Oral Dysplasia and cancer cases Flashcards
38 years old
Risk factor - topical tobacco (snuff)
Otherwise fit and well
Thickened keratotic lesion, red patches, red spots
Biopsy - benign
Recommendation - stop smoking, regular review
64 year old
Unaware of the lesion left commissure
Risk factors - 20 cigs a day since 16 yrs, 10 pints beer per week, eats processed foods with little fresh fruit and vegetables.
Keratotic lesion (thickened in appearance), painless, very speckled.
Biopsy - Candidal leukoplakia
Treatment - Systemic antifungals,
Second biopsy - Squamous cell carcinoma
Treatment - Surgical excision with a margin of 1cm of normal tissue , 5 yr follow up review.
32 yr old
Left sided tongue white patch
Risk factors - smoker 10 a day since 18 yrs
1 bottle of vodka per week
White patches, red patches.
Biopsy - severe dysplasia (lesion will all become cancerous if not excised)
Treatment - excision with 5 mm normal tissue, smoking cession, alcohol reduction, long-term regular follow up.
47 yr old
Multiple white patches
Asymptomatic
Risk factors - none identified
Mapping biopsies
Close clinical follow up
Self examination
78 yrs old
Multiple white patches: bilateral buccal mucosa, lower right gingivae, right soft palate.
Mapping biopsies
Moderate to severe dysplasia
Treatment excision of lesions with 5mm normal margin
58 yr old
asymptomatic
white patch lingual alveolus FOM (“ebb and tide” pattern)
risk factor - binge drinker
Biopsy: Severe dysplasia
Treatment: Excision with a perimeter of 5mm normal tissue, follow up, repeat biopsy, risk factor reduction
(second biopsy after 1 year as a follow up)
73 yrs
Long history of lace like white patches inside both cheeks
not symptomatic
Risk factors - none identified
Lichen planus (potentially malignant condition)
Investigation - incisional biopsy
52 yrs
painful left cheek for several months
former smoker, stopped 6 year before was 15 cigarettes per day since age 20 yrs
Lichenoid reaction in the mouth (shouldn’t be confused with a lichen planus) as a result of amalgam restorations.
54 yrs
20 year history of oral white patches bilateral; buccal mucosa and left soft palate onto hard palate
Risk factors - alcohol <10 units per week
Thick, keratotic lesion, indurated margins
62 yr old, rheumatoid arthritis (taking strong immunosuppressants) and Sjorgrens syndrome.
Asymptomatic white patch right lateral tongue
No risk factors
Striated pattern
Hairy leukoplakia (can be associated with HIV)
65 yr painless lesion on right side of the tongue
unknown duration
Smoker 20 a day for 40 years
alcohol 4 bottles of wine per week
Indurated, squamous cell carcinoma, large
78 yrs old, asymptomatic white patch on the left gingivae in the LL5 and LL6 region, found by his own dentist on routine examination.
No risk factors
Medically - well controlled hypertension with amlodipine and statins.
Heterogenous patches
73 yr old, lesion on right side of tongue
Patient noticed an ulcer 6 weeks previously
not painful
noticed a lump in the right neck for the past month not painful
risk factors - none identified
White patch with red speckles, heat thick white patch, exophytic (growing out the way)
34 yr old, vague right side jaw and neck pain
present for 6-7 months
her glands were up and had not come down for a few months
the dentist suggested that her symptoms were due to her impacted wisdom teeth
medically she was fit and well, never smoked and consumed less than 10 units of alcohol per week.
Cancer
Treatment for cancer
A homogeneous white patch of the left buccal mucosa measuring 2cm in diameter is found on routine examination of a new patient. Immediately adjacent is amalgam restored molars. The patient was not aware of this white patch. They do not smoke or consume a lot of alcohol. What is the most likely diagnosis?
lichenoid reaction
A 69 year old male patient comes for a routine assessment and you note a red/white speckled area of the anterior floor of mouth that the patient was not aware of. He is partially dentate but does not wear anything over that area. He has smoked roll -up cigarettes for the past 50 years and drink 5 days per week usually 3 pints per day. What do you think the most likely diagnosis is?
Potentially malignant lesion
A patient comes with a constantly painful area on the left cheek of 10 days duration. He is aware that there is a broken filling in the area and is concerned that it does not seem to be getting better. He suffers from mouth ulcers but they usually only last 5-7 days and get better. You see a 1 cm ulcer with a erythematous perimeter which is very tender to touch at the level of a fractured amalgam in the UL7. What is the most likely diagnosis?
trauma causing ulceration
A 47 year old female patient attends as a new patient to your practise. You notice that she has white patches on her ventrolateral tongue on the right side, soft palate on the left side and the anterior attached gingivae. When you ask her she says she can see the white gums at the front but they have bee like that for years and her previous dentist did not think that they were anything to be concerned about. She does not smoke or drink except a sherry on a special occasion. What do you think the diagnosis might be?
field change
A 47 year old female patient attends as a new patient to your practise. You notice that she has white patches on her ventrolateral tongue on the right side, soft palate on the left side and the anterior attached gingivae. When you ask her she says she can see the white gums at the front but they have bee like that for years and her previous dentist did not think that they were anything to be concerned about. She does not smoke or drink except a sherry on a special occasion. What do you think the diagnosis might be?
field change
Breaking bad news stages
- Setting (physical settings, body language etc.)
- Listening skills (open questions)
- Perception of condition (gauge patients level of understanding/anxiety)
- Invitation (how much information does the patient they want)
- Knowledge (understandable, no jargon, give info in small chunks, respond to patients reactions, explore denial)
Empathetic response when breaking bad news
Identify emotion
Identify the cause or source of the emotion
Respond in a way that shows that you have made a connection
Strategising at the end of breaking bad news
Next steps
Patient expectations
Ensure patient understands
Agree on a plan
SUMMARISE: any more questions to discuss? Make a clear plan for next context.
