Lecture 7 - Diagnosis of SCC Flashcards Preview

Oral Rad Path Final! > Lecture 7 - Diagnosis of SCC > Flashcards

Flashcards in Lecture 7 - Diagnosis of SCC Deck (19)
Loading flashcards...
1

Potentially Malignant Lesions

Leukoplakia
Erythroplakia
Submucous Fibrosis
Lichen Planus

2

Leukoplakia

"White patch"

Clinical term, diagnosis of exclusion

Lesions on floor of mouth, ventral tongue, and soft palate (non-keratinized squamous cell epithelium)

3

Leukoplakia Major Types and Subcategories

Types:
-Localized
-Proliferative

Both Types have these Subcategories:
-Homogeneous
-Verrucous/nodular
-Erythro-leukoplakia

4

Leukoplakia Treatment

ALWAYS biopsy

Options:
-watch w/ periodic biopsies
-Complete excision
-Laser ablation (destroys tissue)

Long-term follow-up
Address risk factors

5

Risk of Leukoplakia developing into SCC

30-40% are dysplasia, carcinoma in situ, or SCC

15% of "benign hyperkeratosis without dysplasia" develop into SCC

6

Proliferative Leukoplakia

Women

7

Verrucous Carcinoma

Warty mass on alveolar ridge, buccal mucosa, or palate

Marked epithelial hyperplasia

Associated with smokeless tobacco use

Usually doesn't metastasize
Treat by excision

8

Erythroplakia

Uncommon

Velvety red plaque or macule, sometimes with leukoplakia

Usually painless

>90% are dysplastic, carcinoma-in-situ, or invasive

9

Oral Submucous Fibrosis

Associated with Betel/Areca nut chewers in SE Asia

Thick bands (piano wires) on buccal mucosa

Pain, burning, limits opening of mouth

10

Squamous Cell Carcinoma Risk Factors

Smoking
Alcohol
Areca/Betel nut
Immune suppression
Autoimmune disease
Hx of cancer
Chemo
Family hx of cancer
Plummer-Vinson syndrome
HPV-16 (mostly oropharyngeal)

11

Squamous Cell Carcinoma Prevalence

30,000 cases in US

>50yo - 1/3000

12

SCC Appearance

Leukoplakia
Erythroplakia
Non-healing ulcer
Mass
Induration (painless)

13

SCC Histo

Invasion of underlying tissue by islands of malignant cells, depending on how much keratin is formed

14

SCC Treatment

Wide excision
Lymph node dissection
Radiation, Chemo (mainly stage III or IV laryngeal and nasopharyngeal)

15

SCC 5yr Survival Prognosis

Overall: 58.8%

Stage I and II: 81%
Stage III and IV (with M0): 52%
Stage III and IV (with M1): 25%

16

Tumor Staging

TNM

T = Tumor Size
N = Lymph node involvement
M = Metastases

1 = T1N0M0
2 = T2N0M0
3 = T3N0/1M0
4 = Any T4, Any TN2M0, Any M1

17

Tumor Size

T1 = <2cm
T2 = 2-4cm
T3 = 4cm
T4 = Invades surrounding structures

18

Lymph Node Involvement Staging

NX = cannot assess
N0 = no metastases
N1 = one ipsilateral node, 3cm
N2(a,b,c) = any nodes, 3-6cm)
N3 = >6cm

19

Biopsy Techniques

Exfoliative cytology (pap smear)
Transepithelial brush biopsy
Scalpel biopsy (excisional or incisional)
Punch biopsy
Fine needle aspiration (glands)