Dysplasia And Oral Cancer

Question 1

2 distinct disease patters of oral cancer?

Answer 1

OCC

OPC

Question 2

What gender is OCC and OPC more common in?

Answer 2

Males

Question 3

High risk sites of mouth cancer?

Answer 3

FOM

Retromolar regions

Lateral border of tongue

Soft and hard palate

Buccal mucosa

Gingivae

Question 4

Incidence of OCC and OPC?

Answer 4

OCC is 2.5 / 100,000

OPC is 1.4 / 1000,000

Question 5

What are the risk factors for oral cancer

Answer 5

Smoking

Drinking

PAAN chewing

SES

Family history

Oral health

Sexual activity
- number of partners

Question 6

Incidence of malignancy in white lesions?

Answer 6

.2 - 4%

Question 7

What are cytlogical changes that can be seen?

Answer 7

Variation in nucleus size

Variation in nucleus shape

Variation in cell size and shape

Atypical mitotic figures

Increased number of nuclei

Nuclei hypochromatism

Question 8

Wha are some architectural changes that can occur?

Answer 8

Irregular stratification

Drop shaped rete ridges

Premature / abnormal keratinisation

Loss of epithelial cell cohesion or adhesion

Increased number of mitoses

Question 9

What are the typical low grade dysplasia histological changes

Answer 9

Architectural
- tumour originates from squamous epithelium
- considerable keratin production
- stratification
- well formed basal layer surrounding tumour islands
- tumour islands are well defined and continuous with surface epithelium

Ctyological
- atypia or dysplasia may not be prominent

Where it is into middle 1/3, cellular atypia will decide if low or high grade

Question 10

Typical high grade dysplasia histologically?

Answer 10

Little resemblance to squamous epithelium

Architectural
- upper third changes
- little resemblance to epithelium

Cytology
- considerable atypia
- prominent mitotic figures
- non cohesive front of invasion

Question 11

Prognostic factors in histological samples?

Answer 11

Pattern of invasion
- bulbous rete pegs better prognosis than wider small islands

Depth of invasion
- tumours greater than 4mm 4x more likely to metastasise

Perineural invasion
- significant when tumour seen within large nerve at some site distant to tumour mass

Invasion of vessels
- associated with node involvement and metastases

Question 12

What is field cancerisation concept?

Answer 12

High cancer risk in 5cm radius of original primary cancer

Question 13

How is oral cancer STAGED

Answer 13

T - size

N - metastases to lymph nodes

M - distant metastases

Question 14

What stage cancer do most patients present?

Answer 14

I/II - 1/3 of patients

Question 15

Cure rate of stage I and II of oral cancer?

Answer 15

I = 80%

II = 65%

Question 16

5 year survival % and cure % if someone presents later than stage II?

Answer 16

5 year survival = <50%

Cure = <30%

Question 17

Survival time of oral cancer if untreated with metastases?

Answer 17

4 months

Question 18

Presentation of lip cancer?

Answer 18

Lower lip more common
- non healing ulcer or swelling

Question 19

Aetiology of lip cancer?

Answer 19

Sunlight and UV

SMOKING

Question 20

Behaviour of lip cancer?

Answer 20

Slow growth

Local invasion

Rare node metastases

• hence good prognosis as early detection

Question 21

Give some ways oral cancer can be screened?

Answer 21

HPV16 screen

Toluidene blue stain

VELscope

Clinical judgement

Histopathological analysis and biopsy

Question 22

Role of GDP in oral cancer in primary care?

Answer 22

Primary prevention
- smoking cessation advice
- alcohol reduction advice
- healthy diet promotion

Question 23

T in TNM?

Answer 23

Tx - cannot be assessed

T0 - no evidence of primary tumour

Tis - carcinoma in situ

T1 - 2cm or less

T2 - 2 - 4cm

T3 - >4cm

T4a - moderately advanced local disease

T4b - advanced local disease

Question 24

N in TNM?

Answer 24

NX - cannot be assessed

N0 - no regional LN metastases

N1 - single ipsilateral LN 3cm or less

N2a - single LN 3-6cm

N2b - multiple ipsilateral LN <6cm

N2c - mutliple bilateral LN <6cm

N3 - any metastases >6cm

Question 25

M in TNM?

Answer 25

Metastases

Mx - distant ones cannot be assessed

M0 - no distant metastases