Potentially Pre Malignant Lesions And OC Flashcards
What are the types of leukoplakia
Homogenous : mainly white lesions with a uniform appearance
Non homogenous/speckled: predominantly white
Eryhtroleukplakia : white with red spots and irregular texture. Much greater risk of maligancy
What are the potentially premalignant lesions of the mouth?
Leukoplakia Proliferative verrucous leukoplakia Erthroplakia Oral lichen planus Oral sub mucous fibrosis Discoid lupus Actinic chelitis
What are the factors that increase the risk profile of leukoplakia?
Absence of tobacco Sex: increased risk of malignancy for females Site: high risk sites eg floor of mouth Non homogenous Raised compared surrounding mucosa Induration of base of leukoplakia and surrounding tissue Presence of ulceration Presence of tobacco Increased age
What is the malignant transformation risk in dysplasia ?
Degree of dysplasia None: 1% Mild: 5% Moderate: 15% Severe: 25%
High risk sites include: FOM, tongue, retro molar and soft palate
What is the management for leukoplakia?
Surgical excision
Monitoring: mild to moderate dysplasia and need follow up since 3rd of all leukoplakia transform to OSCC in the first 2 years so need long term follow up. Periodic re biopsy
Medical management
What percentage of leukoplakia become OSCC within 2 years?
Less than 2 % each year
How does erthroplkia appear on biopsy?
All moderate to severe dysplasia
WHat is the mamagement for eryhtroplkia ?
Since the vast majority will undergo malignant transformation all eryhtroplkia a should be excised
What is proliferative verrucous leukoplakia? And what is the maligancy potential?
Variant of leukoplakia
Rough irregular surface which slowly expand
Almost all turn into verrucous OSCC
How do you mange chronic hyperplasia candida?
Follow up
Systemic AF
1/10 develop into cancer
What is the change for malignant transformation in submucosa fibrosis?
Less than or equal to 7%
Trials OM effective of Lycopene, pentoxyfylene
What is the transformation risk for OLP?
Low
Recall 6momthyl
Which type of OLP is likely to undergo maligant change?
Plaque like and erosive
Amalgam has low
What percentage of oral cancers are OSCC?
90%
What percent are minor salivary glans tumours, lymphoma and maligant melona?
10%
What are the sinister features of OSCC?
Symptoms: sore throat, hoarseness, stridor, difficulty in swallowing, lump on neck,unilateral ear pain
Signs: red or white patch in mouth Oral ulcer Loose teeth Lateral neck mass Cranial nerve palsy Orbital mass Unilateral ear effusion
What are the NICE guidelines on when to refer for OC?
- Unexplained red and white patched or OM that are painful or swollen or bleeding
- unexplained ulceration or mas for more than 3 weeks
-persistent symptoms where a defensive benign diagnosis cannot be made should be followed up and if they have not disappeared after 6 weeks need urgent refers
How do all OSCC appear histologically?
With invasion and destruction of local tissues
What are the important pathological prognosic indicators?
Degree of differentiation (grade)
Pattern of invasion
Vascular or neural involvemtn
Cervical LN involvement
What does grading of a tumour relate to?
Degree of differentiation
Well moderate poor
Why is grading important?
To predict response to adjunctive radio and chemotherapy
What are the features of a well differentiate tumour?
Neoplastic epithelium is obviously squamous
Masses of pickcle cell layer
Intercellular bridge recognisable
Cells are clearly recognisable as epithelial origin
What are poorly differentiated tumours features?
Sparse keratin pearls
Prickle cell and nuclei are more prominent
Abundant and occasional atypical mitosis
Cells not recognised as epithelial in origin
What is depth of invasion related to?
Nodal metastasis
For T1 and t2, what is the invasion threshold for predicting cervical node metastasis?
4mm
Invasion is subdivided into?
Depth and pattern
What are the types of invasion?
Broad sheets: more than 15 cells across
Narrow strands: non cohesive small groups or single cells
Which type of invasion, perivaacualr or perineural invasion indicates a more aggressive disease type?
Perineural
Perivaacualr is a weak indicator of nodal metasteses
What does perineural invasion indicate?
Local recurrent rate
Nodal metastasis
Survival
May indicate Need for adjunctive therapy
What does extra capsular spread indicate?
Poor prognosis
Manifestation of biological aggression
What is more effective in the treatment for leukoplakia? Surgery or medical?
No evidence which one
Which medical treatment are available for leukoplakia?
VitaminA
Retinoids
Beta carotene
Lycopene
When would you carry out surgical treatment for leukoplakia?
Severely dysplasic
What are the advantages and disadvantages of carrying out excision of leukoplakia?
Advantages: Entire lesion can be examined histopathology
Disadvantages: asscocited with morbity and leukoplakia has a low transformation rate
What is the effect of stoping smoking or alcohol in precancerous lesions?
No good evidence that proves this is helpful
What is erthroplkia?
Red patch which cannot be identified clinical or histology as any other disease
T/F eryhtroplkia is associated with a high rate of maligant transformation?
T
What are the aetiological factors associated with eryhtroplasia?
How does it appear ?
Tobacco and alcohol
Flat red plaque
What are the aetiological factors associated with leukoplakia?
How does it appear ?
Tobacco
Alcohol
HPV
What are the aetiological factors associated with proliferative verrucous leukoplakia ?
How does it appear ?
Tobacco
Alcohol
White or speckled modular plaque
What is the aetiology behind sublingual keratosis and how does it appear?
Tobacco and alcohol
White plaque
What are the aetiological factors associated with actinic chelitis?
How does it appear ?
Sunlight
White plaque and erosions
What are the aetiological factors associated with licen planus?
How does it appear ?
Idiopathic
Reticular, plaque, erosive, Atrophic, bullous
What are the aetiological factors associated with submicous fibrosis?
How does it appear ?
Areca
Immobile mucosa
What are the aetiological factors associated with DLE?
How does it appear ?
Idiopathic
White plaque erosions
What are the aetiological factors associated with chronic candida ?
How does it appear ?
C albicans
White or speckled plaque
What are the aetiological factors associated with syphylitic leukoplakia?
How does it appear ?
Syphylis
White plaque
How should you manage actinic chelitis?
If severe dysplasia then need to excise
