OMIT - Malignancies

Question 1

What is an oral potentially malignant disorder?

Answer 1

A group of lesions and conditions in the oral mucosa that can display an increased risk of malignant transformation.

Question 2

Most common types of OPMDs?

Answer 2

Leukoplakia
Erythroplakia
Oral submucous fibrosis

Question 3

Oral leukoplakia clinical features?

Answer 3

A keratotic lesion that cannot be removed
Asymptomatic
Homogenous or non-homogenous

Question 4

Oral leukoplakia risk factors

Answer 4

Smoking
Alcohol

Question 5

Oral leukoplakia cancer risk?

Answer 5

anywhere from 0.13%-34%

Question 6

Oral sub mucous fibrosis, define, and give clinical features.

Answer 6

An oral precancerous condition characterized by a inflammation and progressive fibrosis of the submucosal tissues.

Burning sensation
Blanching
Trismus
Loss of pigmentation
Mucosal surfaces and third of esophagus

Question 7

key diagnostic for leukoplakia

Answer 7

Can’t be removed
Absence of any other cause
Diagnosis through exclusion

Question 8

Leukoplakia likelyhood for malignancy

Answer 8

Very variable: 0.1-30%
Dependant on modifiable risk factors

Question 9

Erythroplakia diagnosis

Answer 9

Exclusive diagnosis

Question 10

Erythroplakia malignancy rate

Answer 10

14-15%

Question 11

Define proliferative verrucous leukoplakia?

Answer 11

It is an aggressive slow growing form of leukoplakia with high malignant transformation.

Non-homogenous affecting multiple sites with nodular appearance. More common in females and elderly.

Question 12

Histopath factors associated with risk of malignancy

Answer 12

Chromosome number abnormality
Loss of heterozygosity
DNA and mRNA hypermethylation
Gene expression profiling

Question 13

What clinical factors raise your suspicion of malignancy?

Answer 13

Non-healing
Unexplained
Changes in the lesion
High risk site (ventro-lateral tongue FOM)

Question 14

What is key when biopsying mixed colored lesions?

Answer 14

Obtain representative sample, with a sample of healthy tissue for comparison.

Question 15

What screening tools are available for potentially malignant disorders?

Answer 15

Clinical exam under white light
Vital staining
Light based detection
Oral brush biopsy
Salivary diagnostics

Question 16

What vital staining may indicate potentially malignant tissue?

Answer 16

Toluidine blue
Acetic acid
Lugol’s iodine solution

Question 17

What are the benefits and drawbacks of vital staining?

Answer 17

Positives
- Further testing to confirm
- Quick results

Negatives
- Tastes bad
- False negatives

Question 18

What types of light-based detection are available

Answer 18

Reflective visualization
Optical fluorescence imaging

Question 19

What is oral brush biopsy?

Answer 19

Minimally invasive approach for harvesting cells in oral mucosa.

Brush obtains superficial cells, however this is less effective than full biopsy.

Utilizes exfoliative replacement cytology.

Question 20

What is the purpose of salivary diagnostic as an OPMD screening tool?

Answer 20

Contains hormones, DNA, RNA, antibodies etc.
Saliva can mirror physiological changes of the body.

Question 21

What is the difference in surgical excision margins between OPMDs and OSSC?

Answer 21

OSSC generally larger.

Question 22

What are the main principles in treating OPMDs?

Answer 22

Risk factor modification
Topical medicaments
Systemic medications
Monitoring and surveillance
Surgical intervention

Question 23

What types of surgical interventions can be undertaken to manage these lesions?

Answer 23

Excision with cold steel
Ablation
Cold blade
CO2 Laser
Photodynamic therapy

Question 24

What is the purpose of prescribing steroids for OPMDs?

Answer 24

Symptom management only, will not lower malignancy risk.

Question 25

What are some of the issues when deciding to perform surgery on an OPMD or not?

Answer 25

Risk of malignancy Removal of OSCC much more destructive Patient response to non-surgical therapy Patient wishes and opinions

Question 26

What is a P16 cancer?

Answer 26

p16 is a tumor supressor gene, that when activated can act as a biomarker for HPV infection - a risk factor for oral cancer.

Question 27

How do HPV related tumors respond to treatment?

Answer 27

Respond better to radiotherapy, better outcome

Question 28

How to monitor potentially malignant disorder?

Answer 28

Degree of dysplasia Changes in clinical features

Question 29

How is cancer staged?

Answer 29

TNM Staging (Tumor, nodes, metastasis)

Question 30

How is cancer graded?

Answer 30

Low grade - slow growing Intermediate - middle grade High Grade - Fast growing

Question 31

What risk factors can be modified in a patient with OPMDs?

Answer 31

Tobacco use Alcohol intake Areca nut chewing Poor diet/nutrient deficiencies

Question 31

Outline the steps taken during active monitoring?

Answer 31

Predicative risk assessment Assessment with screening tools Further biopsy appointments Dedicated appointments for lesion

Question 31

What is radiotherapy?

Answer 31

Utilizes ionizing radiation to target and kill cancer cells. Damages DNA inside the targeted cells preventing them from multiplying.

Question 32

What is the typical dose of radiation given during radiotherapy?

Answer 32

Total dose is around 60-70Gy

Question 33

What are the general side effects of chemotherapy?

Answer 33

Fatigue Skin changes – irritated and sensitive Nausea and vomiting – if tx near abdomen Hair loss – specific to tx area Difficulty swallowing Changes in taste or appetite Diarrhoea or bowel changes Urinary changes

Question 34

What are the oral side effects of chemotherapy?

Answer 34

* Oral mucositis * Pain in teeth and gingivae * Taste loss * Trismus * Odynophagia * Dysphagia * Candidiasis * Radiation dermatitis * Osteoradionecrosis

Question 35

What are the long term complications of chemotherapy?

Answer 35

Tissue fibrosis Chronic fatigue Skin changes Secondary cancers Bone and joint problems Hormonal changes Organ dysfunction Cognitive changes

Question 36

Outline the WHO scale of oral mucositis?

Answer 36

0 - None: - I - Mild: Oral soreness and erythema II - Moderate: Oral erythema, ulcers, solid diet tolerated III – Severe: Oral ulcers, liquid diet only IV – Life Threatening: Oral alimentation impossible

Question 37

What is chemotherapy?

Answer 37

The use of medications to reduce rate of cancer cell division when compared to most cells in the body. The medications are cytotoxic and interact with cancer DNA or RNA to disrupt cell life cycle.

Question 38

What are the oral implications of chemotherapy?

Answer 38

Altered taste Increased bleeding Xerostomia Candidal infection Nausea and vomiting Anaemia Caries Chemotherapy induced mucositis

Question 39

What are the main considerations for a dentist managing a patient undergoing treatment for H+N cancer?

Answer 39

Promote prevention and OH Avoid dentures encourage SDA Diet and lifestyle advice High F toothpaste Follow up protocols when concerned Management of oral manifestations