ORAL CANCER Flashcards
Combined - OM, OMFS, SCD (48 cards)
OMFS
What are some general intra and extra-oral signs and symptoms of oral cancer ?
- Mobility of teeth.
- Trismus.
- Dysarthria.
- Jaw fracture.
- Numbness/paraesthesia.
- Acquired malocclusion.
- Dysphagia.
- Unexplained weight loss.
- Pain.
- Persisting head or neck lump.
OMFS
Describe what a oral cavity cancer might be like clinically.
- Red or mixed red-white patch.
- Ulceration.
- Bleeding.
- Non-healing.
- Indurated (firm).
- Immobile from underlying tissues.
- Rolled margins.
- Asymptomatic.
- Verrocous appearance.
- Pre-dysplastic lesion.
- Uneven surface.
- Exophytic.
OMFS
What signs would alarm you and cause a 2 week referral to be made ?
- Unexplained head/neck lump persisting for >2 weeks.
- Unexplained non-healing ulcer/indurated lesion of mucosa persisting for >2 weeks.
- All red and red-white mixed patches persisting for >2 weeks.
- Persistent hoarseness or throat pain or dysphagia persisting for >2 weeks.
OMFS
Describe cancer staging and how it is diagnosed.
How big is the primary tumour and has it spread to regional lymph nodes or distant organs ?
Diagnosed from imaging & clinical examination.
OMFS
Describe cancer grading and how it is diagnosed.
How abnormal are the cells and tissue ?
Diagnosed from histopathology biopsy.
OMFS
How would a cN0 patient be managed surgically ?
No lymph node involvement.
Will have microscopic metastases removed during primary resection with macroscopic margin of resection.
Resection of level I, II, III cervical lymph nodes during primary surgery.
OMFS
How would a cN+ve patient be managed surgically ?
Requires secondary surgery to removal specific affected lymph nodes, confirmed through PET scan.
OMFS
Define sentinel nodes.
Those with direct lymphatic drainage from primary tumour.
OM
What are the most common sites affected by oral cavity cancer (OCC) ?
- Floor of mouth.
- Lateral border of the tongue.
- Retormolar regions.
- Hard and soft palate.
- Gingivae.
- Buccal mucosa.
OM
OCC - smokers who don’t drink - at what risk are they at for development of OCC ?
x2
OM
Drinkers who have never smoked - at how much greater risk are they at for development of OCC ?
x2
OM
Smokers who do drink - how much greater risk are they at for development of OCC ?
x5
OM
What are the main risk factors for OCC ?
Smoking - frequency, duration of use.
Alcohol - frequency.
Betel quid (paan) - x3.
Socioeconomic status - x2.
Possible - FH, poor OH, sexual activity/partners.
OM
List some potentially malignant conditions.
- Leukoplakia.
- Erythroplakia.
- Lichen planus - erosive and ulcerated subtypes.
- Chronic hyperplastic candidasis.
- Oral submucous fibrosis.
- Iron deficiency.
- Tertiary syphilis.
- HPV.
OM
Define leukoplakia.
Undiagnosed white patch which cannot be rubbed off or attributed to any other disease.
Lower malignancy potential (<4%).
Proliferative verrucous leukoplakia - highest malignant transformation potential.
OM
Define erythroplakia.
Unexplained, undiagnosed red patch which cannot be attributed to any other disease.
High malignancy potential (50%).
Erythema indicative of vascular change.
OM
What are the two factors which dysplasia categorisation is based upon (grading) ?
- Cellular atypia i.e. cytological.
- Epithelial architectural organisation i.e. architectural.
OM
What are some examples of dysplastic cytological changes in cells ?
- Abnormal variation in nuclear size, number and shape.
- Pleomorphism - variation in cell size and shape.
- Nuclear hyperchromatism - increased DNA staining in nuclei.
- Increased/altered nuclear-cytoplasmic ratio.
- Atypical mitotic figures.
OM
Provide some examples of architerctural changes in dysplastic lesions.
- Irregular epithelial stratification.
- Loss/disturbed polarity of basal cells.
- Drop chaped rete pegs.
- Increased and abnormal mitoses.
- Premature keratinisation.
- Abnormal keratinisation.
- Loss of epithelial cell cohesion/adhesion.
OM
Define low grade dysplasia.
Architerctural changes into lower 1/3.
Cytological atypia may not be prominent.
OM
Define high grade dysplasia.
Architectural changes in middle third.
Cytological atypia evident.
OM
Define carcinoma in situ.
Abnormal architecture of full thickness.
Severe cytological atypia.
OM
What are some histological prognostic factors which will influence how the cancer is managed ?
- Pattern of invasion - small islands and single cells associated with poorer prognosis vs. bulbous rete pegs.
- Depth of invasion - >4mm poorer prognosis.
- Perineural invasion - poor prognosis if secondary tumour in large nerve distant from primary tumour.
- Invasion of vessels - associated with lymph node involvement & poorer prognosis.
OM
Explain field cancerisation concept.
- Whole mouth exposed to aetiological factor.
- Same changes in cells might be occuring in different locations in the mouth at different rates.
- i.e. not always metachronous lesions (secondary tumours), can be synchronous lesions.
