oral cancer

Question 1

What gives urgent suspicion of oral cancer?

Answer 1

1. Persistent unexplained head and neck lumps for >3 weeks
2. Unexplained ulceration or unexplained swelling/induration of the oral mucosa for >3 weeks
3. All unexplained red or mixed red and white patches of the oral mucosa for >3 weeks
4. Persisting (not intermittent) hoarseness lasting for >3 weeks
5. Persistent pain in the throat or pain on swallowing lasting for >3 weeks

Question 2

Name 4 signs and symptoms of oral cancer

Answer 2

Any from:
- pain on eating
- difficulty swallowing
- unilateral earache
- trismus
- dysarthria
- sensory loss
- unexplained tooth mobility
- submucosal mass lesion
- verrucous lesion
- hemi-tongue atrophy/fasciculation
- fracture of mandible
- nasal obstruction/blood stained rhinorrhoea
- coughing blood

Question 3

How is oral cancer staged?

Answer 3

TNM
T - size and extent of tumour
N - regional lymph nodes
M - distant metastasis

Question 4

Describe curative treatment of oral cancer

Answer 4

Most likely if cancer is found early and limited to a local region
Usually surgery
Sometimes surgery and adjuvant radiotherapy

Question 5

Describe palliative treatment of oral cancer

Answer 5

Control the symptoms - sometimes radiotherapy, rarely surgery
Prolong survival with immunotherapy

Question 6

Describe surgery for primary oral cancer

Answer 6

If resected the patient is very likely to do well
Wide local excision - 1cm of normal tissue all the way round the cancerous lesion

Question 7

Describe cN0 neck

Answer 7

Clinically no lymph node pathology
Patient can still have microscopic metastasis

Question 8

Describe cN1 neck

Answer 8

Malignant spread to one or more lymph nodes

Question 9

What are sentinel lymph nodes?

Answer 9

Those with a direct lymphatic afferent from the primary tumour

Question 10

What causes toxicity post-op in oral cancer?

Answer 10

Due to lack of saliva, rate of caries and periodontal disease spreads

Question 11

Name 4 signs of late toxicity

Answer 11

Any from:
- fibrosis/vascular depletion
- ORN
- dysphagia
- flexion deformity
- trismus
- hypothyroidism

Question 12

What is the prognosis of head and neck cancer?

Answer 12

Around half the patient with head and neck cancers are cured

Question 13

Describe the link between oral cancer and socioeconomic status

Answer 13

More than 40% of patients are in deprivation category 1