Term
Definition of Oral submucous Fibrosis |
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Definition
Chronic, progressive, scarring, high-risk precancerous condition of oral mucosa linked to chronic oral use of betel nute quid (paan) |
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Term
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Definition
Nut from areca palm tree mixed w/ slaked lime, usually w/ tobacco and sometimes sweeteners and flavoring agents, wrapped in betel leaf |
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Term
What effects of slaked lime have? |
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Definition
Releases alkaloids from areca nut producing sense of euphoria and well being |
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Term
What do areca nut alkaloid (arecoline) and flavonoids do? |
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Definition
Stimulate collagen synthesis and are carcinogenic |
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Term
What is process of fibrosis? |
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Definition
Increased collagen synthesis and reduced matrix degradation mediated through transforming growth factor-beta leads to fibrosis |
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Term
Clinical features of Oral submucous Fibrosis |
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Definition
-Progressive pallor, fibrosis, and marble-like rigidity of tissues usually beginning in soft palate and fauces, then involving buccal mucosa, lips and tongue
-Ulcers, areas of erythema, vesicles, petechiae, melanosis, xerostomia, and symptoms of burning usually first signs/symptoms; then dev marble-like pallor and progressive stiffness of subepithelial tissues
-Palpable fibrous bands run vertically down buccal mucosa in advanced lesions leading to reduction in mouth opening and trismus
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Term
Histopathologic features of oral submucous fibrosis |
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Definition
CT shows dense, hypovascular collagen w/ varying # of inflammatory cells
Epithelium may show subepithelial vesicles, then hyperkeratosis, epi atrophy
Epithelial dysplasia present in 10-15% of cases; carcinoma in 6-8% |
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Term
Treatment and prognosis of oral submucous fibrosis |
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Definition
TX: Following biopsy to exclude dysplasia or carcinoma, mild cases may be treated with intralesional corticosteroids to reduce symptoms; surgical splitting or excision of fibrous bands
PX: must be following carefully for dev of epidermoid carcinoma - 8% |
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Term
Definition of Actinic Cheilosis |
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Definition
Premalignant alteration of lip vermillion resulting from excessive exposure to UV radiation of sunlight |
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Term
Most common location for actinic cheilosis is? |
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Definition
Lower light, in light complexion people who burn more easily |
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Term
Clinical features of actinic cheilosis |
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Definition
Most common after age 45; M/F up to 10:1
Slowly dev; atrophy of vermillion border, blurring of margin between vermillion and skin
Becomes scaly, dry, thick, leukoplakic, peeling, ulcerative |
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Term
Histopathologic features of actinic cheilosis |
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Definition
Epithelial atrophy, hyperkeratosis, varying degrees of epi dysplasia
Underlying CT shows band of amorphous, acellular basophilic change (solar or actinic elastosis) due to UV induced alteration of collagen and elastic fibers |
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Term
Treatment and prognosis of Actinic Cheilosis |
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Definition
Lip balm w/ sunscreen for mild cases
Surgical lip or laser ablation
6-10% dev epidermoid carcinoma, usually well-differentiated, usually after age 60 |
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Term
Keratoacanthoma definition |
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Definition
Self-limiting, epithelial proliferation w/ strong clinical and histopathologic similarity to well-differenctiated squamous cell carcinoma.
Known as well-differentiated form of SCC |
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Term
Types of lesions of keratoacanthoma |
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Definition
Cutaneous lesions arise from infundibulum of hair follicles
Oral lesions are rare (some don't accept as intraoral disease) |
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Term
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Definition
Unknown but thought sun exposure and HPV subtypes 26 and 37 have been proposed. |
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Term
Increased lesions of keratoacanthoma could be associated with what disease? |
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Definition
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Term
Clinical features of Keratoacanthoma |
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Definition
Males mostly over 45
95% found on sun exposed skin
Firm, nontender, well-demarcated, sessile, dome-shaped nodule w/ a central plug of keratin |
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Term
Evolution stages of Keratoacanthoma |
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Definition
Growth phase, Stationary phase, involution phase |
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Term
Treatment for Keratoacanthoma |
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Definition
Surgical excision is preferred treatment and 4-8% if pts experience regrowth |
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Term
Definition of SCC (sqamous cell carcinoma) |
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Definition
Malignant neoplasm of squamous epi |
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Term
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Definition
Most common malignancy of oral cavity (94%)
22,000 new cases/year in US; 5,300 die
SCC of lip not as aggressive, behaves more like SCC of skin |
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Term
Key to reducing incidence of SCC: |
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Definition
Increasing understanding, awareness, and avoidance of etiologic factors
WHERE PTs COME IN! |
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Term
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Definition
Candidal infection
Oncogenic viruses: HPV 16, 18, 31, 33; HPV 16 pos better prognosis than HPV neg; EBV esp in nasopharyngeal Ca; HSV evidence less compelling
Immunosuppression
Oncogenes and tumor suppressor genes (p53) |
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Term
Key to reducing death rate w/ SCC: |
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Definition
High index of suspicion leading to early diagnosis
THATS WHERE WE COME IN! |
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Term
General clinical features of SCC |
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Definition
- US most common in older adults (exceptions)
Male to female: 3:1
Often painless and hides in dark places, leading to tragic delay in diagnosis and consequent advancement in stage before treatment
Can mimic other more harmless conditions |
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Term
Clinical presentations of SCC |
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Definition
Exophytic (mass forming, fungating, papillary, verruciform)
Endophytic (invasive, burrowing, ulcerated)
Leukoplakic
Erythroplakic
Erythroleukoplakic |
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Term
Principle regions of oral cancer involvement in SCC: |
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Definition
Lips, intraoral, oropharyngeal |
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Term
Histopathologic Features of SCC |
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Definition
-Neoplastic islands, strands, sheets and individual cells invade underlying tissue including fibrous CT, muscle, nerves, and blood vessels
-Neoplastic epi characterized by all changes listed as dysplastic
-Neoplasms vary in differentiation from well to moderately to poorly to undifferentiated: well differentiated appears much like normal epi cells and tissue; undifferentiated very difficult to recognize
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Term
Histopathologic Criteria for Epithelial dysplasia |
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Definition
Enlarged nuclei & cells, large & prominent nucleoli, increased nuclear-to-cytoplasmic ratio, hyperchromatic nuclei, pleomorphic nuclei and cells, dyskeratosis and individual cell keratinization, increased mitotic activity, abnormal mitotic figures, bulbous or teardrop-shaped rete ridges, loss of polarity, keratin or epi pearls, loss of typical epi cell cohesiveness
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Term
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Definition
Most common: ipsilateral cervical nodes: stony hard, nontender, enlarged and may be fixed; occasionally contralateral or bilateral nodes; small % have distant metastasis: most commonly lungs, liver, bone but any site may be involved
SCC of lowerl ip and oral floor: submental nodes
SSC from posterior oral cav: superior jugular and digastric nodes, retropharyngeal nodes
Farther posterior primary, greater chance of local and distant metastasis |
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Term
Histologic Grading of SCC |
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Definition
Degree to which histologically resembles its parent tissue (squamous epi) reflected in histologic grade (grade 1-3 or 4)
Can also be graded according to degree of differentiation (well, moderately, poor, undifferentiated)
Higher grade number (3 or 4) more poorly differentiated the tumor vice versa |
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Term
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Definition
Most reliable indicator of prognosis of most malignancies
TNM system used: T = size of primary tumor in cm; N = involvedment of local lymph nodes; M = presence of distant metastasis |
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Term
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Definition
Anterior 2/3s is wide surgical excision often following by radiation;chemo
Posterior 1/3 solely radiation w/ or w/out chemo
Lymph node dissection (radical neck dissection) may be done if involved clinically or risk of involvement is high |
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Term
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Definition
Overall 5-year survival of Oral SCC remains at 5-59%
Tends to be better anteriorly than posteriorly
Early detection can minimize advancement of cancer
Increased risk (6-44%) of getting other malignancies |
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