Oral Cancer Clinical Correlates

Question 1

EPITHELIAL MALIGNANCY (SKIN, MUCOSA, GLANDS) IS TERMED ______

Answer 1

Carcinoma

Question 2

WHEN TISSUES OF MESENCHYMAL ORIGIN BECOME MALIGNANT THEY ARE TERMED ______

Answer 2

Sarcomas

Question 3

% increase in cancer since 70s

Answer 3

15%

Question 4

Incidence of oral cancers (what % of all cancers are oral)

Answer 4

2.9%

Question 5

Oral cancer is more common in who (men or women)

Answer 5

16.9 men and 6.2 in women (11.2/100,000 in US)

Question 6

Squamous cell carcinoma probability if black

Answer 6

~Same in latest data

Question 7

Localized vs metastatic survival rates Vs Regional

Answer 7

Metastatic has much worse survival rates than both

Localized > Regional

Question 8

Prognosis of whites vs blacks

Answer 8

African Americans lower prognosis, probably SES

Question 9

SEER

Answer 9

Surveillance Evaluation End Results-Data on cancer

Question 10

Death rates of black vs white in oral cancer

Answer 10

Black higher death rates

Question 11

THE ORAL CAVITY:

Answer 11

THE AREA BOUNDED BY THE LIPS, THE HARD AND SOFT PALATE, THE TONGUE AND THE FLOOR OF THE MOUTH-HIGHLY VASCULAR

Question 12

What is significant regarding oral cavity metastisis

Answer 12

Lymph drainage into oral cavity

Question 13

Why oral cancer diagnosis is so bad

Answer 13

Lymph drainage

Question 14

Oral cancer and oral pharyngeal cancer? Same?

Answer 14

NO! Oral-pharyngeal cancer has much higher survival rates- not as bad

Question 15

Most common type of oral cancer?

What are the rest?

Answer 15

95% cancer cell carcinoma

4% are adenocarcinoma

1% something else

Question 16

Etiology of SCC

Answer 16

Tobacco-smoking is biggest factor

Question 17

SCC is a _____ driven disease

Answer 17

Smoking/tobacco

Question 18

Other etiology of SCCA

7

Answer 18

 Alcohol
 UV radiation (lower lip)
 Protracted irritation
 Poor oral hygiene
 Betel nut
 Virus- human papilloma types 16,18 and 33
 Tobacco

Question 19

Betel nut

Answer 19

Will cause SCC, wrap in a leaf and suck on it?

Question 20

HPV virus types that cause SCC

Answer 20

16,18,33

Question 21

_____ times more likely to have a second primary lesion after 5 year survival

Answer 21

20x

*Also at risk for other cancers

Question 22

TNM classification used for

Answer 22

wide variety of tumors

Question 23

Prognosis of TMN

Answer 23

always worse for higher stages

Question 24

For most malignant tumors, stage ____ disease not generally considered curable

Answer 24

Stage IV

Question 25

Tx tumor

Answer 25

cannot be assessed

Question 26

T0 tumor

Answer 26

no evidence of primary tumor

Question 27

Tis

Answer 27

Carcinoma in situ-has not penetrated to the CT beneath epithelial tissue

Question 28

T number gets bigger

Answer 28

gets worse

Question 29

T4 Tumor **IMPORTANT

Answer 29

T4 Tumor invades adjacent structures e.g., through cortical bone, into maxillary sinus, skin, pterygoid muscle, deep muscle of tongue. (Gingival tumors become T4 quickly) **T4 not big here, but penetrates into adjacent structures

Question 30

"best T you can get"

Answer 30

Tis

Question 31

N means what in TNM

Answer 31

Nodes present? Feel, radiographically?

Question 32

T in TNM means

Answer 32

Primary tumor

Question 33

Nx N0 N1

Answer 33

NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension

Question 34

N3

Answer 34

N3 Metastasis in a lymph node more than 6 cm in greatest dimension this is the biggest

Question 35

Staging of TNM cancer 0-IV

Answer 35

```  Stage 0 (carcinoma in situ) Stage I Minimal Localized Disease Stage II More extensive localized disease Stage III Node positive disease Stage IV Distant metastatic disease ```

Question 36

M of TNM Mx, M0, M1

Answer 36

Distant Metastasis (M) MX Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis

Question 37

T4 lesions include what

Answer 37

(Remember T4 lesions include any that erode into bone)

Question 38

For most types of malignancies, Stage ___implies incurable disease.

Answer 38

IV

Question 39

Curative intent curing

Answer 39

chemo/radiation

Question 40

Dentist role in oral cancer

Answer 40

Diagnose/catch early!

Question 41

Pallative treatment

Answer 41

without curative intent, more for comfort

Question 42

Oral cancer visible?

Answer 42

Yes, and palpable

Question 43

Squamous cell carcinoma often arises from “______” which appear as

Answer 43

pre-malignant white, red, or white and red lesions.

Question 44

Tumor looks like what

Answer 44

a painless, non-healing ulcer

Question 45

Are leukoplakia and erthroplakia diagnostic **KNOW THIS Describe these Potential to do what?

Answer 45

Leukoplakia and erythroplakia are descriptive terms, not diagnoses A white plaque or red plaque that cannot be characterized as any other disease. -CANNOT BE WIPED OFF No uniform histologic appearance Both can potentially give rise to (or be) oral scca

Question 46

Dysplasia is characterized by four major pathological microscopic changes: (histological findings of cancer cells)

Answer 46

 4.Presence of mitotic figures (an unusual number of cells which are currently dividing – often abnormal mitotic figures) Dysplasia is characterized by four major pathological microscopic changes:  1.Anisocytosis (cells of unequal size)  2.Poikilocytosis (abnormally shaped cells)  3.Hyperchromatism (excessive pigmentation) *NOT on his section by had with Maloney

Question 47

Diffuse leukoplakia lateral border tongue

Answer 47

invasive s.c.c.

Question 48

ERYTHROPLAKIA

Answer 48

A RED LESION, VELVETY, OFTEN GRANULAR, CIRCUMSCRIBED AREAS THAT MAY OR MAY NOT BE RAISED WITH POORLY DEFINED BOUNDARIES. HISTOLOGICALLY, ERYTHROPLAKIA ALMOST ALWAYS REVEALS MARKED DYSPLASIA

Question 49

Verrucous carcinoma maxillary ridge

Answer 49

Wart like, not as bad

Question 50

Erythroplakia % transformation to SCC

Answer 50

50% **KNOW THIS

Question 51

Leukoplakia or erythroplakia worse?

Answer 51

Erythro-transform to SCC 50%

Question 52

ERYTHROPLAKIA:

Answer 52

“SPECKLED” LESIONS (MIXED RED AND WHITE) BEHAVE LIKE ERYTHROPLAKIA

Question 53

MINOR GLANDS ______ PROGNOSIS THAN MAJOR GLANDS

Answer 53

Poorer

Question 54

Melanomas | Appearance? Might look like?

Answer 54

Pigmented, hard to distinguish. Melanotic macule, amalgam tatoo

Question 55

Melanotic macule

Answer 55

freckle in the mouth

Question 56

Melanomas spread through

Answer 56

Blood

Question 57

Why do you not cut across pigmented lesions

Answer 57

Melanomas-spread through blood

Question 58

Frequency of oral sarcomas, scca and salivary tumors, metastatic tumors to the jaws

Answer 58

ORAL SARCOMA (AND OTHER SARCOMAS) MUCH LESS COMMON THAN SCCA OR SALIVARY TUMORS. ALSO LESS COMMON THAN METASTATIC TUMORS TO THE JAWS.

Question 59

Metastasis to the jaw indicates

Answer 59

Metastasis to the jaw indicates stage IV disease, very poor prognosis

Question 60

Tumors most commonly metastasize from where to the mouth

Answer 60

Lung, Breast, Colon, Kidney

Question 61

Brush-biopsy of mouth Can you diagnose cancer with it?

Answer 61

take scraping and -not very telling NO

Question 62

Remove more or less teeth in cancer patients

Answer 62

more

Question 63

Remove more or less teeth in cancer patients

Answer 63

more

Question 64

Clinical diagnostic aids

Answer 64

Do not replace biopsies

Question 65

Clinical practice for biopsing lesions

Answer 65

Best clinical practice is to not biopsy lesions that | are strongly suspicious for cancer – refer it to the treating surgeon untouched