid, low socioeconomic status
clinical features: common sites (FOM, lateral tongue, soft palate), trismus, lymphadenopathy

Question 4

OPSCC
- epidemiology
- risk factors
- clinical features

Answer 4

epi: M>F, 40-70, north america and south asia
risks: alcohol, tobacco, HPV
clinical: ulcerative or exophytic mass in oropharynx, dysphagia, tonsillar asymmetry, ear pain

Question 5

what differentiates carcinoma and carcinoma in situ

Answer 5

carcinoma sees invasion across basement membrane into connective tissue

Question 6

what are the 6 hallmarks of cancer

Answer 6

1. insensitivity to anti-growth signals
2. self sufficient in growth signals
3. evading apoptosis
4. sustained angiogenesis
5. limitless replicative potential
6. tissue invasion and metastasis

Question 7

how are tumours graded

Answer 7

based on degree of tumour differentiation
grade 1 - well differentiated, resembles normal squamous epithelium
grade 2 - moderately (80%)
grade 3 - poorly differentiated - little cytoplasm, unrecognisable as epithelial cells

Question 8

staging of tumours

Answer 8

uses TNM system
T - primary tumour size
N - lymph node involvement
M - distant metastases

x means cant be assessed

Question 9

what is radiation dose measured in

Answer 9

grays (Gy)

Question 10

cumulative dose for 2Gy per day for 5 days for 5 weeks

Answer 10

50Gy

Question 11

what is radiation therapy

Answer 11

medical treatment using high dose radiation to target and kill cancer cells. Goal is to damage DNA and prevent replication

Question 12

why would radiotherapy treatment be undertaken

Answer 12

cancer treatment
- primary treatment - to eliminate/control localised cancer
- adjuvant treatment after surgery to target remaining cells
- palliative care - to relieve symptoms
- inoperable tumours

Question 13

name 3 short term side effects of radiotherapy

Answer 13

oral mucositis
changes to appetite
fatigue
diarrhoea

Question 14

name 3 long term side effects of radiotherapy

Answer 14

hyposalivation - almost all radiotherapy patients affected
- ORN - exposed necrotic bone for >12weeks in patients with a history of radiation
- organ dysfunction

Question 15

above what cumulative dose of radiotherapy is permanent damage to salivary glands likely

Answer 15

30Gy

Question 16

what is chemotherapy

Answer 16

medical treatment using drugs to stop growth of cancer by killing cells or stopping them dividing
given IV in hospitals or orally at home

Question 17

chemotherapy induced mucositis
- description
- prevention
- management

Answer 17

• mucosal inflammation leading to ulceration
• nothing really, cryotherapy suggested, improves a few weeks after chemo stopped
• opioid analgesics, avoid hard/spicy/acidic food, topical analgesics

Question 18

field change theory

Answer 18

head and neck cancer survivors are at risk of developing another cancer within a 5cm radius of primary tumour.

Around 10% HN cancer patients develop another tumour