Screening programmes for oral cancer

Question 1

why is there not a national screening programme for mouth cancer?

Answer 1

Sensitivity not enough as get lots of false positives
Specificity is enough don’t get many false negatives

Question 2

what is primary prevention and how is it done?

Answer 2

prevents the disease from happening

Identify risk factors and education e.g. smoking cessation

Question 3

what is secondary prevention and how is it done?

Answer 3

detect the disease whilst its localised/early

Done during the examination

Question 4

what is tertiary prevention and how is it done?

Answer 4

to mitigate the morbidities from the established disease and to improve quality of life

Post cancer treatment maintaining oral health and risk factor education

Question 5

Only been one study that evaluated the clinical or cost efficacy of mouth cancer screening

Done over 15yrs in India, 4 rounds of screening on 19,288 people

Reduction in morbidity of high risk individuals who used tobacco and/or alcohol and saved lives

Cost $6 per person for programme

Question 6

Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant

size?

Answer 6

> 200mm

Question 7

Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant

texture?

Answer 7

nonhomogeneous -> irregular, bumpy

Question 8

Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant

colour?

Answer 8

red or speckled

Question 9

Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant

site?

Answer 9

floor of the mouth or lateral tongue

Question 10

Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant

sex?

Answer 10

female

Question 11

Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant

age

Answer 11

> 50yrs

Question 12

Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant

habits?

Answer 12

risk factors e.g. smoking, alcohol

Question 13

what is a leukoplakia?

Answer 13

white patch in the mouth with an unknown cause

Question 14

what is an erythroplakia?

Answer 14

red patch with unknown cause - have a higher potential for being malignant

Question 15

what does indurated margins mean?

Answer 15

margins are thick and rubbery to touch
sign of the cancer invading the underlying mucosal margin

Question 16

what is an endophytic lesion?

Answer 16

inwards growing

Question 17

what is an exophytic lesion?

Answer 17

outwards growing

Question 18

what is the size classifications for lesions?

Answer 18

T classification
T1,T2,T3 and T4

Question 19

what is T1 size classification?

Answer 19

<2cm

Question 20

what is T2 size classification?

Answer 20

2-4cm

Question 21

what is T3 size classification?

Answer 21

4-6cm

Question 22

what is T4 size classification?

Answer 22

> 6cm or involves underlying bone

Question 23

what does a higher T classification mean?

Answer 23

poorer prognosis

Question 24

if the cancerous lesion is painful what does this mean?

Answer 24

perineural spread
worrying sign

Question 25

what does oral cancer tend to spread to?

Answer 25

lymphatics

Question 26

what will happen to the patient once u have referred them to maxfax? 4

Answer 26

Biopsy under local anaesthetic

Imaging of the head, neck ad chest to check for spread and stage the lesion

Diagnosis

Treatment
- Primarily surgery in the first instance
- Tissue graft to replace lost tissue
- Chemotherapy and radiotherapy

Question 26

what should u do if u r concerned about a lesion? 6

Answer 26

Get a history from the patient e.g. how long its been there, progression

Document findings in notes including risk factors

Photograph to document clinical appearance at that point in time

If you think it could be due to trauma within the mouth e.g. rough fillings then fix those

Review in 1-2 weeks later to note if improvement

Refer to maxillofacial department using urgent pathway -> established cancer pathways