3. Malignant Epithelial Lesions Flashcards Preview

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Flashcards in 3. Malignant Epithelial Lesions Deck (91)
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What are the Risk Factors for OSSC?

  • 80% associated with tobacco, with or without alcohol
  • 20-25% show no identifiable RFs, increasing incidence in: 
    • Young Adults , especially females on Lateral Tongue
    • Older Women on Gingiva 


What is the Clinical Differential Diagnosis for Oral SCC? (6)

  • Non-Specific Ulcer:
    • Traumatic Granuloma
  • Specific Infections:
    • TB
    • Deep Fungal Infection
    • Syphilis
  • Immune-Mediated Conditions:
    • Wegener's Granulomatosis
    • Chron's Ds


What are the best indicators of prognosis, and what guides tx, in Oral SCC?


  • Tumor Size  
  • Extent of Metastatic Spread 

The TNM System, except for nodal involvement


What is the most important prognostic factor in Oropharyngeal CA?

HPV status, rather than stage


Why do HPV+ tumors respond better to chemo?

Lack p53 mutations and field cancerization

  • 60% reduction in risk of death
  • 30% greater 5 yr survival than HPV - tumors


What gives the best locoregional control and disease-free survival for advanced stages: 3, 4a, 4b-no distant mets OSCC?

Post-operative concurrent chemoradiation therapy 


What is the tx for OSCC with Distant Mets?

Single/multi-agent Chemotx

Not going to radiate it becuase it is throughout the entire body!


What drugs are using in OSCC Chemotherapy?

  • Cisplatin or Carboplatin
  • 5-fluorouracil
  • Taxanes (paclitaxel, docetaxel)


What OSCC Radiation, targets the tumor site and mimimizes damage to surrounding tissue?

Intesity-Modulated Radiation Therapy (IMRT)


What OSCC Radiation involves the placement of tiny radioactive seeds, used for small intraoral tumors or with IMRT to increase dosage?



What is the Clinical appearance of OSCC?

  • Irregular shape, mixture of red and white
  • Ulcerated center with elevated rolled border, that is much firmer (indurated) than surrounding tissues 
  • Early lesions are Aysmptomatic (don't hurt)
    • Pain is a late feature 


What occurs with bone involvement in OSCC?

  • "Moth-Eaten" Ragged RL
  • Osteomyelitis 
  • Pathologic Fracture 
  • Bone Loss 
    • Faster than perio bone loss


How does SCC of the Lip develop?

  • Sun induced, not tobacco induced
  • In the setting of Actinic Cheilitis; changes in months 


What is the clinical appearance of SCC of the Lip?

  • 90% Lower Lip
  • Crusted, non-tender, indurated ulceration
  • < 1cm when discovered 
  • Slow-growing, well-differentiated lesion = better prognosis 


What is the most common site of involvement for OSCC (>50%)?

Lateroventral Tongue

(mostly posterior)


In what population is SCC of the Tongue typically seen in?

  • Younger people (< 40 yrs old)
    • Almost always at this site
  • Majority have a history of tobacco and alcohol abuse 


What OSCC is most likely to develop from preexisting white/red lesion?

SCC of the FOM


What is SCC of the FOM often associated with?

2nd Primary Malignancy 

Ask the pt if they have a history of oral cancer


What is the incidence for SCC of the FOM?

  • Almost equals Lateral Tongue as a common site for OSCC (~35%)
  • Majority have a history of of tobacco and alcohol abuse


In what population is the prevelance of Oral Cancer the highest in?

Adult Disease

  • White Men > 65 yrs
  • Middle Aged Black Men


In what population is SCC of the Gingiva/Alveolar Mucosa most prevelant in?

  • Women (2:1)
  • Those w/o identifiable RFs


What is the clinical appearance of SCC of the Gingiva/Alveolar Mucosa?

  • Epithelium will have a speckled (red and white), pebbly, granular surface  


What can SCC of the Gingiva/Alveolar Mucosa mimic?

Benign Reactive Lesions of Gums

  • Pyogenic Granulomas
    • Can appear big and red,  ~ inflammation
  • Perio Ds
    • Smooth surfaced, and pink
    • Bone loss will occur faster than in PD
    • Biopsy if PD doesn't respond to tx after a month


Where do most SCC of the Palate arise?

Lateral Soft Palate - Oropharyngeal 

Hard to tell if it arised in the max sinus and invaded down


Where do most Oropharyngeal Carcinomas arise from?

70% from Tonsillar Region 


What are the Symptoms associated with Oropharyngeal Carcinoma (SCC of Palate)?

  • Persistant Sore Throat
  • Dysphagia (difficulty swallowing)
  • Odynophagia (pain on swallowing)
  • Dull/Sharp Pain Referred to Ear

Pt may think they have a toothache so ask about these symptoms


In what population does SCC of the Buccal Mucosa occur?

  • Very common in India due to betel quid use
  • Not very common site for OSCC in the western world


What can SCC of the Buccal Mucosa be confused for?

  • Aphtous Ulcer, but it will be: 
    • Firm 
    • Persistant > 2 weeks 


What is the Histology of OSCC? (3)

  • Invasive cords/nests of malignant squamous epithelial cells arising from, but not connected to, dysplastic surface epithelium 
  • Varying degrees of Keratin Production (keratin pearls) and Dyskeratosis 
  • Desmoplasia = tumor induced fibrosis 
    • Why the lesions feel firm 


What Histology do the Tumor Cells of OSCC show? (3)

  • Increased nuclear:cytoplasmic 
  • Cellular and nuclear pleomorphism
  • Mitotic activity