Oral Cancer: Diagnosis, Biopsy Principles and Staging

Flashcards covering the diagnosis pathway, biopsy techniques, histopathologic grading, and TNM staging for oral cancer based on the lecture transcript.

Induration

The most suspicious clinical feature during palpation indicative of potential malignancy.

Dysphagia

Difficulty swallowing, which is an associated symptom to monitor during oral cancer history taking.

Odynophagia

Painful swallowing, identified as a relevant symptom in the assessment of suspicious oral lesions.

Trismus

Difficulty or inability to open the jaw, which can be an indicator of facial nerve weakness or advanced oral cancer.

Paraesthesia

Abnormal sensations, such as numbness or tingling, which is considered a red flag feature for malignancy.

Leukoplakia

A white lesion that usually requires biopsy unless a traumatic cause is identified and resolved.

Erythroplakia

A red lesion that is among those usually requiring biopsy to rule out malignancy.

Site, Size, Shape, Surface, Margin, Colour, Consistency, Tenderness, Fixation

The systematic approach (S-S-S-S-M-C-C-T-F) used for documenting every oral lesion.

Toluidine Blue

A diagnostic adjunct that binds to nucleic acids and preferentially stains areas of increased cellular activity.

Tissue Autofluorescence

A principle where normal tissues fluoresce differently from abnormal tissues when exposed to blue light, utilized by devices like VELscope®.

Brush Cytology

A minimally invasive technique where a rotating brush collects epithelial cells through the full thickness for cytological examination.

Incisional Biopsy

The removal of a representative portion of a lesion, including the junction of normal and abnormal tissue, used for large lesions or suspected malignancy.

Excisional Biopsy

The complete removal of a lesion, appropriate for small lesions less than $1\,\text{cm}$ that appear benign.

Punch Biopsy

A simple and quick technique using a circular instrument to remove a cylindrical core of tissue from flat mucosal lesions.

FNAC

An acronym for Fine Needle Aspiration Cytology, used primarily for assessing enlarged cervical lymph nodes or salivary gland masses.

10% Neutral Buffered Formalin

The specific solution used for immediate fixation of biopsy specimens, ideally in a $10:1$ ratio of formalin to tissue volume.

Mild Epithelial Dysplasia

Histologic grading where the abnormal microscopic features involve the lower one-third of the epithelium.

Moderate Epithelial Dysplasia

Histologic grading where the abnormal microscopic features involve the lower two-thirds of the epithelium.

Severe Epithelial Dysplasia

Histologic grading where abnormal microscopic features involve more than two-thirds of the epithelium.

Carcinoma in situ

Full-thickness epithelial dysplasia with no invasion through the basement membrane.

Invasive Squamous Cell Carcinoma

Malignant epithelial cells that have breached the basement membrane and invaded the connective tissue.

Keratin Pearls

A histologic feature consisting of rounded masses of keratin within cancer islands, characteristic of well-differentiated Squamous Cell Carcinoma.

T1 (Primary Tumour)

A primary tumour that is less than or equal to $2\,\text{cm}$ in its greatest dimension.

T2 (Primary Tumour)

A primary tumour that is greater than $2\,\text{cm}$ but less than or equal to $4\,\text{cm}$.

T3 (Primary Tumour)

A primary tumour that is greater than $4\,\text{cm}$ in size.

T4 (Primary Tumour)

A tumour that invades adjacent structures such as bone, skin, the maxillary sinus, or deep muscles.

N0 (Regional Lymph Nodes)

Clinical stage indicating no regional lymph node metastasis.

N1 (Regional Lymph Nodes)

Clinical stage indicating metastasis in a single ipsilateral lymph node.

M1 (Distant Metastasis)

Clinical stage indicating distant metastasis is present, commonly in the lungs, liver, or bone.

Level IA Lymph Nodes

The Submental cervical lymph nodes.

Level IB Lymph Nodes

The Submandibular cervical lymph nodes.

Level II Lymph Nodes

The Upper deep cervical lymph nodes.

Level III Lymph Nodes

The Mid-jugular cervical lymph nodes.

Level IV Lymph Nodes

The Lower deep cervical lymph nodes.

Level V Lymph Nodes

The Posterior triangle cervical lymph nodes.

MDT

Acronym for Multidisciplinary Team, a collaborative core of specialists (surgeons, pathologists, oncologists, etc.) required for oral cancer management.