OMIT - Malignancies Flashcards

(41 cards)

1
Q

What is an oral potentially malignant disorder?

A

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

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2
Q

Most common types of OPMDs?

A

Leukoplakia
Erythroplakia
Oral submucous fibrosis

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3
Q

Oral leukoplakia clinical features?

A

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

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4
Q

Oral leukoplakia risk factors

A

Smoking
Alcohol

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5
Q

Oral leukoplakia cancer risk?

A

anywhere from 0.13%-34%

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6
Q

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

A

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

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7
Q

key diagnostic for leukoplakia

A

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

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8
Q

Leukoplakia likelyhood for malignancy

A

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

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9
Q

Erythroplakia diagnosis

A

Exclusive diagnosis

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10
Q

Erythroplakia malignancy rate

A

14-15%

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11
Q

Define proliferative verrucous leukoplakia?

A

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.

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12
Q

Histopath factors associated with risk of malignancy

A

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

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13
Q

What clinical factors raise your suspicion of malignancy?

A

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

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14
Q

What is key when biopsying mixed colored lesions?

A

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

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15
Q

What screening tools are available for potentially malignant disorders?

A

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

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16
Q

What vital staining may indicate potentially malignant tissue?

A

Toluidine blue
Acetic acid
Lugol’s iodine solution

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17
Q

What are the benefits and drawbacks of vital staining?

A

Positives
- Further testing to confirm
- Quick results

Negatives
- Tastes bad
- False negatives

18
Q

What types of light-based detection are available

A

Reflective visualization
Optical fluorescence imaging

19
Q

What is oral brush biopsy?

A

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.

20
Q

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

A

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

21
Q

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

A

OSSC generally larger.

22
Q

What are the main principles in treating OPMDs?

A

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

23
Q

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

A

Excision with cold steel
Ablation
Cold blade
CO2 Laser
Photodynamic therapy

24
Q

What is the purpose of prescribing steroids for OPMDs?

A

Symptom management only, will not lower malignancy risk.

25
What are some of the issues when deciding to perform surgery on an OPMD or not?
Risk of malignancy Removal of OSCC much more destructive Patient response to non-surgical therapy Patient wishes and opinions
26
What is a P16 cancer?
p16 is a tumor supressor gene, that when activated can act as a biomarker for HPV infection - a risk factor for oral cancer.
27
How do HPV related tumors respond to treatment?
Respond better to radiotherapy, better outcome
28
How to monitor potentially malignant disorder?
Degree of dysplasia Changes in clinical features
29
How is cancer staged?
TNM Staging (Tumor, nodes, metastasis)
30
How is cancer graded?
Low grade - slow growing Intermediate - middle grade High Grade - Fast growing
31
What risk factors can be modified in a patient with OPMDs?
Tobacco use Alcohol intake Areca nut chewing Poor diet/nutrient deficiencies
31
Outline the steps taken during active monitoring?
Predicative risk assessment Assessment with screening tools Further biopsy appointments Dedicated appointments for lesion
31
What is radiotherapy?
Utilizes ionizing radiation to target and kill cancer cells. Damages DNA inside the targeted cells preventing them from multiplying.
32
What is the typical dose of radiation given during radiotherapy?
Total dose is around 60-70Gy
33
What are the general side effects of chemotherapy?
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
34
What are the oral side effects of chemotherapy?
* Oral mucositis * Pain in teeth and gingivae * Taste loss * Trismus * Odynophagia * Dysphagia * Candidiasis * Radiation dermatitis * Osteoradionecrosis
35
What are the long term complications of chemotherapy?
Tissue fibrosis Chronic fatigue Skin changes Secondary cancers Bone and joint problems Hormonal changes Organ dysfunction Cognitive changes
36
Outline the WHO scale of oral mucositis?
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
37
What is chemotherapy?
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.
38
What are the oral implications of chemotherapy?
Altered taste Increased bleeding Xerostomia Candidal infection Nausea and vomiting Anaemia Caries Chemotherapy induced mucositis
39
What are the main considerations for a dentist managing a patient undergoing treatment for H+N cancer?
Promote prevention and OH Avoid dentures encourage SDA Diet and lifestyle advice High F toothpaste Follow up protocols when concerned Management of oral manifestations