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BDS5 Oral Med > Pre-Malignant Conditions > Flashcards

Pre-Malignant Conditions Flashcards

(40 cards)

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1
Q

What is a pre-malignant lesion?

A
  • morphologically altered tissue in which cancer is more likely to occur than in its apparently normal counterpart
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2
Q

What is a pre-malignant condition?

A
  • a condition w/ significantly increased risk of developing cancer
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3
Q

What is Leukoplakia?

A

= predominantly white lesion of the oral mucosa that cannot be
characterised as any other definable disease & not associated w
any physical or chemical causative agent except tobacco

~5% chance of malignant transformation

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4
Q

What are the two appearance types of Leukoplakia?

A
  1. Homogenous
    - uniform flat appearance
    - shallow cracks/smooth/corrugated surface w/ consistent texture
  2. Non- Homogenous (more concerning)
    -white or white+red lesion (erythroleukoplakia)
    - irregularly flat or nodular or exophytic

Nodular lesions = raised, rounded, red + or white

Excrescences exophyic lesions (cauliflower, polyp appearance) = irregular blunt or sharp projection

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5
Q

What is the aetiology of Leukoplakia?

A
  • 10% of oral leukoplakia = idiopathic
    90% assoc. w/ the use of tobacco/ Areca nut
    M > F
  • diagnosed in middle age +
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6
Q

What area of the mouth does Leukoplakia affect?

F^^^ing BMT

A
  • Buccal mucosa (~25% of cases)
  • Mandibular gingiva (~20% cases)
  • Tongue (~10% cases)
  • Floor of mouth (~10% cases)
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7
Q

What are the clinical features that suggest increased risk of malignant transformation of leukoplakia?

SSC AG

A

Surface = raised or nodular

Site- FoM, lateral border of tongue, retromolar region, buccal sulcus (esp paan chewers), labial commissure

Colour = red/ white (speckled)

Age (old)
Gender Female

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8
Q

What is the aetiology of Leukoplakia? (3)

A
  • Tobacco (chewing i.e. paan, or smokeless tobacco i.e. snuff ~ 60% of users develop keratosis at site of snuff placement)
  • Reverse smoking, pipe smoking, smoking cigarettes
  • Candida albican (30% of leukoplakia may contain contain candida aka CHC)
    lesion may show dysplasia, most commonly at corner of mouth, some lesions regress if candida treated systemically w oral fluconazole
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9
Q

What is Erythroplakia?

A

= bright red velvety plaque which cannot be characterised as any other definable lesion (disease)

~80% chance of malignant transformation

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10
Q

Is Eythroplakia always associated with dysplasia?

A

YES, high risk lesions + is always assoc. w/ dysplasia or carcinoma

Risk of malignant change is greatest in lesions showing severe dysplasia, in comparison to those w/ mild dysplastic change

MUST REFER VIA 2 WEEK OM URGENT REFERRAL PATHWAY

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11
Q

Other causes of white patches:

Name 2 conditions that are normal anatomy?

A

1) Fordyce spots

2) Leucoedema

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12
Q

Other causes of white patches:

Name a condition that is developmental ?

A
  • White sponge naevus
    (aka hyperkeratinisation of mucosa)
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13
Q

Other causes of white patches:

Name 3 conditions that are caused by trauma?

A

Frictional Keratosis

Cheek biting

Traumafrom dentures, cusps, restorations, ortho appliance

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14
Q

Other causes of white patches:

Name 2 conditions whose cause is chemical?

A

Aspirin burns

Smokers keratosis (on palate)

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15
Q

Other causes of white patches:

Name 2 conditions whose cause is autoimmune?

A

Lichen Planus

Lupus Erythematous

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16
Q

Other causes of white patches:

Name 2 conditions whose cause is ineffective?

A

CHC

Oral hairy leukoplakia

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17
Q

What are Fordyce Spots/Granules?

Study These Flashcards
A

= common + BENIGN
= appear in childhood (increase at late puberty + adult life)

represent sebaceous glands
creamy-yellow papules (may coalesce on buccal or labial mucosa)

  • tx: reassure pt its normal anatomy
18
Q

What is Leucoedema?

Study These Flashcards
A

= variation of normal
= BILATERAL, diffuse, translucent, greyish appearance on OM
= optical illusion, white patch disappears on stretching of mucosa

mostly affecting black population, occurring in white population too

19
Q

What is Oral Hairy Leukoplakia?

Study These Flashcards
A

= not malignant
- painless
- usually involving lateral borders of tongue
- assoc w. EBV
- If assoc. w/ AIDS, resolves w/ HAART
- may mimic other mucosal diseases

20
Q

What is Lichen Planus?

Naani iss ACE

Study These Flashcards
A

= a pre-malignant condition

  • Pts w/ long standing OLP may develop oral SCC (monitor pts)

Changes to look out for?
-isolated areas of increasing whiteness
- speckling (areas of redness + whiteness)
- solitary ulceration (unlikely to reflect trauma)

Advice given to OLP pts:
- make aware of malignant potential
- Avoid tobacco + alcohol
-Diet rich in Vit A,C, E/ antioxidants
- Good OH + regular visits to GDP

21
Q

What is Chronic Hyperplastic Candidosis?

Study These Flashcards
A
  • uncommon
  • assoc w tobacco use
  • rx to immunodeficiencies sometimes
  • Resistant to topical anti-fungal tx (need to use systemic anti-fungals for 6 weeks)
  • Tx: candida organisms, as they produce malignant compounds
22
Q

Pre-Malignant Conditions:

What is Syphilis + how does it present?

Study These Flashcards
A

= bacterial STI caused by Treponema pallidum Treponema palladium
(primary, secondary, latent + tertiary types)

  • IO pres:
    Syphilitic leukoplakia, presenting on central dorsum of tongue (rare)
    Glossitis w mucosal atrophy

Other oral pres:
painless ulcers (chancres),
mucous patches/maculopapular lesions
on = tongue, lips, + buccal mucosa

Diagnosis: dark-field microscopy, UV microscopy or phase contrast

23
Q

Pre-Malignant Conditions:

What is Sideropenic Dysphagia + how does it present?

aka Patterson Kelly or Plummer Vinson Syndrome

Study These Flashcards
A

aka Patterson Kelly or Plummer Vinson Syndrome

  • Fe def anemia
  • generalised mucosal atrophy
  • oesophageal web
  • middle aged women
24
Q

Pre-Malignant Conditions:

What is Oral Submucous Fibrosis + how does it present?

Prahlaad

Study These Flashcards
A
  • Fibrosis of OM + difficulty opening mouth
  • Marbled mucosa
  • Paan + Betal nut chewers!
    ~ 30% may develop OSCC !
25
Pre-Malignant Conditions: What is Actinic Keratosis + how does it present? 🌞
- sunlight induced changes in the lip (normally lower lip) - increased risk of OSCC!
26
Management of Leukoplakia + Erythroplakia: What clinical information should you gather about the lesion as GDP? (step 1) | **SSS CH**
Determine the level of **RISK**, depending on the: site size surface colour habits
27
Management of Leukoplakia + Erythroplakia: After gathering clinical information, what should you do next as GDP? (step 2)
**Urgent referral to OMFS** (Do not biopsy the lesion yourself!) (If lesion very suspicious, mark the letter as urgent or tx within two week rule & phone relevant consultant. Fax letter & send through post too)
28
What is the survival rate for Oral Cancer?
= only **40%** survival, therefore early detection is KEY 🔑
29
Management of Leukoplakia + Erythroplakia: What type of biopsy would OMFS conduct in hospital setting ? (step 3)
- Always biopsy most suspicious part & include margin of normal tissue! - Incisional biopsy for LARGE LESIONS (multiple biopsies if necessary) - Exicisonal biopsy if lesion= SMALL
30
Management of Leukoplakia + Erythroplakia: What key information should you make the pt aware about post tx/ biopsy?
Regardless of tx, leukoplakia can REOCCUR (current tx, will not prevent progression of future leukoplakia to SSC) Therefore, MODIFICATION OF HABITS is key 🔑
31
What lesions are regarded as high risk?
**ALL red patches** (erythroplakia) **Non-homogenous leukoplakia** i.e. speckled + nodular appearance **All lesions showing dysplasia** (risk of malignant transformation is directly linked to degree of dysplasia identified on histological exam)
32
Management according to level of dysplasia: What is management for a lesion displaying MILD dysplasia? | N A R (mild)
- Advice on tobacco + alcohol cessation - Nutritional assessment - Review every 3-6m (biopsy at 3m to re-assess dysplasia + further biopsy at 2-3yr mark)
33
Management according to level of dysplasia: What is management for a lesion displaying MODERATE dysplasia?
Surgical excision if: lesion = small OR if, pt unlikely to modify RFs For candidal leukoplakia: - Fluconazole tx for 6weeks - VBA for smoking - Re-biopsy after 3m to re-assess dysplasia
34
Management according to level of dysplasia: What is management for a lesion displaying **S**EVERE dys**p**lasia? | SP
1) Surgical excision by: scalpel, laser or cryotherapy 2) Photodynamic therapy: useful for multiple lesions has systemic effect, therefore need to stay in darkened room due to photosensitivity
35
Summary: state 4 crucial facts about leukoplakia + erythroplakia:
1. Both are conditions assoc. **w/ varying risk of malignant transformation** 2. **Degree of dysplasia** within the biopsy is a better indicator of **malignant potential** 3. Erythroplakia almost **ALWAYS shows dysplasia or carcinoma**on biopsy 4. Leukoplakia will show a more **varied degree of dyplasia** (non-homogenous pres. more sinister than homogenous)
36
Histology: Key definitions + terminology (8): [don't need to memorise, just here to refresh memory a little]
**Keratosis** = keratinisation in an epithelium that is not normally keratinised (ie non keratinised epithelium, eg buccal mucosa) **Hyperkeratosis** = Increased thickness of the keratinised layer **Orthokeratosis** = increased keratin w flat, anucleate superficial cells w homogenous eosinophilc cytoplasm **Parakeratosis** = flat, homogenous eosinophilc superficial cells BUT w pyknotic nuclei **Acanthosis** = Increased number of cells in prickle cell layer 🌵 -Associated w broadening of rete ridges & thicker epithelium **Atrophy** = decreased epithelial thickness (thinning epithelium) - Associated w *loss of rete ridges* - Epithelium may be roughly equal thickness throughout **Atypia** = changes to individual cell **Dysplasia** = changes in whole epithelium
37
What are the 10 histological features of oral dysplasia?
1. **Nuclear Hyperchromatism** (increased DNA content) 2.**Nuclear + cellular PLEOMORPHISM** (variation in size+shape) 3. Inc.**nuclear: cytoplasm** ratio 4. Inc. no. of **BIZARRE MITOSES** 5. **Mitosis in prickle cell layer** (normally found in basal cell layer which is lower down) 6. **Premature keratinisation in prickle cell layer** (Acanthosis) 7.**Loss of polarity of basal cells** (nuclei in unusual positions) 8. **Loss of epithelial stratification** 9. **Drop shaped rete ridges** 10. **Loss of cell adherence**
38
What are the histological features of Leukoplakia? (6) | VICAAH
Hyperkeratosis or parakeratosis (responsible for white colour) Variable hyperplasia Acanthosis (inc. thickness of prickle cell layer) 🌵 Atrophy Candidal Hyphae (~30%) Inflammation (may show one of more features of dysplasia listed on other cards)
39
What are the histological features of Erythroplakia? | (oh) DIA
**D**ysplasia **I**nflammation **A**trophy (responsible for red colour)
40
State the grading + features of dysplasia for each grade?
**None**= Epithelial cells appear normal **Mild**=Few epithelial cells in the basal layers show atypia **Moderate**= Most cells in the basal layers & some suprabasally show atypia **Severe**=Almost all cells show atypia but there is no evidence of invasion into the underlying tissues

BDS5 Oral Med (12 decks)

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