Potentially Malignant Disorders and Oral Cancer

Question 1

what is a potentially malignant lesion

Answer 1

altered tissue in which cancer is more likely to form

Question 2

what is a potentially malignant condition

Answer 2

generalised state with increased cancer risk

Question 3

name some potentially malignant oral conditions

Answer 3

lichen planus
oral submucous fibrosis
iron deficiency
tertiary syphilis

Question 4

what version of lichen planus is more likely to be malignant

Answer 4

ulcerative or erosive

Question 5

why is iron deficiency potentially malignant

Answer 5

atrophy of oral epithelium means the barrier function is diminished

Question 6

what types of leukoplakia can be potentially malignant

Answer 6

chronic hyperplastic candidosis
proliferative verrucous leukoplakia

Question 7

what are the 2 general types of potentially malignant lesions in the mouth

Answer 7

leukoplakia
erythroplakia

Question 8

where does chronic hyperplastic candidosis occur

Answer 8

commissures

Question 9

who gets chronic hyperplastic candidosis

Answer 9

smokers

Question 10

what is chronic hyperplastic candidosis caused by

Answer 10

candida albicans

Question 11

what do you need to do if you suspect chronic hyperplastic candidosis

Answer 11

take a biopsy

Question 12

what takes of histology stains are needed for chronic hyperplastic candidosis

Answer 12

2 stains - H&E and PAS (periodic acid schiff)

Question 13

what is seen on the H&E histology of chronic hyperplastic candidosis

Answer 13

excessive keratin formation where epithelium is generally non-keratinised
chronic inflammatory cells
microabscesses in upper layers

Question 14

what would you see on the PAS histology of chronic hyperplastic candidosis

Answer 14

candida albicans hyphae

Question 15

what is the treatment for chronic hyperplastic candidosis

Answer 15

systemic antifungal - fluconazole capsules 50mg once a day for 14 days
biopsy
smoking cessation
observe

Question 16

what factors helps you predict whether a leukoplakia can become malignant

Answer 16

age and gender
idiopathic
site - floor of mouth and tongue
clinical appearance

Question 17

what type of leukoplakia has the highest transformation rate

Answer 17

proliferative verrucous leukoplakia

Question 18

what is seen on the histopathology of a leukoplakia turning malignant

Answer 18

dysplasia
atrophy of epithelium
candida infection

Question 19

what is dysplasia

Answer 19

disordered maturation in a tissuewh

Question 20

at

Question 21

what are the 2 main groups of epithelial dysplasia

Answer 21

architectural changes
cytological abnormalities

Question 22

what type of changes are seen in the architecture of epithelium

Answer 22

abnormal maturation and stratification

Question 23

what type of changes are seen in the cytology of the epithelium

Answer 23

cellular atypia

Question 24

what is the grading of epithelial dysplasia based on

Answer 24

histopathology

Question 25

what is seen in basal hyperplasia

Answer 25

increased basal cell numbers regular stratification but basal compartment larger no cellular atypia

Question 26

what is seen in mild dysplasia

Answer 26

architectural changes in the lower third mild atypia

Question 27

what is seen in moderate dysplasia

Answer 27

architectural changes extend into the middle third moderate atypia

Question 28

what is seen in severe dysplasia

Answer 28

architectural changes extend to upper third severe atypia and numerous mitoses

Question 29

what is seen in carcinoma in situ

Answer 29

abnormal architecture in the full thickness of viable cell layers mitotic abnormalities frequent

Question 30

what are the disadvantages of biopsy

Answer 30

invasive cannot monitor tissue response to treatment effectively not suitable for mass screening

Question 32

what techniques are available to identify potentially malignant lesions

Answer 32

vital staining oral cytology optical imaging

Question 33

what genes are involved in cancer

Answer 33

oncogenes tumour suppressor genes Tp53 genes which regulate apoptosis genes involved in DNA repair microRNA

Question 34

what changes to chromosomes can cause cancer

Answer 34

aneuploidy translocations amplifications

Question 35

what changes to genes can cause cancer

Answer 35

mutations deletions amplifications

Question 36

what are the hallmarks of cancer

Answer 36

self sufficiency in growth signals evading apoptosis insensitivity to anti-growth signals sustained angiogenesis limitless replicative potential tissue invasion and metastasis

Question 37

what is included in the diagnosis of cancer

Answer 37

differentiation and grading pattern of invasive front related to nodal spread local extension of disease

Question 38

what type of front is associated with lymph node involvement

Answer 38

non-cohesive front

Question 39

where can oral cancer spread to

Answer 39

local extension - bone lymphatic spread haematogenous spread

Question 40

when a patient is edentulous how does cancer spread in the bone

Answer 40

in gaps in the cortex of the bone

Question 41

when a patient is dentate how does cancer spread in the bone

Answer 41

along the PDL

Question 42

where does the cancer spread if it spreads along a nerve

Answer 42

along the myelin sheath

Question 43

what system is used for staging oral cancer

Answer 43

TNM

Question 44

what does the letters TNM mean when it comes to staging oral cancer

Answer 44

T - size of tumour you can see N - lymph node involvement M - metastasis