Potentially Malignant Lesions and Oral Cancer Flashcards
Which is the most serious potentially malignant lesion?
Erythroplakia
Leukoplakia:
What are the 3 indications of greatest malignant potential for leukoplakias?
- Speckled, nodular or verrucous lesions
- LOCATION = at-risk sites i.e. lateral or ventral tongue and FOM
- Associated with Candida
Which has a higher rate of malignant change, specked or non-speckled leukoplakia?
Speckled leukoplakia
Chronic hyperplastic candidosis - Candidal leukoplakia
What social factor is mostly related to this?
Smoking
What is dysplasia?
Dysplasia = abnormal development (of organs or cells) or an abnormal structure resulting from such growth
In actinic cheilitis (farmer’s/sailor’s lip), which cancer develops in around 6-10% of cases?
Squamous cell carcinoma
Submucous fibrosis:
How is this caused?
How does this present?
What do patients complain of?
Caused by areca nut chewing, spices, autoimmunity
Presents as tight vertical bands in buccal mucosa
Patients complain of difficulty eating and sleeping - restricts oral opening and stiffens tongue
Which type of oral lichen planus has potential to undergo malignant change?
Erosive form of lichen planus
What is discoid lupus erythematosus (DLE)?
DLE = chronic photosensitive skin eruption
List 5 risk factors for potentially malignant lesions:
- Older than 45 years
- Combined alcohol and tobacco use
- Sun exposure
- Immunosuppression
- Human papilloma virus (HPV-16)
What is a neoplasia?
Neoplasia = cell proliferation and differentiation disorders
Describe the relationship benign and malignant neoplasms can have with the surrounding tissues:
BENIGN NEOPLASM = the cells of the neoplasm grow as a compact mass as they expand
MALIGNANT NEOPLASM = the cells invade the surrounding tissues and may even speak to distant sites
List the 4 main characteristics of benign neoplasms:
- Local invasion
- No metastasis
- Expanding growth pattern
- Usually contained within a capsule
List the 4 main characteristics of malignant neoplasms:
- Invade surrounding tissues
- Invade blood and lymph vessels leading to metastasis
- Grow in an irregular pattern
- No capsule
List 3 factors which can cause cells to grow out of control?
- Genetic
- Ultraviolet - sun
- Infections i.e. candida albicans, HOV
List 3 ways tumour cells evade immune defences:
- CHEMICAL MESSENGERS - Cancers produce chemical messengers that inhibit immune cell action
- ANTIGENT PRESENTATION - Cancers have defects in the way they present antigens on their cell surface
- LOCATION - some cancers grow in areas which are not regularly patrolled by immune cells i.e. eyes or brain
What % of all malignancies does oral cancer represent?
What are the most common malignant neoplasms of the mouth?
Oral cancers accounts for 3% of all malignancies
Most common = squamous cell carcinoma (over 90%)
What is the most common site of oral cancer?
Why is the thought to be the most common place?
The lower lip
Carcinogens pool in the lower mouth before swallowing
Stages of oral cancer:
Stage 0 or carcinoma in situ (CIS) - describe this stage
Stage 0 - there are cancer cells but are all contained within lining of mouth or oropharynx.
If this pre-cancer is left untreated, highly likely it will develop into invasive cancer
Describe the following:
Stage 1 of oral cancer
Stage 2 of oral cancer
Stage 3 of oral cancer
Stage 1 = Earliest stage of invasive cancer - cancer has started to grow through tissue lining of mouth or oropharynx into deeper tissues
- no more than 2cm across and has NOT spread to nearby tissues
Stage 2 = Cancer is more than 2cm across but less than 4cm
-has NOT spread to nearby tissues
Stage 3 = Cancer is bigger than 4cm across but has NOT spread to any lymph nodes or other parts of the body
OR
The cancer is any size but has spread to ONE LYMPH NODE (no more than 3cm across LN) on the same side of the neck
Stage 4 oral cancer has 3 substages - describe them.
Stage 4a = Cancer has grown through the tissues around the lips and mouth
-lymph nodes may or may not contain cancer cells
Stage 4b = Cancer is any size and has spread to more than one lymph node on same side
-Cancer has spread to lymph nodes on both sides of the neck
-Any lymph node is bigger than 6cm
Stage 4c = Cancer has spread to other parts of the body e.g. lungs or bones
In order to try and achieve the best prognosis for oral cancer, what is the most crucial part?
EARLY DIAGNOSIS
SCC of the lower lip: describe the presentation of this
Vermillion boarder to one side of the midline
Area of thickening
Induration
Ulceration
Crusting
Verrucous carcinoma - how does this present?
White, warty appearance that forms a well-circumscribed mass
Melanoma - what is it?
Malignant neoplasms of melanocytic origin that form from a benign melanocytic lesion or from melanocytes in skin or mucosa
What are the 4 worst areas of melanoma prognosis? (BANS)
B - Back
A - Arms
N - Neck
S - Scalp
When is melanoma almost ALWAYS fatal?
When the disease spreads (disseminated)
Basal cell carcinoma:
What causes this?
How does it present?
What is it the most common form of?
How is it treated?
Caused by excessive sun exposure and some hereditary disorders
Presents as raised, pale/pearly in colour with central depression
Most common form of non-melanoma skin cancer
Treated by surgical removal
What is the best way to screen for oral cancer?
The Gold Standard Examination
List 4 screening methods of oral caner:
- Clinical judgement - Gold Standard Examination
- Toluidine blue
- Photodynamic Diagnosis
- HPV16 screening
How does a HPV16 screen indicate oral cancer?
HPV16 E6 antibodies in the blood indicate a very high risk of developing a HPV-associated cancer of the oropharynx
How does Toluidine Blue work to detect cancer?
The dye selectively binds to dysplastic or malignant cells in the oral epithelium
How does Photodynamic diagnosis work to detect cancer?
Malignancies show up as fluorescent areas and can detect cancer in its earliest stages long before it becomes a tumour
How does VELscope work to detect cancer?
Suspicious lesions cause a lack of fluorescence and appear dark in colour
What is a brush biopsy?
The removal of cells using a brush designed to collect cells from all layers of a lesion - sent off to a lab to be examined
When should a patient be sent on an urgent referral?
List 3 factors:
Unexplained red or white patches that are:
1. Painful
2. Swollen
3. Bleeding
Where do 95% of oral cancers arise?
What is a late feature of oral cancer?
What are the main sites of oral cancer?
95% of oral cancers arise in normal mucosa
Pain is a late feature of oral cancer
Lips, tongue, FOM and soft palate are the main sites of oral cancer
