Oral Cancer 1 Flashcards
(18 cards)
What is the epidemiology of Oral cancer?
5-10 per 100,000 population in the UK
M:F = 2:1
Peak age 55-65
Not as common as breast, prostate, colorectal and lung cancer.
5 year survival rate is 40-50%
Vast number of cases are preventable
Disproportionately affects people from lower socio-economic backgrounds (more likely to have it and die from it)
Risk factors of oral cancer
Known risk factors are behavioural, not inherited
- Smoking, Alcohol, Paan, Betel nut, Areca nut
- Excessive sun exposure to your lips.
- A sexually transmitted virus called human papillomavirus (HPV) associated with oro-pahryngeal cancer and tonsil cancer (not so much tongue cancer and mouth cancer)
- A weakened immune system e.g. people who have had a transplant
- Fanconi Anemia (inherited)
What is Fanconi Anemia?
Inheritable disease which affects DNA’s ability to self-repair = increased RO genetic mutations = more likely to develop oral cancer
How can people with Fanconi Anemia present?
- Absent or hypoplastic thumb
- Short stature
- Low set ears, deafness
- Strabismus
- Skin hypopigmentation
- Renal abnormalities
- RX: Bone marrow transplant
Natural History of Oral Cancer
- Normal Mucosa
If you damage normal mucosa repeatedly then you can develop dysplasia - Dysplasia
It is the cellular and architectural abnormalities in the epithelium
Can be mild/moderate/severe or low-grade/high-grade
It can come and go between different stages. May even completely resolve - Carcinoma in-situ
Dysplasia that extends right through
No longer reversible - Invasive carcinoma
Usually takes 2-4 years to go from normal mucosa to invasive carcinoma
Low-grade or Mild/Moderate Dysplasia
Dysplasia that is limited to basal third of the mucosal epithelium
High-grade or Severe Dysplasia
Dysplasia that extends to top two basal thirds of the mucosal epithelium
Carcinoma in situ
Dysplasia that extends right through
Invasive carcinoma
Abnormal cells are invading through the basement membrane. If the basement membrane is unaffected then it is either severe dysplasia or carcinoma in situ
Natural History of Oral Cancer
- T: Primary site- side of the tongue is most common
- N: Regional Lymph Nodes
- M: Distant Metastases
TNM classification for staging cancer
Why is it important to understand the progression of oral cancer?
So that we know how to treat it and can estimate survival
Survival chance
If tumour is limited to primary site = 90-95% chance of being cured
If it has spread to regional nodes then = 60%
If it has spread to distant metastases then = 5-10%
Symptoms of Oral Cancer
Very variable from pt. to pt.
- pain/discomfort
- may be painless
- lesion may be present for a long time (does not mean it is not oral cancer as we know there is a long 2-4 yrs progression)
- pt. may be unaware of any abnormality
Signs of Oral cancer
- white patch (leukoplakia)
FOM is a high risk area to have one
Side of the tongue - red patch (erythroplakia)
- speckled red and white patches (speckled leukoplakia)
- ulcer
Most common benign ulcer is an recurrent apthous ulcer which is described at punched out and lasts up to 1 - 2 weeks
If it lasts longer than 3 weeks or a big ulcer with a rolled & raised edge (not distinct line between normal and abnormal tissue) = treat with suspicion
Signs of Oral cancer
- White patch (leukoplakia)
FOM is a high risk area to have one
Side of the tongue - Red patch (erythroplakia)
- Speckled red and white patches (speckled leukoplakia)
- Ulcer
Most common benign ulcer is an recurrent apthous ulcer which is described at punched out and lasts up to 1 - 2 weeks
If it lasts longer than 3 weeks or a big ulcer with a rolled & raised edge (not distinct line between normal and abnormal tissue) = treat with suspicion - Lumps
Surface does not look like normal, healthy mucosa. It will look irregular and touching it may lead to bleeding and it may be giving pt. bad breath - Unexplained loose teeth
Big, irregular, poorly-defined radiolucency associated with the mobile teeth - Unexplained bleeding
Very rapid bone loss, loose teeth and absence of chronic periodontal disease but there is bleeding then investigate to rule out oral cancer - Unexplained persistent pain
Possible outcomes of treatment
May significantly affect your quality of life
- affects swallowing, speech
- appearance
What increases the chance of a better QoL after treatment
Small tumour
No involvement of neck nodes
Conservative surgery
No radiotherapy
Summary
Often early cancer is asymptomatic
Early lesions may be present for years before becoming symptomatic
Lesions/signs are obvious on clinical examination
Early disease = better survival + better QoL
