SCCA

Question 1

Oral cancer - new cases in 2015? Deaths?

Answer 1

45K new cases

8K deaths

Question 2

5 year survival rate for oral cancer?

Answer 2

62%

Question 3

Most oral cancer is what kind?

Answer 3

SCCA 89%

Question 4

Clinical presentation of oral SCCA

Answer 4

Leukoplakia
Erythroplakia
Non-healing ulceration
Exophytic mass

Question 5

Leukoplakia clinical features

Answer 5

Well-demarcated
Verrucous
Nodular
Speckled (erythro-leukoplakia)

Question 6

Gender predilection for leukoplakia

Answer 6

Way more for males

Question 7

Proliferative Verrucous Leukoplakia (PVL) related to Leukoplakia how?

Answer 7

Multifocal recurrent leukoplakia

Question 8

Proliferative Verrucous Leukoplakia transforms how much into SCCA?

Answer 8

70% transform into Verrucous CA or SCCA

Question 9

Proliferative Verrucous Leukoplakia associated with what habit?

Answer 9

tobacco

Question 10

Erythroplakia vs leukoplakia

Answer 10

Less common

More worrisome

Question 11

Erythroplakia diagnoses %
Dysplasia
Ca-In-Situ
SCCA

Answer 11

9% Dysplasia
40% Ca-In-Situ
51% SCCA
(way worse than Leukoplakia)

Question 12

Management of Leukoplakia and Erythroplakia

Answer 12

Biopsy all unexplained red/white lesions persisting>2 weeks, prioritize heterogeneous areas

Question 13

Oral epithelial dysplasia microscopic features

Answer 13

Basilar hyperplasia
Tear-drop shaped rete ridges
Loss of normal stratification Dyskeratosis
Nuclear enlargement & hyperchromaticity
Cellular pleomorphism
Increased mitotic activity

Question 14

Levels of oral epithelial dysplasia

Answer 14

Mild - lower 1/3
Moderate - lower 2/3
Severe - >2/3
Ca-in-situ - full-thickness

Question 15

Risk factors for oral cancer

Answer 15

Tobacco
Alcohol
Areca nut
Actinic damage (from sun, NOT trauma)
HPV infection
immune suppression
Family or H/O cancer
Sanguinaria

Question 16

More tobacco has what effect on risk of scca?

Answer 16

more tobacco = more risk

Question 17

Smokers consist of what % of leukoplakias

Answer 17

80%

Question 18

Risk of SCCA is how much greater for smokers

Answer 18

6x

Question 19

How does risk change when smoking stops?

Answer 19

declines with time

Question 20

Heavy drinkers (4 per day) risk of SCCA how much greater?

Answer 20

2-14x greater

Question 21

Effects of alcohol and tobacco on SCCA risk are…? What is combined risk?

Answer 21

synergistic, 30x combined risk

Question 22

Epithelial dysplasia of lip is?

Answer 22

Actinic Cheilitis

Question 23

Actinic cheilitis occurence?

Answer 23

90% lower lip

Question 24

Actinic cheilitis resembles what cancer most?

Answer 24

skin cancer

Question 25

Low risk HPV types?

Answer 25

HPV 6 & 11

Question 26

Low risk HPV causes?

Answer 26

squamous papillomas

Question 27

High risk HPV types?

Answer 27

16 & 18

Question 28

High-risk HPV causes?

Answer 28

HPV-associated epithelial dysplasia

Question 29

Plummer-Vinson Syndrome common in...

Answer 29

Scandinavian females

Question 30

Plummer-Vinson Syndrome causes

Answer 30

oral/eso SCCA, iron deficiency anemia

Question 31

Oral submucous fibrosis characterized by what?

Answer 31

scarring of mucosa, precancerous condition (19x risk)

Question 32

oral submucous fibrosis associated with eating what

Answer 32

betel quid, asian thing

Question 33

Oral SCCA gender predilection?

Answer 33

male to female 2.5:1

Question 34

Oral SCCA average age at diagnosis?

Answer 34

62

Question 35

What is field cancerization?

Answer 35

patience with with one oral cancer are at increased risk for additional ones (35% within 5 years)

Question 36

Intraoral high-risk locations for oral SCCA?

Answer 36

Ventro-lateral tongue Floor of mouth Soft palate

Question 37

Most oropharyngeal carcinomas attributed to what infection?

Answer 37

HPV - improved prognosis

Question 38

Oral SCCA metastasizes to what lymph nodes

Answer 38

Ispilateral cervical lymph nodes - 21% SCCA, 50% oropharyngeal Lip cancer to submental nodes

Question 39

Nodes with metastatic carcinoma usually what apperance?

Answer 39

hard, nontender, enlarged

Question 40

Distant metastatic sites of oral SCCA?

Answer 40

lungs, liver, bones

Question 41

Verrucous Carcinoma is a variant of what?

Answer 41

low-grade variant of oral SCCA,

Question 42

Verrucous carcinoma who gets?

Answer 42

avg age 65-70, male predilection

Question 43

Verrucous Carcinoma locations?

Answer 43

everywhere but soft palate, floor of mouth

Question 44

Verrucous Carcinoma associated with consumption of what

Answer 44

smokeless tobacco

Question 45

Verrucous Carcinoma histopath features?

Answer 45

deceptively bland microscopic apperance

Question 46

Verrucous Carcinoma treatment, prognosis?

Answer 46

excision, 90% cure rate at 5 years