Week 2: Oral Cavity SCCa Flashcards
36F w/painful lesions on her tongue, iron deficiency anemia, and dysphagia. Her esophagram is shown. She is at increased risk of SCCa as which site?
Patients w/Plummer-Vinson Syndrome are at increased risk for SCCa of the Post-Cricoid region (+ esophagus).
57M referred for a bx of a tongue lesion. The pathologist note indicates it stained s/apple green birefringence using Congo red staining. Further questioning of the patient reveals that he has a labile BP. He also notes frequent kidney stones. PE is concerning for a central neck mass. Based on the above presentation and path, what is the most likely dx of the neck mass?
Medullary thyroid carcinoma.
(bx shows amyloid deposits on tongue. Can be seen when calcitonin produced by Parafollicular C cells gets deposited in the tissue.)
What dietary factors can reduce the risk of developing head & neck cancer?
Increased consumption of fruits and vegetables.
Which of the following is considered a RF for the development of OC cancer?
A. HPV
B. EBV
C. Chewing betel quid (Paan)
D. CMV
E. Previous dental surgery
C. Chewing betel quid (Paan)
(this is commonly chewed in SE Asian countries)
SCCa arising in the _____lip have a worse prognosis than those originating in the _____, due to more rapid growth, ulcerating sooner, and metastasizing earlier.
SCCa arising in the upper lip (and oral commissure) have a worse prognosis than those originating in the lower lip, due to more rapid growth, ulcerating sooner, and metastasizing earlier.
Basal cell carcinomas are more commonly found in the ___ lip, however, ___ is the most common type of tumor of the ___ lip.
Basal cell carcinomas are more commonly found in the upper lip, however, SCCA is the most common type of tumor of the upper lip.
A “well-delineated oval radiolucency surrounding an unerupted third molar” is a description most likely associated with a ___.
Dentigerous cyst.
(2nd most common dental cyst, Radicular cysts are the most common)
Dentigerous cysts possess a slight risk of transformation into a ___.
Ameloblastoma.
Patient presents with hard palate lesion shown. The bx reveals salivary gland necrosis and squamous metaplasia of the adjacent ducts and acini. The lesion has been present for several weeks and is not painful.
What is the diagnosis?
Necrotizing sialometaplasia (a benign condition of the salivary glands - thought to be related to ischemic injury and linked to sickle cell, bulimia, carotid embolization and Raynaud’s).
Patient presents with hard palate lesion shown. The bx reveals salivary gland necrosis and squamous metaplasia of the adjacent ducts and acini. The lesion has been present for several weeks and is not painful.
What is the best next step?
Recheck in 2 weeks.
(Necrotizing sialometaplasia is a benign self-limited condition, and typically does not require treatment once diagnosis is confirmed)
T stage is based on:
- ___
- ___
- ___
T stage is based on:
- Size
- Depth of invasion
- Invasion of adjacent structures
T-staging by Size:
T1: ___
T2: ___
T3: ___
T4: ___
T-staging by Size:
T1: <2cm
T2: 2-4cm
T3: 2-4cm (w/DOI >10mm) or >4cm (w/DOI </=10mm)
T4: >4cm (& invading local structures)
T-staging by DOI for OC cancer:
T1: ___
T2: ___
T3: ___
T4: ___
T-staging by DOI:
T1: <5mm
T2: 5-10mm
T3: dependent on tumor Size. (tumor 2 - 4 cm w/DOI >10 mm or tumor >4 cm, w/DOI ≤10 mm)
T4: >10mm (& invading local structures)
T-staging of OP cancer by invasion of adjacent structures:
T4a: ___
T4b: ___
T-staging by invasion of adjacent structures:
T4a: tumor invades mandible (could not move freely from mandible) OR tongue (limited mobility of tongue)
T4b: tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid
Nodal staging by size:
N1:
N2a:
N2b:
N2c:
N3:
Nodal staging by size:
N1: <3cm
N2a: 3-6cm (w/single ipsilateral)
N2b: >6cm (w/multiple ipsilateral)
N2c: <6cm (w/bilateral involvement, regardless of size)
N3: >6cm (w/bilateral involvement)
When is it appropriate to perform a Marginal Mandibulectomy for oral cavity SCCa?
A marginal mandibulectomy is performed if the periosteum is involved but no gross involvement of bone.
When is it appropriate to perform a Segmental Mandibulectomy for oral cavity SCCA?
Gross involvement of the mandible (T4a and greater).
The order in which osteotomies are created during a subtotal/total maxillectomy is important as there can be 1)____ following osteotomies at the 2)____ due to multiple branches of the 3)____ a.
1) heavy bleeding
2) pterygomaxillary fissure
3) internal maxillary a. + pterygoid plexus of veins
