SCCA Flashcards
Oral cancer - new cases in 2015? Deaths?
45K new cases
8K deaths
5 year survival rate for oral cancer?
62%
Most oral cancer is what kind?
SCCA 89%
Clinical presentation of oral SCCA
Leukoplakia
Erythroplakia
Non-healing ulceration
Exophytic mass
Leukoplakia clinical features
Well-demarcated
Verrucous
Nodular
Speckled (erythro-leukoplakia)
Gender predilection for leukoplakia
Way more for males
Proliferative Verrucous Leukoplakia (PVL) related to Leukoplakia how?
Multifocal recurrent leukoplakia
Proliferative Verrucous Leukoplakia transforms how much into SCCA?
70% transform into Verrucous CA or SCCA
Proliferative Verrucous Leukoplakia associated with what habit?
tobacco
Erythroplakia vs leukoplakia
Less common
More worrisome
Erythroplakia diagnoses %
Dysplasia
Ca-In-Situ
SCCA
9% Dysplasia
40% Ca-In-Situ
51% SCCA
(way worse than Leukoplakia)
Management of Leukoplakia and Erythroplakia
Biopsy all unexplained red/white lesions persisting>2 weeks, prioritize heterogeneous areas
Oral epithelial dysplasia microscopic features
Basilar hyperplasia
Tear-drop shaped rete ridges
Loss of normal stratification Dyskeratosis
Nuclear enlargement & hyperchromaticity
Cellular pleomorphism
Increased mitotic activity
Levels of oral epithelial dysplasia
Mild - lower 1/3
Moderate - lower 2/3
Severe - >2/3
Ca-in-situ - full-thickness
Risk factors for oral cancer
Tobacco Alcohol Areca nut Actinic damage (from sun, NOT trauma) HPV infection immune suppression Family or H/O cancer Sanguinaria
More tobacco has what effect on risk of scca?
more tobacco = more risk
Smokers consist of what % of leukoplakias
80%
Risk of SCCA is how much greater for smokers
6x
How does risk change when smoking stops?
declines with time
Heavy drinkers (4 per day) risk of SCCA how much greater?
2-14x greater
Effects of alcohol and tobacco on SCCA risk are…? What is combined risk?
synergistic, 30x combined risk
Epithelial dysplasia of lip is?
Actinic Cheilitis
Actinic cheilitis occurence?
90% lower lip
Actinic cheilitis resembles what cancer most?
skin cancer
Low risk HPV types?
HPV 6 & 11
Low risk HPV causes?
squamous papillomas
High risk HPV types?
16 & 18
High-risk HPV causes?
HPV-associated epithelial dysplasia
Plummer-Vinson Syndrome common in…
Scandinavian females
Plummer-Vinson Syndrome causes
oral/eso SCCA, iron deficiency anemia
Oral submucous fibrosis characterized by what?
scarring of mucosa, precancerous condition (19x risk)
oral submucous fibrosis associated with eating what
betel quid, asian thing
Oral SCCA gender predilection?
male to female 2.5:1
Oral SCCA average age at diagnosis?
62
What is field cancerization?
patience with with one oral cancer are at increased risk for additional ones (35% within 5 years)
Intraoral high-risk locations for oral SCCA?
Ventro-lateral tongue
Floor of mouth
Soft palate
Most oropharyngeal carcinomas attributed to what infection?
HPV - improved prognosis
Oral SCCA metastasizes to what lymph nodes
Ispilateral cervical lymph nodes - 21% SCCA, 50% oropharyngeal
Lip cancer to submental nodes
Nodes with metastatic carcinoma usually what apperance?
hard, nontender, enlarged
Distant metastatic sites of oral SCCA?
lungs, liver, bones
Verrucous Carcinoma is a variant of what?
low-grade variant of oral SCCA,
Verrucous carcinoma who gets?
avg age 65-70, male predilection
Verrucous Carcinoma locations?
everywhere but soft palate, floor of mouth
Verrucous Carcinoma associated with consumption of what
smokeless tobacco
Verrucous Carcinoma histopath features?
deceptively bland microscopic apperance
Verrucous Carcinoma treatment, prognosis?
excision, 90% cure rate at 5 years
