Oral Path Exam 2 - Premalignant White and Red Lesions Part 2 Flashcards
What type of lesion?
Uncommon, high risk presentation
Proliferative verrucous leukoplakia (VPL)
What type of lesion?
NOT associated with HPV
Proliferative verrucous leukoplakia (VPL)
What type of lesion?
Multiple leukoplakias, often extensive, that spread and thicken over time
Proliferative verrucous leukoplakia (VPL)
What type of lesion?
Often involve the gingiva; other sites may be affected as well
Proliferative verrucous leukoplakia (VPL)
What type of lesion?
Female predilection (4:1)
Mean age = 65 years
Only 1/3 have traditional risk factors
Proliferative verrucous leukoplakia (VPL)
What type of lesion?
Hyperkeratosis/hyperplasia w/ variable dysplasia, often verrucous surface
Proliferative verrucous leukoplakia (VPL)
What type of lesion?
Optimal tx remains to be determined
Proliferative verrucous leukoplakia (VPL)
What type of lesion?
Surgical or ablative therapy, but recurrence is common
Proliferative verrucous leukoplakia (VPL)
What type of lesion?
Malignant transformation is a frequent complication, even in lesions w/o previous biopsy evidence of dysplasia
Proliferative verrucous leukoplakia (VPL)
Remember: red or white lesions that persist for more than 2-3 weeks that cannot be ascribed to any known causes must get a _____________
biopsy!!
What type of lesion?
Term for actinic keratosis, involving the vermilion zone of the lower lip
Actinic cheilosis (chelitis)
What type of lesion?
Strong male predilection
Actinic cheilosis (chelitis)
What type of lesion?
Clinical progression: atrophy (blotchy pale), dryness, fissures -> scaly/crusty and thickening -> leukoplakia -> ulceration
Actinic cheilosis (chelitis)
What type of lesion?
Tx: excision w/ scalpel or laser
Actinic cheilosis (chelitis)
What type of lesion?
Prognosis: long term follow-up recommended as there is a 2x increased risk for cancer of the lip
Actinic cheilosis (chelitis)
What are the causes of oral cancer and precancerous lesions?
Tobacco (smoked/smokeless)
Alcohol
HPV
Radiation (UV or therapeutic)
Immunosuppression
The etiology of oral cancer is a multifactorial process of ___________ and ___________ factors
intrinsic; extrinsic
What % of people with oral cancer are smokers?
80%
Which has the highest oral cancer risk: cigarettes, cigars, or pipes?
Pipes and cigars have a higher risk than cigarettes
What is the cancer risk if you smoke 2 packs/day? What about 4 packs/day?
2 packs: 5x higher risk
4 packs : 17x higher risk
T/F: In those who smoke, the risk of oral cancer is dose-dependent and increases with time
True
T/F: Leukoplakias with no or mild dysplasia may shrink with smoking cessation
True
How many years after quitting smoking does the oral cancer risk approximate that of non-smokers?
10 years after
Risk for 2nd primary upper aerodigestive tract carcinoma is _________ greater in those that continue to smoke compared to those that quit after 1st cancer
2-6x
Placing burning end inside mouth; practiced in isolated areas in India and South America
Reverse smoking
Up to ______% of oral malignancies in populations of people who reverse smoke will occur on the ______________
50%; hard palate
T/F: Meta-analyses can’t confirm or refute an association between head and neck cancer and marijuana use. But, recent cohort study shows an association. There is also emerging “suggestive” evidence of multiple associated cancers, but need need more data
True
T/F: Effects due to use of marijuana with ethanol or tobacco are poorly understood. Given current increased legalization and usage trends (including synthetic cannabinoids), future study is important
True
What is the risk of oral cancer for heavy alcohol use (4+ beverages/day)?
2-14x increased risk
(or maybe even 30x increased risk as said in lecture)
What is the risk of oral cancer for alcohol use combined with tobacco use?
15x increased risk
(synergistic effect)
What is the pathogenesis of oral cancer due to alcohol?
Ethanol -> acetaldehyde (carcinogenic)
Carcinogenic impurities in alcoholic drinks
Increased permeability to epithelium and solubility of carcinogens
T/F: HPV-associated (mostly HPV16) oropharyngeal squamous cell carcinoma has increased dramatically
True
What cause of oropharyngeal cancer?
Patients tend to be ~ 10 years younger
HPV (oropharynx)
What cause of oropharyngeal cancer?
Affects a higher socioeconomic group; increased % in whites
HPV (oropharynx)
What cause of oropharyngeal cancer?
Strong association w/ sexual behavior
HPV (oropharynx)
What cause of oropharyngeal cancer?
Conflicting data on tobacco/alcohol association
HPV (oropharynx)
What cause of oropharyngeal cancer?
More favorable prognosis (~30% better)
HPV (oropharynx)
What cause of oropharyngeal cancer?
56% have transcriptionally active HPV16 infection
HPV (oropharynx)
What cause of oral cancer?
Role in oral cavity carcinogenesis is uncertain
HPV (oral)
What cause of oral cancer?
Expression of viral oncogenes E6 and E7 mRNA is now gold standard for determining clinically relevant infection
HPV (oral)
What cause of oral cancer?
0-9% have transcriptionally active HPV16 infection
HPV (oral)
What is the predominant type of HPV in oral cancer?
HPV16
When should you test for HPV?
All oropharyngeal squamous cell carcinoma
All cervical lymph node metastases of unknown primary
(we do NOT test HPV for oral cancers!!)
What cause of oral cancer?
Chronic sunlight exposure is the main cause of actinic cheilitis -> lip cancer
Radiation (UV irradiation)
What cause of oral cancer?
Decreases immune response and causes alterations in DNA
Radiation (X-irradiation)
What cause of oral cancer?
Increased risk of new primary malignancy (either carcinoma or sarcoma)
Radiation (X-irradiation)
What cause of oral cancer?
Increased risk for oral squamous cell carcinoma and other H&N malignancies for pts with AIDS, on immunosuppressive tx, or had organ transplant
Immunosuppression
Anti-microbial/anti-inflammatory herbal extract (blood-root plant) added to oral hygiene products
Sanguinaria
Strong association (not cause) w/ maxillary vestibule or alveolar mucosal leukoplakia
Sanguinaria
Unknown if increases risk of cancer development, but pt should stop use if leukoplakia is seen
Sanguinaria
Proven cause of premalignancy or oral cancer?
Oral sepsis - bad oral hygiene
Broken teeth
Dentures
Galvanism
Mouthwash
Routine dental X-Rays
NO
Proven risk factor of premalignancy or oral cancer?
Oral bacteria
Periodontal bacteria
Candida
NO
May interact with tobacco and alcohol, increasing acetaldehyde
Oral bacteria
Association with oral cancer not confirmed due to variable results
Periodontal bacteria
Can overlay leukoplakias, but does not cause them
Candida
Some strains may metabolize ethanol to acetaldehyde or produce nitrosamines, but link to oral cancer is not shown
Candida
Tumor suppressor genes can exhibit loss of _______________ (LOH), ___________ (p53), or ________________(p16, RAR-B2), which can each lead to inactivation and tumor growth
heterozygosity; mutation; hypermethylation
EGFR, telomerase, and cyclin D1 ______________ lead to increased growth
overexpression
Increasing ___________ (extra chromosomal copies) can lead to molecular carcinogenesis
polysomy
What are the 6 diagnostic techniques?
Scalpel biopsy
Cytology
Toluidine blue
Vizilite
Velscope
Brush biopsy
Which diagnostic technique?
Gold standard
Scalpel biopsy
Which diagnostic technique?
Adjuncts to clinical evaluation/biopsy
Scalpel biopsy
Which diagnostic technique?
Limited application on red lesions
Cytology
Which diagnostic technique?
Most useful in red lesions
Toluidine blue
Which diagnostic technique?
May help visualize subtle leukoplakia, but limited application
Vizilite
Which diagnostic technique?
Some application in margin delineation, but insufficient evidence for use as a screening device
Velscope
Which diagnostic technique?
Not recommended as indications for use would also require scalpel biopsy
Brush biopsy
