Screening programmes for oral cancer Flashcards
why is there not a national screening programme for mouth cancer?
Sensitivity not enough as get lots of false positives
Specificity is enough don’t get many false negatives
what is primary prevention and how is it done?
prevents the disease from happening
Identify risk factors and education e.g. smoking cessation
what is secondary prevention and how is it done?
detect the disease whilst its localised/early
Done during the examination
what is tertiary prevention and how is it done?
to mitigate the morbidities from the established disease and to improve quality of life
Post cancer treatment maintaining oral health and risk factor education
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
Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant
size?
> 200mm
Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant
texture?
nonhomogeneous -> irregular, bumpy
Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant
colour?
red or speckled
Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant
site?
floor of the mouth or lateral tongue
Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant
sex?
female
Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant
age
> 50yrs
Signs that mean oral potentially malignant disorders and lesions are more likely to become malignant
habits?
risk factors e.g. smoking, alcohol
what is a leukoplakia?
white patch in the mouth with an unknown cause
what is an erythroplakia?
red patch with unknown cause - have a higher potential for being malignant
what does indurated margins mean?
margins are thick and rubbery to touch
sign of the cancer invading the underlying mucosal margin
what is an endophytic lesion?
inwards growing
what is an exophytic lesion?
outwards growing
what is the size classifications for lesions?
T classification
T1,T2,T3 and T4
what is T1 size classification?
<2cm
what is T2 size classification?
2-4cm
what is T3 size classification?
4-6cm
what is T4 size classification?
> 6cm or involves underlying bone
what does a higher T classification mean?
poorer prognosis
if the cancerous lesion is painful what does this mean?
perineural spread
worrying sign
what does oral cancer tend to spread to?
lymphatics
what will happen to the patient once u have referred them to maxfax? 4
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
what should u do if u r concerned about a lesion? 6
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
