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Oral Cancer Flashcards

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1
Q

What is the 5 yr survival for mouth cancer?

A

<50%

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2
Q

What is the commonest cancer of the mouth?

A

Squamous cell carcinoma

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3
Q

What are the risk factors of oral cancer?

A
  • Tobacco
  • alcohol
  • HPV (OPC)
  • age
  • deprivation
  • genetics
  • diet
  • M>F
  • previous cancer
  • potentially malignant conditions
  • immunocompromised
  • sunlight/UV light - lip cancer
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4
Q

what is dysplasia?

A

abnormal growth

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5
Q

how does a cell become cancerous?

A

cancer results from a mutation in genes resulting in a cell that grows and proliferates at an uncontrolled rate, is unable to repair DNA damage within itself, or refuses to die

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6
Q

what is a prognosis?

A

prediction of the probable course and outcome of a disease. Appropriate tx and estimated survival

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7
Q

what classification is used for staging malignant tumours?

A

TNM

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8
Q

What cancers fall under the umbrella of head and neck cancers?

A
  • mouth
  • oropharynx
  • nasopharynx
  • hypopharynx
  • ear
  • nose
  • paranasal sinuses
  • larynx
  • salivary glands
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9
Q

what area of the mouth are we concerned about when talking about mouth cancer?

A

anterior 2/3 of tongue

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10
Q

what area of the mouth are we concerned about when talking about oropharyngeal cancer?

A

posterior 1/3 of tongue

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11
Q

what is the largest risk factor of oral cancer?

A

tobacco

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12
Q

what is the second largest risk factor of oral cancer?

A

alcohol

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13
Q

what age group does oral cancer mostly effect?

A

> 55

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14
Q

how does alcohol contribute to mouth cancer?

A

it causes thinning of the overlying mucosa making it more permeable for the carcinogens to enter the epithelial cells

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15
Q

what are the different forms of consuming tobacco?

A
  • roll ups
  • cigarettes
  • chews
  • cigars/pipes
  • snuff
  • betal nut/quid
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16
Q

what is oral submucous fibrosis?

A

abnormal collagen deposition

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17
Q

what does excessive alcohol consumption do to the metabolic pathway for oxidation of ethanol?

A

slows it down, preventing acetaldehyde from converting to acetate

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18
Q

what is the recommended alcohol consumption per week in units?

A

14

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19
Q

how long does it take the body to eliminate 1 unit of alcohol?

A

1 hr

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20
Q

how can a poor diet contribute to oral cancer?

A

low fruit and veg increases risk
insufficient levels of supplements such as iron can cause the mucosa to become thinner making it more permeable for carcinogens

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21
Q

what is the known carcinogen in alcohol?

A

ethanol is broken down into acetaldehyde

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22
Q

where is alcohol metabolised in the mouth?

A

salivary glands
mucosa
oral bacteria

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23
Q

what is the metabolic pathway for oxidation of ethanol?

A

ethanol > acetaldehyde > acetate > CO2 > H2O

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24
Q

what is the third biggest risk factor for mouth cancer?

A

Human Papilloma Virus

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25
which high risk HPVs are associated with mouth cancer?
HPV 16 and 18
26
what are the low risk HPVs?
HPV 6 and 11
27
what are the 2 main benign oral HPV lesions?
papilloma condylomata
28
does mouth cancer generally give patients symptomatic or asymptomatic lesions?
asymptomatic
29
what does it mean for an area of the mouth do be indurated?
hard and rubbery
30
what are the 2 main risk factors behind HPV?
number of sexual partners weakened immune system
31
what is the epstein-barr virus (EBV)?
a type of herpes virus
32
what does EBV most commonly cause?
glandular fever
33
what is the most common oral symptom of a HIV positive patient?
oral candidiasis hairy leukoplakia accelerated periodontal disease kaposi's sarcoma salivary gland disease oral ulcers
34
what is kaposi's sarcoma?
a rare type of cancer that affects the skin, mouth and occasionally the internal organs
35
what are usually the first symptoms of kaposi's sarcoma?
red, purple or brown patches, plaques or nodules on the skin
36
where is commonly effected by UV light as a risk of mouth cancer?
lower lip
37
what is the most common lesion with a viral aetiology?
papilloma
38
what are the 3 types of prevention?
primary secondary tertiary
39
define primary prevention and what is the role of the clinician here?
prevents a disease from developing giving risk factor education - e.g. smoking/alcohol consumption
40
define secondary prevention and what is the role of the clinician here?
to detect disease while it is localised or 'early' screening oral cavity - looking for what is normal/abnormal
41
define tertiary prevention and what is the role of the clinician here?
to mitigate morbidity from established disease and to improve quality of life maintaining oral health and remaining dentition after patients have been treated/undergoing treatment also giving advice regarding risk factors
42
what does OPMD stand for?
Oral Potentially Malignant Disorder
43
name a common OPMD
lichen planus
44
what is meant if something is homogenous?
uniform/normal in colour, texture
45
are white or red lesions more worrying?
red
46
what sites in the mouth are at highest risk for developing mouth cancer?
Lat border of tongue FOM retromolar region
47
what does leukoplakia mean?
clinical term that means a white patch, isn't easily removed with gauze, no obvious risk factors (a white patch of unknown cause)
48
what is the clinical term to describe red lesions of an unknown cause?
erythroplakia
49
what is meant by endophytic?
inwards growing
50
what is meant by exophytic?
outwards growing
51
when can cancers become painful?
when they are secondarily infected or when they invade nerves
52
what is meant by a perineural spread?
cancerous cells that have invaded the nerves
53
what is meant by a vascular invasion?
when there is a presence of cancerous cells in the blood
54
how is the sizes of a lesion recorded?
T sizes
55
how big is a T1 lesion?
<2cm
56
How big is a T2 lesion?
4-6cm
57
How big is a T4 lesion?
>6cm or if it involves bone
58
what should you do if you spot a suspicious lesion?
photograph/document in notes eliminate trauma review refer using urgent pathways (2wks) get another opinion?
59
when examining a patients lymph nodes what are you looking for?
- symmetry - soft non tender lymph nodes - palpate all anatomical sites of lymph nodes - skin moves freely over the nodes they are not attached - think about anatomical drainage from the mouth to the nodes of the neck - symmetrical salivary glands
60
what are papillomas caused by?
Low risk HPVs (6 and 11)
61
what are the features of cancer?
- red/white/speckled lesion - ulcerated areas (often pain free) - high risk sites - symptom free (usually) - unknown duration - RF history
62
Buckman (2005) proposes the communication protocol...to break bad news
SPIKES
63
what does SPIKES stand for?
SETTING and listening skills patients PERCEPTION of condition and seriousness INVITATION from the patient to give information KNOWLEDGE - giving the facts explore emotions and EMPATHISE as patients responds STRATEGY and summary
64
what is the overview for overall oral health assessment and review?
- assessment of patients history - assessment of oral health status - diagnosis and risk assessment - personal care plan
65
what is frictional keratosis?
type of white patch position of lesion corresponds to cause and disappears when cause is removed common on lat border of tongue and cheeks
66
what is lichen planus?
a type of white patch autoimmune disease bilateral reticular lesions, affecting the cheeks, lat tongue, gingivae, skin, scalp and nails
67
what is a lichenoid reaction?
a type of white patch resembles lichen planus can be due to drugs or amalgam if amalgam it will be unilateral on tongue or on cheeks adjacent to restoration
68
what are the clinical features of a traumatic ulcer
position of ulceration corresponds to suspected cause and disappears when removed
69
what are the clinical features of minor aphthous ulcer?
recurrent, young individuals, painful, small lesions, lips FOM. last 10-14 days
70
what are the clinical features of a squamous cell carcinoma ulcer?
long duration, non healing ulcer, no obvious cause, raised rolled margins, firm/hard to touch high risk sites include FOM lat border of tongue, retromolar area
71
what does a herpes ulcer look like?
on gingivae and palate patients systemically unwell lasts 10-14 days
72
what do pemphigus vulgaris ulcers look like?
blisters which break down to give ulcers and erosions affects older individuals skin lesions
73
what is a list of benign lesions?
- leaf fibrosis - denture induced hyperplasia - papillary hyperplasia - papilloma - condylomata - toris mandibularis palatinus - apthous ulcers - lipoma - mucocele - epulis
74
what is an epulis?
chronic area of irritation - overhang gum swelling preg hormones
75
what causes a mucocele?
trauma to salivary gland
76
what is an apthous ulcer?
clusters pain resolve in two weeks
77
what causes papilloma or codylomata?
low risk HPV (6,11)
78
When do you screen patients for oral cancer?
recalls new patients concerns review
79
what are you feeling for lymph nodes?
- not ewnlarged - not tender - freely moving - symmetry - not firm/indurated
80
what is the prevalence of cancer?
90% = SSC high prevalance - most deprived 6th common cancer in scotland males >55 56% year survival
81
what carcinogens does tobacco contain?
- arsenic - tar - acetylaldehyde - Carbon monoxide
82
what effects the diagnosis?
- proliferation rate - aggressive nature - deprivation - education - delayed professionals - low confidence, lack of time, fear of inducing anxiety
83
what are the features of cancer?
- unknown duration - non-wipeable - RFs - ulcerated - risk sites - size >200mm - heterogenous - speckled patch - erythroplakia - leukoplakia - no pain
84
what to include in a refferal?
- document details - photographs - referral - biopsy - size - colour - location - time - photographs
85
whats normal?
dorsum of tongue: - black hairy tongue - geographical tongue - fissured tongue Ventral tongue: - frenum - veins - glands - bullae (blister) lateral tongue: - keratosis - clenching bruxism
86
what is routine or urgent referral?
- 2 weeks - unexplained lesion - unknown duration - severe pain - RFs - painless - immunosupressed - leukoplakia - red/speckled - >3 weeks
87
what viruses can cause oral cancer?
HPV low risk 6,11 high risk 16, 18 EBV - burkitts lymohoma HIV - AIDS - weak immune s
88
what is kaposi sarcoma?
HHV8 or HIV oral patches/nodules - red, brown, purple
89
what are the symptoms of lichen planus?
pain/burning associated with auto - immune disease buccal tongue bilateral white red pain/burning
90
what are OPMDs?
oral potentially malignant disorders - leukoplakia - lichen planus - chronic candidiasis - erthroplakia - erythroleukoplakia - leukoplakia

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