ORAL PATH oral cancer

Question 1

what is oral submucous fibrosis?

Answer 1

a chronic, progressive oral potentially malignant disorder

Question 2

what is oral submucous fibrosis associated with?

Answer 2

betel quid/ areca nut

Question 3

describe the clinical appearance of oral submucous fibrosis

Answer 3

pale coloured mucosa
firm to palpate
fibrous bands which affect buccal mucosa, soft palate and labial mucosa

Question 4

what are clinical symptoms of oral submucous fibrosis?

Answer 4

very marked trismus

Question 5

histopathology of oral submucous fibrosis?

Answer 5

submucosal deposition of dense collagenous tissue
decreased vascularity
marked epithelial atrophy
variable grades

Question 6

where is epithelial dysplasia limited to?

Answer 6

surface squamous epithelium

Question 7

what is epithelial dysplasia?

Answer 7

atypical epithelial alterations limited to surface squamous epithelium

architectural or cytological changes

Question 8

what sites of the mouth are associated with higher risk of malignant transformation of epithelial dysplasia?

Answer 8

lat border of tongue
ventral tongue
retromolar area
FOM

Question 9

List the 11 histological features of epithelial dysplasia?

Answer 9

1. nuclear and cellular pleomorphism
2. alteration in nuclear/ cytoplasmic ratio
3. nuclear hyperchromatism
4. prominent nucleoli
5. increased and abnormal mitoses
6. loss of polarity of basal cells
7. basal cell hyperplasia
8. drop-shaped rete pegs
9. irregular epithelial stratification or disturbed maturation
10. abnormal keratinisation ‘dyskeratosis’
11. loss/reduction of intercellular adhesion

Question 10

how is epithelial dysplasia graded?

Answer 10

mild
moderate
severe

grading is subjective and varies based on intra and interobservation

Question 11

describe mild epithelial dysplasia?

Answer 11

disorganisation, increased proliferation and atypia of basal cells

Question 12

describe moderate epithelial dysplasia?

Answer 12

more layers of disorganised basaloid cells, atypia, suprabasal mitoses

Question 13

describe severe epithelial dysplasia?

Answer 13

very abnormal, affects full thickness of epithelium

Question 14

what types of epithelial dysplasia have a higher risk of malignant transformation?

Answer 14

higher grade - moderate and severe

Question 15

difference between SCC and epithelial dysplasia?

Answer 15

epithelial dysplasia - confined to surface epithelium
SCC - atypical cells invade into underlying connective tissue

Question 16

management of epithelial dysplasia?

Answer 16

modify risk factors
antifungal tx (if super imposed candida)
excision
topical agents
close clinical review
rebiopsy

Question 17

what areas are classed as oral cancer?

Answer 17

oral cavity and external lip (vermillion border)

Question 18

what is the survival rate of oral cancer?

Answer 18

5 year
55%

Question 19

what are the risk factors of oral cancer?

Answer 19

tobacco
alcohol
betel quid/pan/areca nut
previous oral cancer
exposure to UV light (lip)
poor diet
immune suppression
oral potentially malignant disorders
genetics
fam history
HPV

Question 20

list some signs and symptoms that may indicate oral cancer?

Answer 20

lumps and bumps
ulcers
white patches
red patches
speckled patches
non-healing socket
tooth mobility not associated with perio
induration/ fixation of mucosa
dysphagia
pain/ paraesthesia
bleeding

Question 21

what guideline is used for referring suspected oral cancer?

Answer 21

scottish referral guidelines for suspected cancer

Question 22

who do you refer suspected oral cancer to and within what time frame?

Answer 22

oral and maxillofacial surgery
2 weeks

Question 23

what is the criteria for referring suspected oral cancer?

Answer 23

head and neck lump
ulceration/ swelling
red/ mixed red and white patches
hoarseness
throat pain/ dysphagia

ALL PERSISTING FOR MORE THAN 3 WEEKS

Question 24

how is oral SCC diagnosed?

Answer 24

confirmed by biopsy
H+E stained slides

immunohistochemistry for p16 and HPV in situ hybridisation used for all oropharyngeal SCC - NOT ORAL CAVITY

Question 25

how are SCC graded by degree of differentiation?

Answer 25

well-differentiated: tumour cells very obviously squamous with ‘prickles’ and keratinisation
moderately differentiated
poorly differentiated: may be difficult to identify tumour cells as epithelial

Question 26

where is the initial tissue diagnosis of oral cancer discussed?

Answer 26

multidisciplinary team meeting

Question 27

treatment for oral cancer?

Answer 27

surgery
+/- adjuvant therapy
monoclonal antibodies

Question 28

what is staging of oral cancer?

Answer 28

anatomical extent of the disease - the major determinant of appropriate tx and diagnosis

Question 29

how is a tumour staged?

Answer 29

clinical and radiographically - preop
pathologically - postop

Question 30

what are the components to staging tumours?

Answer 30

T - extent of primary tumour
N - absence or presence and extent of regional lymph node metastasis
M - category describes the absence or presence of distant metastasis

Question 31

how does TNM staging work?

Answer 31

each component is given a number - this higher the number, the more extensive the disease, poorer prognosis

Question 32

what are the most significant prognostic factors?

Answer 32

tumour size
depth of invasion
nodal status
distant metastases