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BDS4 Oral Medicine > Dysplasia and Oral Cancer > Flashcards

Dysplasia and Oral Cancer Flashcards

1
Q

What is the international classification of Oral Cancer?

A
  • ICD-O
    International classification of disease for Oncology
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2
Q

What are the 2 distinct disease patterns of OC?

A
  • Oral cavity cancer (OCC)
  • Oro-pharyngeal cancer (OPC)
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3
Q

What is the epidemiology for Oral cancer?

A
  • Highest in Scotland for OCC and OPC compared to rest of UK
  • Makes higher than females for both in all of UK but that is decreasing 2:1
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4
Q

What are the high risk sites for Oral Cancer?

A
  • Floor of mouth
  • Lateral border of tongue
  • Retromolar regions
  • Soft and hard palate
  • Gingivae
  • Buccal mucosa
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5
Q

The rates are rapidly rising for Oro-pharyngeal cancer what is this linked to>

A
  • Linked to rising HPV epidemic
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6
Q

What are the risk factors for Oral Cancer?

A
  • Smokers who don’t drink x2 risk
  • Drinkers 3-4 drinks/day X2 risk
  • Smoke and drink x5 risk
  • Betel quid x3 risk
  • Socioeconomic status x2 risk
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7
Q

Inregard to oral cancer what are we uncertain have an effect on predisposition?

A
  • Family history
  • Oral health
  • Sexual activity (may be due to HPV)
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8
Q

What are the benefits to stopping smoking and drinking?

A
  • Benefits of quitting smoking shown within 1 - 4years after stopping
  • Risk reduced to sim level to those who had never smoked after 20yrs quitting
  • Quitting alcohol takes about 20yrs to show
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9
Q

What are Potentially malignant lesions?

A
  • The correct terminology for lesions that might be considered cancerous
  • Small chance of actually becoming malignant
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10
Q

What are some potentially malignant lesions>

A
  • White/red mixed patches
  • Lichen planus
    • Candidal leukoplakia
    • Chronic hyperplastic candidiasis
  • Oral submucous fibrosis
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11
Q

Is erythroplakia or leukoplakia more likely to become malignant?

A
  • Erythroplakia
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12
Q

What is the categorisation of Dysplasia we use today?

A
  • Based on Cellular atypia
    and Epithelial architectural organisation

WHO guidelines 2005

Mild dysplasia - only affects basal third

Moderate dysplasia = affects basal and middle third

Severe dysplasia = affects basal, middle, and top third

Carcinom-in-situ

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13
Q

What is meant by cytological findings that classify oral mucosa dysplasia?

A
  • These are changes in individual cells reflecting abnormal DNA content in nucleus, failure to mature and keratinise correctly and increased proliferation
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14
Q

What cytological findings classify the histological grading of oral mucosa dysplasia?

A
  • Abnorm variation in nuclear size
  • Abnorm variation in nuclear shape
  • Abnorm variation in cell size
  • Abnorm variation in cell shape
  • increased/altered nuclear-cytoplasmic ratio
  • Atypical mitosis figures
  • Increased number and size of nucleoli (prominent nucleoli_
  • Nuclear hyperchromatism
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15
Q

What is meant by Architectural findings in the histological grading of Oral mucosa Dysplasia?

A
  • Changes in the organisation of maturation and normal layering of epithelium
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16
Q

What are the Architectural findings that can be found in histological grading of oral mucosa dysplasia?

A
  • Irregular epithelial stratification
  • Loss/disturbed of polarity of basal cells
  • Drop-shaped rete ridges
  • increased and abnormal mitoses
  • Premature keratinisation in single cells
  • Abnormal keratinisation
  • Keratin pearls within rete ridges
  • Loss of epithelial cell cohesion or adhesion
17
Q

What are the findings for Low grade Oral mucosa dysplasia?

A
  • Easy to identify that the tumour originates from squamous epithelium
  • Architectural change into lower third
  • Cytological atypia or dysplasia may not be prominent
  • Shows a considerable amount of keratin production
  • Evidence of stratification
  • Well formed basal cell layer surrounding the tumour islands
  • Tumour islands are usually well defined and are often continuous with the surface epithelium
    Invasion pattern with intact large branching rete pegs ‘pushing’ into underlying CT
18
Q

What are the findings for High-grade oral mucosa dysplasia?

A
  • Show little resemblance to a normal squamous epithelium
  • Architectural change upper third
  • Usually show considerable atypia
  • Invade in a non-cohesive pattern with fine cords, small islands and single cells infiltrating widely through the CT
  • Mitotic figures are prominent and many may be abnormal
19
Q

What is meant by the term Carcinoma in situ?

A
  • Theoretical concept
  • Cytologically malignant but not invading
    *Abnormal architecture
    Full thickness (or almost full)
    Severe cytological atypia
    *Mitotic abnormalities frequent
20
Q

What are the histological prognostic factors that are helpful in deeming severity?

A
  • Pattern of invasion of rete pegs
  • Depth of invasion as 4mm x 4mm greater than tumours of less
  • Perineural invasion (seen in 60% of OSCC)
  • Invasion of vessels
21
Q

What is the field cancerisation concept?

A
  • Pt who presents with dysplasia or malignancy has chance of devloping malignacy in other parts of mucosa
  • Due to fact that all parts of the mucosa have been exposed to the cancer risk not just the section that has shown as cancerous right now
22
Q

What are synchronous lesions?

A
  • Lesions that have arisen at the same time as other lesions
23
Q

What are metachronous lesions?

A
  • Develop subsequent to original lesion even many months later but are due to the same field cancerisation as the original lesion
24
Q

What are the variables assessed for clinical staging of oral cancer?

A
  • Site
  • Size (T)
  • Spread (N&M)
25
Q

What is the survival of stage I and stage II oral cancer?

A
  • Stage I 80%
  • Stage II 65%
  • If left untreated with metastases survival 4 months
26
Q

What is aetiology of Lip cancer?

A
  • Usually lower lip non-healing ulcer or swelling
  • Sunlight UV-B and smoking
  • Behaviour is slow growth, local invasion , rarely metastasise to nodes
  • Good prognosis if early detection
27
Q

What considerations are important when seeing if oral cancer screening are useful ?

A
  • Benefit vs harm
  • Undetected lesions vs false positives
  • Cost of screening vs cost of disease
  • Cost of screening vs disability from disease
28
Q

Give some examples of Oral cancer screening methods?

A
  • HPV16 screening
  • Toluidene blue
  • VELscope
  • PDD (Photodynamic diagnosis)
  • Clinical judgment of experienced clinician
29
Q

What primary prevention should a GDC do at oral examinations?

A
  • Smoking cessation
  • Healthy diet
  • Alcohol reduction
30
Q

What is the time frame a lesion suspected of cancer should be seen?

A
  • 2 weeks from referral
  • 62 days from referral to txt time for pts with cancer
31
Q
A

BDS4 Oral Medicine (22 decks)

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