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Week 77 > Premalignancy & Oral Cancer > Flashcards

Premalignancy & Oral Cancer Flashcards

1
Q

Hyperplasia

A

increased number of cells

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2
Q

Hyperkeratosis

A

Thickening of stratum corneum

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3
Q

Orthokeratosis

A

Hyperkeratosis without parakeratosis (No nuclei)

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4
Q

Parakeratosis

A

Flattened keratinocyte nuclei within stratum corneum

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5
Q

Hypogranulosis

A
  • Decreased thickness of granular layer
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6
Q

Acanthosis

A

Thickened squamous cell layer

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7
Q

Epidermal atrophy

A

Decreased thickness of epidermis

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8
Q

Dyskeratosis

A
  • Abnormally or prematurely keratinized keratinocytes
    • identified by prominent eosinophilic (red stain) cytoplasm
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9
Q

Apoptosis

A

Programmed cell death

Produces colloid bodies

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10
Q

Pleomorphism

A

variability in size, shape and staining of cells and/or their nuclei

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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
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12
Q

Frictional Hyperkeratosis

A
  • aka Hyperkeratosis without dysplasia
    • frictional keratosis (clinical Term)
  • associated w/Trauma
    • chronic rubbing or friction against oral mucosa
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13
Q

Frictional Keratosis: Location

A
  • Lips
  • lateral tongue
  • Buccal Mucosa
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14
Q

Frictional Hyperkeratosis: Histology

A
  • Macrophages and epithelial cells→ IL-8→keratinocyte-derived chemokine (KC)=mediates proliferation
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15
Q

Frictional Hyperkeratosis Treatment

A
  • remove irritant
  • patient returns in 2-3 weeks (Cell turnover time)
  • Biopsy
    • if lesion has not regressed
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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
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17
Q

Precursor Squamous Lesions

A
  • increased likelihood→SCC
  • Adults (50 y.o.)
  • strong association w/smoking and alcohol abuse
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18
Q

Precursor Squamous Lesions: Risk Factors

A
  • Tobacco & alcohol
    • strong association w/SCC
  • Sunlight
  • Malnutrition
  • Immunocompromising diseases
  • HPV
  • Unknown (15%)
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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
      • Erythroplakia
        • 90% carcinoma insitu or superficially invasive SCC
  • 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
Q

Moderate dysplasia

A
  • atypical cells in lower ⅓ of epithelium
    • but spares the keratin layer
26
Q

Moderate Dysplasia: Management

A
  • complete excision
  • f/u closely for recurrence (re-biopsy)
  • Recommend removal of any residual or recurrent lesion
27
Q

Severe Dysplasia

A
  • Atypical cells in lower ⅔ of epithelium
    • keratin layer remains intact
  • increased lymphocyte in epithelium
28
Q

Severe Dysplasia: Management

A
  • Excise to clean margins (Completely)
29
Q

What is the treatment of choice for premalignant lesions(dysplasia)

A
  • 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
Q

Why is it important to diagnose dysplastic lesion?

A
  • Dysplasia is major cause of SCC (90% oral cancer are SCC)
  • Stage 1 survival rate-80%
31
Q

Oral Squamous Cell Carcinoma: Etiology

A
  • 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
Q

Squamous Cell Carcinoma: Clinical Features

A
  • 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
Q

List the most common locations for intraoral cancer in descending order (SCC)

A
  • Ventrolateral tongue
  • Floor of mouth
  • Soft palate
  • Gingiva
  • Hard Palate
  • Buccal/Labial mucosa
34
Q

Squamous Cell Carcinoma: Histology

A
  • keratin produced deep within the tumor
    • normal-produced on surface
  • look for disorganized proliferation of the epithelial cells
35
Q

Squamous Cell Carcinoma: Diagnosis

A
  • 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
Q

What is carcinoma in-situ

A
  • Histo:
    • Mitotic figures
    • dysplasia of entire epithelial thickness
      • does not invade into CT
37
Q

Metastasis

A
  • 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
Q

Metastasis: What are the best indicators of prognosis

A
  • Tumor size and extent of metastatic spread
    • T
      • size of the primary tumor in centermeters
    • N
      • involvement of lymph nodes
    • M
      • distant metastasis
39
Q

Radiographic appearance of a Malignant Tumor

A
  • ill defined radiolucent lesion
  • No expansion of bone (compare contralateral side)
    • Moth eaten bone
  • Tooth/structure will not be displaced but resorbed
40
Q

Proliferative Verrucous Leukoplakia

A
  • 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
Q

HPV Associated Squamous Cell Carcinoma

A
  • 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
Q

Verrucous Carcinoma

A
  • 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
Q

Spindle Cell Carcinoma

A
  • 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
Q

Basaloid SSC

A
  • 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
Q

Lip Vermilion Carcinoma

A
  • 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

Week 77 (11 decks)

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