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DG2013 - Oral Medicine Day 1 > Potentially Malignant Lesions and Oral Cancer > Flashcards

Potentially Malignant Lesions and Oral Cancer Flashcards

1
Q

Which is the most serious potentially malignant lesion?

A

Erythroplakia

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2
Q

Leukoplakia:

What are the 3 indications of greatest malignant potential for leukoplakias?

A
  1. Speckled, nodular or verrucous lesions
  2. LOCATION = at-risk sites i.e. lateral or ventral tongue and FOM
  3. Associated with Candida
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3
Q

Which has a higher rate of malignant change, specked or non-speckled leukoplakia?

A

Speckled leukoplakia

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4
Q

Chronic hyperplastic candidosis - Candidal leukoplakia

What social factor is mostly related to this?

A

Smoking

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5
Q

What is dysplasia?

A

Dysplasia = abnormal development (of organs or cells) or an abnormal structure resulting from such growth

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6
Q

In actinic cheilitis (farmer’s/sailor’s lip), which cancer develops in around 6-10% of cases?

A

Squamous cell carcinoma

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7
Q

Submucous fibrosis:

How is this caused?
How does this present?
What do patients complain of?

A

Caused by areca nut chewing, spices, autoimmunity
Presents as tight vertical bands in buccal mucosa
Patients complain of difficulty eating and sleeping - restricts oral opening and stiffens tongue

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8
Q

Which type of oral lichen planus has potential to undergo malignant change?

A

Erosive form of lichen planus

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9
Q

What is discoid lupus erythematosus (DLE)?

A

DLE = chronic photosensitive skin eruption

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10
Q

List 5 risk factors for potentially malignant lesions:

A
  1. Older than 45 years
  2. Combined alcohol and tobacco use
  3. Sun exposure
  4. Immunosuppression
  5. Human papilloma virus (HPV-16)
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11
Q

What is a neoplasia?

A

Neoplasia = cell proliferation and differentiation disorders

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12
Q

Describe the relationship benign and malignant neoplasms can have with the surrounding tissues:

A

BENIGN NEOPLASM = the cells of the neoplasm grow as a compact mass as they expand

MALIGNANT NEOPLASM = the cells invade the surrounding tissues and may even speak to distant sites

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13
Q

List the 4 main characteristics of benign neoplasms:

A
  1. Local invasion
  2. No metastasis
  3. Expanding growth pattern
  4. Usually contained within a capsule
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14
Q

List the 4 main characteristics of malignant neoplasms:

A
  1. Invade surrounding tissues
  2. Invade blood and lymph vessels leading to metastasis
  3. Grow in an irregular pattern
  4. No capsule
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15
Q

List 3 factors which can cause cells to grow out of control?

A
  1. Genetic
  2. Ultraviolet - sun
  3. Infections i.e. candida albicans, HOV
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16
Q

List 3 ways tumour cells evade immune defences:

A
  1. CHEMICAL MESSENGERS - Cancers produce chemical messengers that inhibit immune cell action
  2. ANTIGENT PRESENTATION - Cancers have defects in the way they present antigens on their cell surface
  3. LOCATION - some cancers grow in areas which are not regularly patrolled by immune cells i.e. eyes or brain
17
Q

What % of all malignancies does oral cancer represent?

What are the most common malignant neoplasms of the mouth?

A

Oral cancers accounts for 3% of all malignancies

Most common = squamous cell carcinoma (over 90%)

18
Q

What is the most common site of oral cancer?

Why is the thought to be the most common place?

A

The lower lip

Carcinogens pool in the lower mouth before swallowing

19
Q

Stages of oral cancer:

Stage 0 or carcinoma in situ (CIS) - describe this stage

A

Stage 0 - there are cancer cells but are all contained within lining of mouth or oropharynx.
If this pre-cancer is left untreated, highly likely it will develop into invasive cancer

20
Q

Describe the following:

Stage 1 of oral cancer

Stage 2 of oral cancer

Stage 3 of oral cancer

A

Stage 1 = Earliest stage of invasive cancer - cancer has started to grow through tissue lining of mouth or oropharynx into deeper tissues
- no more than 2cm across and has NOT spread to nearby tissues

Stage 2 = Cancer is more than 2cm across but less than 4cm
-has NOT spread to nearby tissues

Stage 3 = Cancer is bigger than 4cm across but has NOT spread to any lymph nodes or other parts of the body
OR
The cancer is any size but has spread to ONE LYMPH NODE (no more than 3cm across LN) on the same side of the neck

21
Q

Stage 4 oral cancer has 3 substages - describe them.

A

Stage 4a = Cancer has grown through the tissues around the lips and mouth
-lymph nodes may or may not contain cancer cells

Stage 4b = Cancer is any size and has spread to more than one lymph node on same side
-Cancer has spread to lymph nodes on both sides of the neck
-Any lymph node is bigger than 6cm

Stage 4c = Cancer has spread to other parts of the body e.g. lungs or bones

22
Q

In order to try and achieve the best prognosis for oral cancer, what is the most crucial part?

A

EARLY DIAGNOSIS

23
Q

SCC of the lower lip: describe the presentation of this

A

Vermillion boarder to one side of the midline
Area of thickening
Induration
Ulceration
Crusting

24
Q

Verrucous carcinoma - how does this present?

A

White, warty appearance that forms a well-circumscribed mass

25
Q

Melanoma - what is it?

A

Malignant neoplasms of melanocytic origin that form from a benign melanocytic lesion or from melanocytes in skin or mucosa

26
Q

What are the 4 worst areas of melanoma prognosis? (BANS)

A

B - Back
A - Arms
N - Neck
S - Scalp

27
Q

When is melanoma almost ALWAYS fatal?

A

When the disease spreads (disseminated)

28
Q

Basal cell carcinoma:

What causes this?
How does it present?
What is it the most common form of?
How is it treated?

A

Caused by excessive sun exposure and some hereditary disorders

Presents as raised, pale/pearly in colour with central depression

Most common form of non-melanoma skin cancer

Treated by surgical removal

29
Q

What is the best way to screen for oral cancer?

A

The Gold Standard Examination

30
Q

List 4 screening methods of oral caner:

A
  1. Clinical judgement - Gold Standard Examination
  2. Toluidine blue
  3. Photodynamic Diagnosis
  4. HPV16 screening
31
Q

How does a HPV16 screen indicate oral cancer?

A

HPV16 E6 antibodies in the blood indicate a very high risk of developing a HPV-associated cancer of the oropharynx

32
Q

How does Toluidine Blue work to detect cancer?

A

The dye selectively binds to dysplastic or malignant cells in the oral epithelium

33
Q

How does Photodynamic diagnosis work to detect cancer?

A

Malignancies show up as fluorescent areas and can detect cancer in its earliest stages long before it becomes a tumour

34
Q

How does VELscope work to detect cancer?

A

Suspicious lesions cause a lack of fluorescence and appear dark in colour

35
Q

What is a brush biopsy?

A

The removal of cells using a brush designed to collect cells from all layers of a lesion - sent off to a lab to be examined

36
Q

When should a patient be sent on an urgent referral?
List 3 factors:

A

Unexplained red or white patches that are:
1. Painful
2. Swollen
3. Bleeding

37
Q

Where do 95% of oral cancers arise?

What is a late feature of oral cancer?

What are the main sites of oral cancer?

A

95% of oral cancers arise in normal mucosa

Pain is a late feature of oral cancer

Lips, tongue, FOM and soft palate are the main sites of oral cancer

DG2013 - Oral Medicine Day 1 (6 decks)

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