ORAL PATH oral cancer Flashcards
what is oral submucous fibrosis?
a chronic, progressive oral potentially malignant disorder
what is oral submucous fibrosis associated with?
betel quid/ areca nut
describe the clinical appearance of oral submucous fibrosis
pale coloured mucosa
firm to palpate
fibrous bands which affect buccal mucosa, soft palate and labial mucosa
what are clinical symptoms of oral submucous fibrosis?
very marked trismus
histopathology of oral submucous fibrosis?
submucosal deposition of dense collagenous tissue
decreased vascularity
marked epithelial atrophy
variable grades
where is epithelial dysplasia limited to?
surface squamous epithelium
what is epithelial dysplasia?
atypical epithelial alterations limited to surface squamous epithelium
architectural or cytological changes
what sites of the mouth are associated with higher risk of malignant transformation of epithelial dysplasia?
lat border of tongue
ventral tongue
retromolar area
FOM
List the 11 histological features of epithelial dysplasia?
- nuclear and cellular pleomorphism
- alteration in nuclear/ cytoplasmic ratio
- nuclear hyperchromatism
- prominent nucleoli
- increased and abnormal mitoses
- loss of polarity of basal cells
- basal cell hyperplasia
- drop-shaped rete pegs
- irregular epithelial stratification or disturbed maturation
- abnormal keratinisation ‘dyskeratosis’
- loss/reduction of intercellular adhesion
how is epithelial dysplasia graded?
mild
moderate
severe
grading is subjective and varies based on intra and interobservation
describe mild epithelial dysplasia?
disorganisation, increased proliferation and atypia of basal cells
describe moderate epithelial dysplasia?
more layers of disorganised basaloid cells, atypia, suprabasal mitoses
describe severe epithelial dysplasia?
very abnormal, affects full thickness of epithelium
what types of epithelial dysplasia have a higher risk of malignant transformation?
higher grade - moderate and severe
difference between SCC and epithelial dysplasia?
epithelial dysplasia - confined to surface epithelium
SCC - atypical cells invade into underlying connective tissue
management of epithelial dysplasia?
modify risk factors
antifungal tx (if super imposed candida)
excision
topical agents
close clinical review
rebiopsy
what areas are classed as oral cancer?
oral cavity and external lip (vermillion border)
what is the survival rate of oral cancer?
5 year
55%
what are the risk factors of oral cancer?
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
list some signs and symptoms that may indicate oral cancer?
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
what guideline is used for referring suspected oral cancer?
scottish referral guidelines for suspected cancer
who do you refer suspected oral cancer to and within what time frame?
oral and maxillofacial surgery
2 weeks
what is the criteria for referring suspected oral cancer?
head and neck lump
ulceration/ swelling
red/ mixed red and white patches
hoarseness
throat pain/ dysphagia
ALL PERSISTING FOR MORE THAN 3 WEEKS
how is oral SCC diagnosed?
confirmed by biopsy
H+E stained slides
immunohistochemistry for p16 and HPV in situ hybridisation used for all oropharyngeal SCC - NOT ORAL CAVITY
how are SCC graded by degree of differentiation?
well-differentiated: tumour cells very obviously squamous with ‘prickles’ and keratinisation
moderately differentiated
poorly differentiated: may be difficult to identify tumour cells as epithelial
where is the initial tissue diagnosis of oral cancer discussed?
multidisciplinary team meeting
treatment for oral cancer?
surgery
+/- adjuvant therapy
monoclonal antibodies
what is staging of oral cancer?
anatomical extent of the disease - the major determinant of appropriate tx and diagnosis
how is a tumour staged?
clinical and radiographically - preop
pathologically - postop
what are the components to staging tumours?
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
how does TNM staging work?
each component is given a number - this higher the number, the more extensive the disease, poorer prognosis
what are the most significant prognostic factors?
tumour size
depth of invasion
nodal status
distant metastases
