Premalignancy & Oral Cancer Flashcards
1
Q
Hyperplasia
A
increased number of cells
2
Q
Hyperkeratosis
A
Thickening of stratum corneum
3
Q
Orthokeratosis
A
Hyperkeratosis without parakeratosis (No nuclei)
4
Q
Parakeratosis
A
Flattened keratinocyte nuclei within stratum corneum
5
Q
Hypogranulosis
A
- Decreased thickness of granular layer
6
Q
Acanthosis
A
Thickened squamous cell layer
7
Q
Epidermal atrophy
A
Decreased thickness of epidermis
8
Q
Dyskeratosis
A
- Abnormally or prematurely keratinized keratinocytes
- identified by prominent eosinophilic (red stain) cytoplasm
9
Q
Apoptosis
A
Programmed cell death
Produces colloid bodies
10
Q
Pleomorphism
A
variability in size, shape and staining of cells and/or their nuclei
11
Q
Leukoplakia
A
- White lesion
- can’t rub off
- no etiology
- no source or diagnosis
- Clinical term ONLY
- no diagnostic meaning
- malignant transformation: 0.7-2%
- most common “risk” lesion
12
Q
Frictional Hyperkeratosis
A
- aka Hyperkeratosis without dysplasia
- frictional keratosis (clinical Term)
- associated w/Trauma
- chronic rubbing or friction against oral mucosa
13
Q
Frictional Keratosis: Location
A
- Lips
- lateral tongue
- Buccal Mucosa
14
Q
Frictional Hyperkeratosis: Histology
A
- Macrophages and epithelial cells→ IL-8→keratinocyte-derived chemokine (KC)=mediates proliferation
15
Q
Frictional Hyperkeratosis Treatment
A
- remove irritant
- patient returns in 2-3 weeks (Cell turnover time)
- Biopsy
- if lesion has not regressed
16
Q
Dysplasia
A
- Lack of proper maturation
- indicator of premalignancy if in epithelium
- increased risk to become SCC
- Keratinocytes cannot form regular layers and produce normal keratin
17
Q
Precursor Squamous Lesions
A
- increased likelihood→SCC
- Adults (50 y.o.)
- strong association w/smoking and alcohol abuse
18
Q
Precursor Squamous Lesions: Risk Factors
A
- Tobacco & alcohol
- strong association w/SCC
- Sunlight
- Malnutrition
- Immunocompromising diseases
- HPV
- Unknown (15%)
19
Q
Precursor Squamous Lesions: Clinical Manifestations
A
- Various presentation
- Discrete to diffuse
- Lekoplkia to erythroplakia
- Leukoplakic
- less likely to be premalignant
- color due to thickness of dysplasia
- thinner=red
- thicker=white
- color due to thickness of dysplasia
- less likely to be premalignant
- Erythroplakia
- 90% carcinoma insitu or superficially invasive SCC
- Leukoplakic
-
Be highly suspicious of lesions in floor of mouth and ventral tongue
- Biopsy w/resection and clean margins
20
Q
Dysplastic Lesions
A
- increased risk to become SCC
21
Q
Dysplasia: Architectural changes include:
A
- Increased:
- Cells and mitotic cells in basal layer
- Keratin pearl formation
- Decreased Polarity
-
Parakeratosis
- Cellular pleomorphism
22
Q
Dysplasia: Cytology features
A
- increased:
- nuclear size
- nucleus:cytoplasm ratio
- Nuclear pleomorphism
- Nuclear hyperchromasia
- Dyskeratosis
23
Q
Mild Dysplasia
A
- Increase crowding of mitotic cells in basal layer
- Dysplasia-lower ⅓ of epithelium
24
Q
Mild Dysplasia: Management
A
Depends on location
- High risk area or patient: Complete excision
- low risk area or patient: watch and observe for 3 months
- if lesion does not regress→ excise
25
Moderate dysplasia
* atypical cells in lower ⅓ of epithelium
* but spares the keratin layer
26
Moderate Dysplasia: Management
* complete excision
* f/u closely for recurrence (re-biopsy)
* Recommend removal of any residual or recurrent lesion
27
Severe Dysplasia
* Atypical cells in lower **⅔** of epithelium
* keratin layer remains intact
* increased lymphocyte in epithelium
28
Severe Dysplasia: Management
* Excise to clean margins (Completely)
29
What is the treatment of choice for premalignant lesions(dysplasia)
* complete surgical removal to clean margins
* Long Term f/u:
* smokers
* heavy alcohol consumption
* Suspicion of Proliferative Verrucous Leukoplakia
* Histologic moderate and high grade
* Immunosuppressed lesions
30
Why is it important to diagnose dysplastic lesion?
* Dysplasia is major cause of SCC (90% oral cancer are SCC)
* Stage 1 survival rate-80%
31
Oral Squamous Cell Carcinoma: Etiology
* Tobacco smoking
* smokeless tobacco
* Betel Quid
* Alcohol
* Phenolic Agents
* Radiation
* Iron Deficiency
* Vitamin A deficiency
* Candidal Infection
* Oncogenic viruses
* Immunosuppression
* Oncogenes and tumor suppressor genes
32
Squamous Cell Carcinoma: Clinical Features
* minimal pain during early growth phase
* Arises from epithelial
* Features:
* rolled border
* ulcerative
* M\>F (65 yrs)
* Exophytic
* mass forming, fungating
* color normal to red to white
* feels hard on palpation
* Endophytic
* invasive, burrowing, ulcerated
* Leukoplakia, Erythroplakia, Erythroleukoplakic
33
List the most common locations for intraoral cancer in descending order (SCC)
* Ventrolateral tongue
* Floor of mouth
* Soft palate
* Gingiva
* Hard Palate
* Buccal/Labial mucosa
34
Squamous Cell Carcinoma: Histology
* keratin produced deep within the tumor
* normal-produced on surface
* look for disorganized proliferation of the epithelial cells
35
Squamous Cell Carcinoma: Diagnosis
* Based on architectural features and cellular changes
* **Hyperchromatism**
* **Altered nuclear/cytoplasmic ratio**
* **atypical mitosis**
* **prominent nucleoli**
* invades into:
* adjacent tissue
* submucosa
* indurated feeling on palpation
* Watch out for long standing ulcer
* rolled borders
* red and white patches
36
What is carcinoma in-situ
* Histo:
* Mitotic figures
* dysplasia of entire epithelial thickness
* does not invade into CT
37
Metastasis
* usually through lympathics
* involved lymph node:
* stony hard, nontender, enlarged
* Fixed (can't move)
* malignant cells perforate node=extracapsular spread
* **Most common sites:**
* **lungs, liver, bone**
* **carcinoma of lower lip and oral floor**
* **submental nodes**
* **Posterior portion of the mouth**
* **superior jugular and digastric node**
* **Oropharynx**
* **jugulodigastric to retropharyngeal node**
38
Metastasis: What are the best indicators of prognosis
* Tumor size and extent of metastatic spread
* T
* size of the primary tumor in centermeters
* N
* involvement of lymph nodes
* M
* distant metastasis
39
Radiographic appearance of a Malignant Tumor
* ill defined radiolucent lesion
* No expansion of bone (compare contralateral side)
* Moth eaten bone
* Tooth/structure will not be displaced but resorbed
40
Proliferative Verrucous Leukoplakia
* unknown etiology
* multifocal development of premalignant lesion
* multiple presentations/leukoplakia in multiple quadrants
* **not connected to each other**
* biopsy different sites in different quadrants
* relentless progression to malignancy
* Long term f/u
41
HPV Associated Squamous Cell Carcinoma
* HPV
* most common cause of sexually transmitted cancer→oropharyngeal SSC
* HPV 16/18
* HPV related SCC
* Rare in oral cavity
* Common in oropharynx, base of tongue, and tnosil
* High risk HPV:
* 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58
* HPV proteins E6 and E7 (oncoprotein)
* E7:
* inhibits pRB
* E6:
* blocks apoptosis
* degrades p53
* p16 over expression
* Histo:
* Basaloid Appearance (bluish)
* Blended cells
42
Verrucous Carcinoma
* aka Dipper's Cancer
* Ackerman's Tumor
* low grade variant of SCC
* associated with
* **smokeless tobacco**
* **betel quid**
* Males
* not invasive but spread laterally
* white/yellow appearance
* Location-where they place the tobacco
43
Spindle Cell Carcinoma
* aka Polypoid SSC
* rare variant
* very aggressive
* fast growing
* High recurrence rate
* Biphasic lesion
* collision tumor b/w carcinoma and sarcoma
* Spindle cells
* anaplastic type of carcinoma cells
* Appearance:
* polyploid mass w/yellow color
44
Basaloid SSC
* Abuser of alcohol and smoked tobacco
* found in upper aerodigest tract mucosa
* other locations:
* larynx, pyriform sinus, tongue base
* Histology: Basaloid appearance within the tumor
* very aggressive
* survival time: 23 months
45
Lip Vermilion Carcinoma
* Classified as subcutaneous malignant neoplasm:
* Not oral cancer anymore
* common in light skin ppl w/long UV exposure
* outdoor occupation
* may arise from site where patient holds cigarette, cigar, or pipe stem
* **Precursor: Actinic Chelitis**
* **Metastasis=rare→submental region**
