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Oral Med > Potentially Pre Malignant Lesions And OC > Flashcards

Potentially Pre Malignant Lesions And OC Flashcards

0
Q

What are the types of leukoplakia

A

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

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1
Q

What are the potentially premalignant lesions of the mouth?

A 
Leukoplakia
Proliferative verrucous leukoplakia 
Erthroplakia
Oral lichen planus
Oral sub mucous fibrosis 
Discoid lupus 
Actinic chelitis
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2
Q

What are the factors that increase the risk profile of leukoplakia?

A 
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
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3
Q

What is the malignant transformation risk in dysplasia ?

A 
Degree of dysplasia 
None: 1%
Mild: 5%
Moderate: 15%
Severe: 25%

High risk sites include: FOM, tongue, retro molar and soft palate

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4
Q

What is the management for leukoplakia?

A

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

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5
Q

What percentage of leukoplakia become OSCC within 2 years?

A

Less than 2 % each year

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6
Q

How does erthroplkia appear on biopsy?

A

All moderate to severe dysplasia

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7
Q

WHat is the mamagement for eryhtroplkia ?

A

Since the vast majority will undergo malignant transformation all eryhtroplkia a should be excised

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8
Q

What is proliferative verrucous leukoplakia? And what is the maligancy potential?

A

Variant of leukoplakia
Rough irregular surface which slowly expand

Almost all turn into verrucous OSCC

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9
Q

How do you mange chronic hyperplasia candida?

A

Follow up
Systemic AF

1/10 develop into cancer

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10
Q

What is the change for malignant transformation in submucosa fibrosis?

A

Less than or equal to 7%

Trials OM effective of Lycopene, pentoxyfylene

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11
Q

What is the transformation risk for OLP?

A

Low

Recall 6momthyl

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12
Q

Which type of OLP is likely to undergo maligant change?

A

Plaque like and erosive

Amalgam has low

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13
Q

What percentage of oral cancers are OSCC?

A

90%

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14
Q

What percent are minor salivary glans tumours, lymphoma and maligant melona?

A

10%

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15
Q

What are the sinister features of OSCC?

A

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
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16
Q

What are the NICE guidelines on when to refer for OC?

A
  • 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

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17
Q

How do all OSCC appear histologically?

A

With invasion and destruction of local tissues

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18
Q

What are the important pathological prognosic indicators?

A

Degree of differentiation (grade)
Pattern of invasion
Vascular or neural involvemtn
Cervical LN involvement

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19
Q

What does grading of a tumour relate to?

A

Degree of differentiation

Well moderate poor

20
Q

Why is grading important?

A

To predict response to adjunctive radio and chemotherapy

21
Q

What are the features of a well differentiate tumour?

A

Neoplastic epithelium is obviously squamous
Masses of pickcle cell layer
Intercellular bridge recognisable
Cells are clearly recognisable as epithelial origin

22
Q

What are poorly differentiated tumours features?

A

Sparse keratin pearls
Prickle cell and nuclei are more prominent
Abundant and occasional atypical mitosis
Cells not recognised as epithelial in origin

23
Q

What is depth of invasion related to?

A

Nodal metastasis

24
Q

For T1 and t2, what is the invasion threshold for predicting cervical node metastasis?

A

4mm

25
Q

Invasion is subdivided into?

A

Depth and pattern

26
Q

What are the types of invasion?

A

Broad sheets: more than 15 cells across

Narrow strands: non cohesive small groups or single cells

27
Q

Which type of invasion, perivaacualr or perineural invasion indicates a more aggressive disease type?

A

Perineural

Perivaacualr is a weak indicator of nodal metasteses

28
Q

What does perineural invasion indicate?

A

Local recurrent rate
Nodal metastasis
Survival
May indicate Need for adjunctive therapy

29
Q

What does extra capsular spread indicate?

A

Poor prognosis

Manifestation of biological aggression

30
Q

What is more effective in the treatment for leukoplakia? Surgery or medical?

A

No evidence which one

31
Q

Which medical treatment are available for leukoplakia?

A

VitaminA
Retinoids
Beta carotene
Lycopene

32
Q

When would you carry out surgical treatment for leukoplakia?

A

Severely dysplasic

33
Q

What are the advantages and disadvantages of carrying out excision of leukoplakia?

A

Advantages: Entire lesion can be examined histopathology
Disadvantages: asscocited with morbity and leukoplakia has a low transformation rate

34
Q

What is the effect of stoping smoking or alcohol in precancerous lesions?

A

No good evidence that proves this is helpful

35
Q

What is erthroplkia?

A

Red patch which cannot be identified clinical or histology as any other disease

36
Q

T/F eryhtroplkia is associated with a high rate of maligant transformation?

A

T

37
Q

What are the aetiological factors associated with eryhtroplasia?
How does it appear ?

A

Tobacco and alcohol

Flat red plaque

38
Q

What are the aetiological factors associated with leukoplakia?
How does it appear ?

A

Tobacco
Alcohol
HPV

39
Q

What are the aetiological factors associated with proliferative verrucous leukoplakia ?
How does it appear ?

A

Tobacco
Alcohol

White or speckled modular plaque

40
Q

What is the aetiology behind sublingual keratosis and how does it appear?

A

Tobacco and alcohol

White plaque

41
Q

What are the aetiological factors associated with actinic chelitis?
How does it appear ?

A

Sunlight

White plaque and erosions

42
Q

What are the aetiological factors associated with licen planus?
How does it appear ?

A

Idiopathic

Reticular, plaque, erosive, Atrophic, bullous

43
Q

What are the aetiological factors associated with submicous fibrosis?
How does it appear ?

A

Areca

Immobile mucosa

44
Q

What are the aetiological factors associated with DLE?

How does it appear ?

A

Idiopathic

White plaque erosions

45
Q

What are the aetiological factors associated with chronic candida ?
How does it appear ?

A

C albicans

White or speckled plaque

46
Q

What are the aetiological factors associated with syphylitic leukoplakia?
How does it appear ?

A

Syphylis

White plaque

47
Q

How should you manage actinic chelitis?

A

If severe dysplasia then need to excise

Oral Med (31 decks)

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