1. What is the 2nd most common cause of death in the US?
  2. Which cancer is the most common cause of death?
    Men and women: lung cancer
  3. How prevalent is oral cancer?
    • Oral cancer is the 8th most common cancer in men.
    • Not as common in women
  4. What is the ratio of oral cancer between men and women?
    2:1 M/F
  5. How many cases of oral cancer exist worldwide?
    8.1 million cases
  6. Which region has the highest incidence of oral cancers?
    • Melanesia, near Australia
    • More common in developed regions (smoking)
  7. How many cancer cases are oral cancer?
  8. Signs and symptoms of oral cancer
    • Non-healing ulcer
    • White/red patch on gums, tongue, oral lining
    • difficulty chewing/swallowing
    • Numbness in the mouth
    • Soreness
  9. Where are ulcers most suspicious?
    Dorsal tongue and floor of the mouth
  10. Oral tissue inspection list (know well)
    • Discoloration
    • Ulceration
    • Dryness
    • Swelling
    • Extraoral salivary gland exam (lymphatic, fmx, probing)
  11. What is the first area you check when screening for oral cancer?
    Lymph nodes
  12. Difference in painful vs. painless lymph palpation
    • Painless: possibly metastatic cancer!
    • Painful: inflammatory process
  13. What is the most common type of oral cancer?
    Squamous cell carcinomas
  14. What most effectively improves morbidity and mortality of oral cancer?
    Early detection and screening
  15. Environmental risk factors of oral cancer
    • Tobacco- most common risk factor
    • Alcohol
  16. Non-environmental risk factors of oral cancer
    • Genetic predisposition (oncogenes, tumor suppressor genes)
    • Human papilloma viruses
  17. 5 year survival rates for blacks and whites
    • Black: 40%, peak mortality age 55-64 years
    • White: 60%, peak mortality age >75 years
  18. How many oral cancer patients smoke?
    9/10 oral cancer patients smoke
  19. What element in tobacco has been isolated to induce buccal carcinoma?
    Hydrocarbons (benzopyrene)
  20. White lesions associated with smoking
    • Nicotinic stomatits
    • tobacco pouch
    • submucous fibrosis
    • pipe smokers
  21. Nicotinic stomatitis
    • Associated with pipe/cigar smoking
    • Correlation with severity and smoking intensity
    • Greatly increased by reverse smoking
    • Increased keratinization(opaque with red dots- salivary ducts)
    • Entire palate is white
  22. Chewing tobacco pouch
    • Placed in mucobuccal fold
    • Changes occur in cheek mucosa
  23. Submucous fibrosis
    • Thick, leathery buccal mucosa
    • Chronic ulceration
    • Moderate trismus (fibrosis of TMJ)
    • Indian male betel quid use
  24. Which diet can prevent HNSCC and precancer?
    • Diets rich in fresh fruits and vegetables
    • Vitamin A
  25. What are biomarkers used for?
    • To measure the progress of disease 
    • To measure treatment effects
  26. What are the two most common tumor suppressor genes?
    p53 and p16
  27. What are the three apoptotic genes?
    • Bcl-2
    • Bax
    • TGF-a
  28. Which virus plays a role in oropharyngeal carcinomas?
    Human papilloma virus (HPV)
  29. What are the two proliferative markers?
    • PCNA (proliferating Cell Nuclear Antigen)
    • Nuclear protein (Ki-67)
  30. What are oncogenes?
    • Control cell growth, proliferation, and differentiation
    • Can mutate to produce abnormal products or overexpress genes
  31. p53 Tumor suppressor gene
    • Important role in normal growth and differentiation
    • Mutation inactivation can result in a tumor
    • Found on chromosome 17
    • Mutated in 45% of SCC
  32. Human papilloma virus
    • 100+ types
    • HPV 6 and 11- condylomas and papillomas
    • HPV 16 and 18- tumorogenic in epithelial cells
    • E6 and E7- viral oncoproteins in HPV 16 and 18. inactivate p53
  33. Where is HPV mostly present?
    • In young female tongue SCC (non smokers and non drinkers)
    • HPV 16 in 25% of HNSCC (oropharynx and tonsillar)
    • HPV is positive in 4-12% of oral cavity SCC
  34. What are the two HPV vaccines available?
    • Gardasil- against HPV 6, 11, 16, 18 (quadrivalent)
    • -prevents genital warts in both genders
    • Cervarix- against HPV 16, 18 (bivalent)
    • -does not protect against genital warts
    • -high risk vaccine
  35. What are the dosage recommendations for Gardasil and Cervarix?
    Both are given in 3 doses at 6 month intervals
  36. At what age should females receive the HPV vaccine?
    • 11-12 years or 13-26 if not previously vaccinated
    • As young as age 9 if high risk
  37. Which has a better prognosis, HPV + or - SCC?
    HPV + has a better prognosis
  38. What is the order of oral cancer progression?
    • 1. Benign squamous hyperplasia
    • 2. Dysplasia
    • 3. Carcinoma in-situ
    • 4. Carcinoma
  39. Image Upload 1
    • Intraepithelial neoplasia
    • Invasion of CT has not occurred yet
  40. Image Upload 2
    • Squamous cell carcinoma
    • Invasion of the connective tissue
  41. Leukoplakia vs. Erythroplakia
    • Leukoplakia- 15% dysplasia and 20% CA development
    • Erythroplakia- 90% dysplasia and >75% CA development
  42. Leukoplakia
    • White patches that don't rub off
    • Wide range of clinical and microscopic presentations
    • usually related to localized irritation
    • Most are benign
  43. Leukoplakia of ventral tongue surfaces and floor of mouth
    • Hardest areas to access
    • Likely cancer (few physical trauma sources)
    • Likely will need surgery
  44. What are the 3 types of oral cancer staging (TNM system)
    • Size of tumor
    • Degree of local invasion
    • Extent of spread-metastasis 
  45. Stages of Oral cancer spread
    • 0- Carcinoma in situ
    • 1- confined to site of origin
    • 2- cancer is locally invasive
    • ---progression around 41 months---
    • 3- spread to regional structures
    • 4- spread to distant sites
    • after stage 4, unresectable in 4 months
  46. Second primary tumors
    • Known consequence of oral SCC
    • 25-40% develop SPT over time
    • Does not improve with smoking cessation
  47. Three levels of Oral cancer reduction
    • 1. Primary prevention (tobacco)
    • 2. Secondary prevention (screening, early detection)
    • 3. Improved treatment
  48. Oral brush biopsy
    • Detection of precancerous and cancerous mouth lesions
    • Complete transepithelial tissue sample
    • Not a definitive diagnostic tool
  49. Toluidene blue
    • Basic thiazine metachromatic dye with nucleic acid affinity
    • Used for suspicious malignant lesions
    • Stains actively growing tissues
    • Only retained in dysplastic sites
  50. What part of an ulcerated lesion do you biopsy
    The borders, not the middle!
  51. oral speculoscopy
    • Visualizes leukoplakic areas
    • Uses diffuse chemiluminescent light
    • Detects atypical or dysplastic mucosal abnormalities
  52. Velscope 
    • Visually enhanced lesion scope
    • Watch for changes in color
    • Emits a pale green fluorescence normally
    • Dysplastic and early tumor cells appear green to black
    • -loss of fluorescence
  53. What is the only tool that can confirm oral cancer diagnosis?
  54. Which HPV strains can cause oral cancer?
    16 and 18
  55. Which is more likely cancerous, moveable or fixed lymph nodes?
    Fixed lymph nodes are more likely cancerous
  56. Do SPTs usually occur in the primary site?
    No. Remember they are secondary
  57. What percent of leukoplakia lesions progress to cancer?
Card Set
Oral Pathology 2