Oral Cancer Flashcards
(187 cards)
1
Q
What three key ways can cell numbers be altered?
A
- Increased or decrease rates of stem cell input
- Apoptosis
- Changes in the rate of proliferation or differentiation
2
Q
What controls the cell cycle?
A
Chemical factors in the micro-environment of the cell ( i.e. stimulators and inhibitors)
3
Q
Describe what is meant by “terminally differentiated” cells
A
Cells that are not capable of replicating
4
Q
Give an example of terminally differentiated cells
A
Epithelial cells of oral cavity
5
Q
What is the difference between dysplasia and neoplasia?
A
Dysplasia is reversible, neoplasia is irreversible
6
Q
Define hypertrophy
A
An increase in cell size ( usually muscle)
7
Q
Define hyperplasia
A
An increase in cell number (proliferation)
8
Q
What is an example of hyperplasia in the oral cavity?
A
Gingival hyperplasia
9
Q
Define atrophy
A
Reduction in cell size by loss of cell substance (decrease in size of body tissue)
10
Q
Define hypoplasia
A
Reduced size of an organ that never fully developed to normal size (a developmental defect)
11
Q
Define metaplasia
A
Reversible change in which one adult cell type is replaced by another adult cells type
(cells change to a form that is not normally found in specific tissue)
12
Q
Which disorder of growth is irreversible?
A
Hypoplasia
13
Q
define dysplasia
A
Abnormal growth of cells
14
Q
What is a pre-malignant process?
A
Dysplasia
15
Q
what are the three different grades of pre-invasive dysplasia?
A
- mild
- moderate
- severe
16
Q
What does a severe grade of dysplasia indicate?
A
A higher risk of progressing to invasive malignancy
17
Q
Define neoplasia
A
Uncontrolled abnormal growth of cells or tissues in the body
18
Q
What are the two main classification of tumours?
A
- Behaviour
- Histogenesis
19
Q
What are the two factors of behaviour classification that need to be considered when diagnosing a tumour?
A
- Benign
OR - Malignant
20
Q
What type of tumour remains localised, is often encapsulated, has a slow growth rate and can be treated through local excision?
A
Benign tumours
21
Q
What is a common type of benign salivary gland tumour, often presenting in the parotid salivary ducts?
A
Pleomorphic adenoma
22
Q
What type of tumour metastasises, has a fast growth rate and may require additional therapy alongside excision for treatment?
A
Malignant tumour
23
Q
What are pleomorphic cells?
A
Cells that grow in multiple shapes and sizes
24
Q
What type of malignant oral cell shows clear pleomorphic nuclei histologically?
A
Oral squamous cell carcinoma
25
Give an example of progression of a benign tumour to a malignant one
Pleomorphic adenoma progresses to carcinoma ex pleomorphic adenoma
26
How would tumours be classified histogenetically?
According to the cell type they resemble (i.e. their differentiation)
27
If a tumour presents in covering epithelia, what is it referred to if it’s:
1. Benign
2. Malignant
1. Papilloma
2. Carcinoma
28
If a tumour presents in glandular epithelia, what is it referred to if it’s:
1. Benign
2. Malignant
1. Adenoma
2. Adenocarcinoma
29
If a tumour presents in smooth muscle, what is it referred to if it’s:
1. Benign
2. Malignant
1. Leiomyoma
2. Leiomyosarcoma
30
If a tumour presents in skeletal muscle, what is it referred to if it’s:
1. Benign
2. Malignant
1. Rhabdomyoma
2. Rhabdomyosarcoma
31
If a tumour presents in bone forming connective tissue, what is it referred to if it’s:
1. Benign
2. Malignant
1. Osteoma
2. Osteosarcoma
32
If a tumour presents in cartilage, what is it referred to if it’s:
1. Benign
2. Malignant
1. Chondroma
2. Chondromasarcoma
33
If a tumour presents in fibrous tissue, what is it referred to if it’s:
1. Benign
2. Malignant
1. Fibroma
2. Fibromasarcoma
34
If a tumour presents in blood vessels, what is it referred to if it’s:
1. Benign
2. Malignant
1. (Haem) angioma
2. Angiosarcoma
35
If a tumour presents in adipose tissue, what is it referred to if it’s:
1. Benign
2. Malignant
1. Lipoma
2. Liposarcoma
36
If a tumour presents in melanocytes, what is it referred to if it’s:
1. Benign
2. Malignant
1. Melanocytic naevi
2. Malignant melanoma
37
What type of tumours may be undifferentiated, showing no definite form of differentiation?
Highly malignant tumours
38
The prediction of the probable course and outcome of disease
Prognosis
39
What is prognosis important for?
Appropriate treatment and estimation of survival
40
Give an example of an odd tumour with unpredictable behaviour
Malignant melanoma
41
What aids in the diagnosis, staging and treatment of tumours?
Knowing the patterns of spread of tumour types
42
What does a histological assessment determine?
How well differentiated the tumour cells are
43
What tumours have better prognosis, well differentiated or undifferentiated tumours?
Well differentiated
44
What does tumour staging describe?
The anatomical extent of disease
45
what type of classification is used to stage cancer?
TNM classifications of malignant tumours
46
What does each letter component of “TNM” describe?
T- extent of primary tumour
N- absence or presence and extent of regional lymph node metastasis
M- absence or presence of distant metastasis
47
When staging, what does a higher number given to TNM indicate?
A more extensive disease
48
What does a higher tumour stage indicate in regards to prognosis?
Poorer prognosis
49
What causes cancer?
Mutations in genes resulting in a cell which grows and proliferates at an uncontrolled rate, and is unable to repair DNA within itself or undergo apoptosis
50
What are the common causes of genetic errors?
1. Inherited
2. Viruses
3. Exposure to chemicals and radiation
51
Define mouth cancer
A variety of malignant tumours that develop in the mouth, affecting the lips, salivary glands, tongue, gums, palate and inside of cheeks
52
What type of cancer is commonly associated with mouth cancer?
Squamous cell carcinoma
53
What age group does oral cancer often present in?
Older age group ( approx over 55 years old)
54
In the UK, how often does death associated with mouth cancer occur?
1 person every 3 hours
55
What are the two largest risk factors of oral cancer?
1. Tobacco
2. Alcohol
56
What are less common risk factors for oral cancer?
- poor diet/obesity
- immunological defect
- sunlight ( UV)
57
If a patient smokes tobacco and drinks alcohol, how much more likely are they to develop oral cancer than a patient who doesn’t smoke or drink?
24 times more likely
58
In what area of the oral cavity is mouth cancer most common?
In the sublingual gutter ( space between tongue and FOM)
59
Why is oral cancer most likely to present in the sublingual gutter?
Due to pooling of carcinogens from tobacco and/or alcohol in this area
60
Describe the consequence of alcohols thinning effect on the oral mucosa
It makes mucosa more permeable to carcinogens, which can enter through the epithelial cell barrier
61
What mutagen and carcinogen is alcohol metabolised to?
Acetaldehyde
62
How is ethanol broken down into acetaldehyde in the oral cavity?
By bacteria in oral cavity and salivary glands
63
What is the daily recommendation of alcohol for both females and males?
2 units
64
What is the weekly recommendation of alcohol for females and males?
14 units
65
How many days are recommended to be taken as ‘alcohol free’ in a week?
2 days
66
What type of food is affective in preventing oral cancer and why?
Fruits and vegetables as they provide vitamins and supplements
67
Cancer in what location is most likely to present due to UV light exposure?
Lip cancer
68
What are the three main viruses associated with oral cancer?
- human papillomavirus (HPV)
- Epstein-barr virus (EBV)
- Human immunodeficiency virus (HIV)
69
Which infectious virus has the largest predisposition for milignant change in the oral cavity?
HPV
70
What type of HPV is associated with oral mucosa?
Beta type
71
What are the two high risk HPV types associated with the oral cavity?
HPV 16 and HPV 18
72
Which HPV type has oncogenes properties ( tumour development)?
HPV 16
73
What type of cell does HPV infect?
Undifferentiated proliferative basal cells
74
Interactions between what proteins cause HPV infection to result in latency and malignant transformation?
Interactions of viral (E6 and E7) proteins with p53 and pRB
75
What are the two types of benign oral HPV lesions?
1. Papilloma
2. Condylomata
76
What is similar to a papilloma but instead is a multiple lesion phenomena?
Condylomata
77
Define exophytic
Growth of a tumour outwards
78
What are the two main risk factors for HPV?
- number of sexual partners
- weakened immune system
79
What virus causes infectious mononucleosis ( glandular fever)?
EBV
80
What rare cancer is associated with EBV?
Burkitt’s lymphoma
81
Which virus causes an increased risk of kaposi sarcoma?
HIV
82
What are oral symptoms of HIV?
Candidiasis, hairy leukoplakia, accelerated perio disease, kaposi sarcoma, salivary gland disease and oral ulcers
83
How is HIV treated?
Highly affective antiviral treatment (HAART)
84
What is kaposi Sarcoma- associated herpesvirus (KSHV) also known as?
Human herpesvirus-8 (HHV-8)
85
What are the first symptoms of kaposi sarcoma?
Red, purple or brown patches/nodules on the skin/mucosa
86
Abnormal thickening of the epithelium
Hyperkeratosis
87
What are squamous cell papilloma’s pedunculated to?
A stalk
88
Atypical epithelial alterations limited to the surface squamous epithelium
Epithelial dysplasia
89
What characterises epithelial dysplasia?
Cytological and architectural alterations with a loss of normal maturation and differentiation. It is a premalignant process.
90
A benign histologic finding characterised by the proliferation of the basal cells
Basal cell hyperplasia
91
Abnormal keratinisation occurring prematurely within individual cells or groups of cells
Dyskeratotic cells
92
Define pleomorphism
Cells or their nucleus having variation in size and shape
93
What is the key feature of identifying oral squamous cell carcinoma histologically?
Invasion of adjacent normal tissues
94
A keratinised structure found in regions where abnormal squamous cells form concentric layers
Keratin pearl
95
If squamous carcinoma cells are better differentiated (more like normal epithelium), how would this effect tumour grade and prognosis?
Lower tumour grade and better prognosis
96
If squamous carcinoma cells are poorly differentiated, how would this effect tumour grade and prognosis?
Higher tumour grade and lower prognosis
97
The application of a test to people who are apparently free of disease to identify those who may have the disease from those who may not
Screening
98
Define primary prevention and give an example
Prevents a disease from developing ( e.g. risk factor education to patients)
99
Define secondary prevention and give an example
To detect disease while it is localised or ‘early’ (e.g. screening oral cavity)
100
Define tertiary prevention and give an example
To mitigate the morbidity from established disease and to improve quality of life (e.g. programs and support groups for people living with disease)
101
What are the three types of population screening programmes?
1. Mass screening
2. Selective screening
3. Opportunistic screening
102
What type of screening are dentists involved in?
Opportunistic screening, as patients present voluntarily to dentists to be assessed.
103
For any screening programme to be successful, what are the two qualities it must possess?
High sensitivity and specificity
104
What is meant by the term ‘sensitivity’ in regards to screening?
The proportion of the population who are correctly classified as having a disease
105
What is meant by the term ‘specificity’ in regards to screening?
The proportion of the population correctly classifies as disease-free
106
What order of sensitivity and specificity do screening tests aim to have in order for them to be usefully applied to the population?
80% or more
107
What did the one properly conducted study (randomised controlled trial carried out over 15 year period) on mouth cancer screening evaluate?
Clinical or cost efficacy of mouth cancer screening
108
What does OPMD stand for?
Oral potentially malignant disorders
109
What is an important example of OPMD?
Lichen planus
110
How can lichen planus manifest?
- white patches
- reticular patches
- rows of patches
- ulcerated patches
- plaques
111
What does OPML stand for?
Oral potentially malignant lesions
112
When would size of a lesion be concerning in terms of potential for malignancy?
If a lesion is above 20cm in size
113
When would texture of a lesion be concerning in terms of potential for malignancy?
If the lesion is irregular in texture, more non-homogenous
114
When would colour of a lesion be concerning in terms of potential for malignancy?
Red lesions are more worrying, followed by speckled, then white lesions
115
What sites in the mouth are highest risk for malignancy?
Tongue and FOM
116
Which sex are at greater risk of developing malignancy?
Females
117
At what age is it most common to develop malignancy?
>50 years
118
A white patch of unknown cause is known as?
Leukoplakia
119
A red patch of unknown cause is known as?
Erythroplakia
120
What is meant by indurated margins?
Heaped, thick and rubbery texture to touch
AND
is a sign of cancer invading underlying mucosal margin
121
Define endophytic lesion
Inwards growing lesion
122
Define exophytic lesion
Outwards growing lesion
123
In what scenario would cancers become painful?
When they are secondary infected or when they invade nerves (perineural spread)
124
How is tumour/lesion size classified?
By T classifications ( T1, T2, T3, T4)
125
What size would a T1 lesion be?
<2cm
126
What size would a T2 lesion be?
2-4cm
127
What size would a T3 lesion be?
4-6cm
128
What size would a T4 lesion be?
>6cm or any lesion that involves the underlying bone
129
When should you refer a patient presenting with an unusual ulcer?
If the ulcer does not heal within 2-3 weeks
130
Who should you refer a patient with an unusual lesion to?
Nearest Maxillofacial department on urgent 2 week referral;
131
What sort of imaging will the Maxillofacial department take to assess patient for potential malignancy?
Head/neck MRI scan and CT of chest
132
What is ‘geographic’ tongue also known as?
Benign migratory glossitis
133
What is the key characteristic of geographic tongue?
Appearance of red or white patches that comes and goes- hence ‘migratory’
134
What is geographic tongue a result of?
Deviation in natural turnover in cells, where some cells turnover fast and are evolved and other turn over slowly, heaping up and forming the patches we see
135
Why does ‘black hairy tongue’ occur?
Where mastication cannot clean dorsum of tongue, elongation of the papilla occurs which becomes infected by pigmented bacteria causing the black appearance
136
How can ‘black hairy tongue’ be treated?
Simply with OH, by focusing cleaning to the tongue
137
Define ‘papillary hyperplasia’
Benign lesion of the oral mucosa which is characterised by enlarged papillae
138
What may a slight white appearance along the occlusal plane of lateral tongue indicate about a patient?
That they may grind their teeth or clench
139
What is a blister in the oral cavity also known as?
Bullae
140
What benign features can normally be seen when assessing the buccal mucosa?
- linea alba
- chewing of cheek
- small white spots
141
What is linea alba?
Linear white line at the level of occlusal plane (indicates clenching habit)
142
Why can benign small white spots appear in buccal mucosa?
Caused by ectopic sebaceous glands
143
Give 9 common examples of benign oral lesions
1. Aphthous ulceration
2.lipoma
3. Mucoceole
4. Epulis
5. Leaf fibroma
6. Denture induced hyperplasia
7. Papillary hyperplasia
8. Papilloma
9. Tori palatinus or mandibularis
144
What is a mucocoele?
A benign mucous containing cystic lesion of the minor salivary gland.
145
What often causes mucocoele’s to form?
Trauma to the area
146
What is an epulis?
A benign mass-like growth in the mouth that typically grows over or around a tooth
147
What is a pyogenic granuloma?
A harmless overgrowth of tiny blood vessels on the skin
148
What is leaf fibroma and why does it occur?
A fibrous epulis forms underneath the palatal base of a denture.
149
What are examples of benign lesions caused by ill-fitting dentures?
- leaf fibroma
- denture induce hyperplasia
- papillary hyperplasia
150
What is torus palatinus?
A harmless, painless bony growth located on the roof of the mouth
151
Why can torus become easily traumatised by mastication to dentures?
As they have thin mucosal layer
152
What is torus mandibularis and where does it occur most often?
A benign bony outgrowth normally located on lingual aspect of alveolus bilaterally
153
When doing an extra-oral exam as part of cancer screening, what are you looking for?
Lymphadenopathy (enlargement of the lymph nodes)
154
How cancerous lymph nodes present ?
Firm, rubbery and non-tender
155
What are features of oral malignancy?
- red/white/speckled lesion
- ulcerated areas
- high risk sites
- asymptomatic
- unknown duration
- risk factor history
156
What is a ‘mapping biopsy’?
Incisional biopsies are carried out at multiple sites
157
What structures does ‘ head and neck cancer’ encompass?
Cancers of the:
- mouth
- oropharynx
- nasopharynx
- hypopharynx
- nose
- paransal sinuses
- larynx
- salivary glands
- ear
158
What type of mucosa do squamous cell carcinomas typically arise from?
Lining mucosa
159
What is an example of cancer of the salivary glands?
Polymorphous adenocarcinoma
160
What is an example of cancer of Odontogenic epithelium?
Ameloblastic carcinoma
161
What is an example of malignant skeletal muscle tumour?
Rhabdomyosarcoma
162
What does aneuploidy mean? And where is it common?
Altered DNA content, common in tumour cells
163
What very simplified stages are involved in the ‘multi step theory of carcinogenesis?
1. Initiation
2. Promotion
164
What happens in the initiation stage of the ‘multi step theory of carcinogenesis?
DNA damage and mutation
165
What happens in the promotion stage of the ‘multi step theory of carcinogenesis?
Clonal expansion of abnormal cells leading to cancer
166
What are the four key elements of tumour growth?
- replication
- escape from senescence (deterioration with age)
- evasion of apoptosis
- limitless replicative potential
167
What are the four key elements in cancer development?
1. Tumour growth
2. Invasive growth
3. Angiogenesis
4. Metastasis
168
What are the three key factors involved in invasive growth of a tumour?
1. Reduction in cell-cell adhesion
2. Invasion of basement membrane and stroma
3. Tumour cell motility
169
What is ‘the angiogenic switch’?
Development of rich blood supply around a tumour
170
What is a critical step in progression of a small localised tumour to a bigger one with metastatic potential?
Angiogenesis
171
What is another term used to describe metastasis?
Secondaries
172
What are tumour implants that are discontinuous with the primary lesion?
Metastasis
173
What organs are very effective at arresting circulating cancer cells?
Lung and liver
174
What is epithelial dysplasia?
A premalignant process- atypical epithelial alterations limited to the surface squamous epithelium
175
Dysplasia involves the invasion of adjacent normal tissues. True or false?
False, limited to the surface squamous epithelium
176
How does WHO grade epithelial dysplasia?
Mild
Moderate
Severe
177
What is the binary system for grading epithelial dysplasia?
Low grade
High grade
178
What grade of epithelial dysplasia is described:
Disorganisation, increase proliferation and atypia of basal cells
Mild dysplasia
179
What grade of epithelial dysplasia is described:
Very abnormal, affects full thickness of epithelium
Severe dysplasia
180
What grade of epithelial dysplasia is described:
More layers of disorganised basaloid cells, atypia, suprabasal mitosis
Moderate dysplasia
181
Define oral potentially malignant disorders
Oral mucosal lesions that have a potential risk of developing into oral SCC
182
Give three examples of oral potentially malignant disorders
1. Oral sub-mucous fibrosis
2.lichen planus
3.chronic hyperplastic candidosis
183
How long is follow up treatment after surgical excision of SCC?
5 years
184
what is the gold stands tool for excisions of potentially malignant lesions?
Carbon dioxide laser
185
What are lichenoid reactions often triggered by?
A long-standing chromic irritation to amalgam or metal-based restorations
186
what is an indolent tumour?
A tumour that causes little or no pain
187
What do groups of cells that display invasive growth have high levels of?
Autocrine pro-migratory factors and proteolytic enzymes
