Malignant epithelial neoplasms + PE

CHECK REVISED PP

what are the three malignant epithelial neoplasms

• basal cell carcinoma (BCC)

• squamous cell carcinoma (SCC)

• verrucous carcinoma

what is basal cell carcinoma also known as

rodent ulcer

is BCC a low, medium, or high grade epithelial malignancy

low grade

cause of BCC

sun exposure

common age assocIated w BCC

> 40 yrs

common location for BCC

• 80% H&N

• mid face most common

prevalence of BCC

most common skin cancer and most common of all cancers

tx for BCC

surgical excision

order these from most to least common:

• BCC

• melanoma

• SSC

BCC > SCC > melanoma

dx

BCC

dx

SCC

dx

verrucous carcinoma

dx

SCC

OKC + multiple BCC + <30-40 yrs =

nevoid basal cell carcinoma; gorlin-goltz or gorlin syndrome

dx

BCC

clinical description of BCC

• begins as a firm, painless papule

• will slowly enlarges and gradually develops a central depression

• rolled borders usually present

• one or more telangiectatic blood vessels are seen

metastasis association w BCC

is extremely rare; locally destructive

BCC can have clinicopathological varieties, what is most common

noduloulcerative

what can cause cutaneous SCC

• chronic sun exposure

• actinic keratosis

• radiation therapy

common location of cutaneous SCC

70% head and neck region

clinical presentation of cutaneous SCC

• non-healing ulcer

• slowly growing

• plaque, papule, or nodule variable degree of scale, ulcer, or crest

• often erythematous base

what is the prevalence and survival rate of oral cancer

• 1 in 3 americans will develop

• 2/3 survive

oral cancer accounts for ____% of deaths in the US

20%

oral cancer accounts for ___% of all cancers

3%

___% of oral cancers are what type…

95% are SCC

what is the cause of SCC

multifactorial

what is verrucous carcinoma also known as

snuff dipper’s cancer / Ackerman’s tumor

clinical presentation of verrucous carcinoma

diffuse, well-demarcated, painless, thick plaque w papillary or verruciform surface projections

verrucous carcinoma is a _____ (high or low)- grade variant of oral SCC

low-grade (90% disease-free survival)

what can cause verrucous carcinoma

smokeless tobacco or from PVL

common location for verrucous carcinoma

mandibular vestibule and gingiva

20% verrucous carcinoma have ____ developing within

SCC

tx for verrucous carcinoma

surgical excision

which of the following is true about BCC:

it commonly affects individuals under 30

it frequently metastasizes to distant organs

common location in FOM

typically has central depression w rolled borders

typically has central depression w rolled borders

which habit is strongly associated w verrucous carcinoma:

cigarette smoking

chewing betel quid

alcohol consumption

using smokeless tobacco

using smokeless tobacco

which is the most common type of skin cancer:

BCC

SCC

melanoma

verrucous carcinoma

BCC

etiology for oral cancer

• smoking

• alcohol

• radiation therapy

• betel quid

gender most affected by OSCC

caucasian men- this is changing

age affected by OSCC

older age group- this is changing

common location of OSCC

FOM, posterior lateral ventral tongue, lower lip

why is there a delay in seeking care in OSCC

bc the early stages are painless

OSCC clinical presentation (5)

• endophytic (ulcerated)

• leukoplakic

• erythroplakic

• erythroleukoplakic

• exophytic (fungating)

rank the following in order from most to least high risk sites for oral cancer:

tongue

lip

FOM

soft palate

FOM > tongue > lip > soft palate

OSCC association w metastasis

spread largely via lymphatics; tends to spread to ipsilateral cervical lymph nodes

how will lymph nodes present in OSCC metastasis

• firm to stony hard

• painless

• enlarged

• fixed- cells have perforated the capsule of the nodes and invaded into surrounding tissue

what is sentinel lymph node

the first lymph node to which cancer cells are most likely to spread from a primary tumor

what is local metastasis in OSCC

lymph nodes in neck

what is distant metastasis in OSCC

below the clavicle

where are the common sites of metastasis in OSCC

lungs and bones

what dictates the tx and is the best indicator of pt prognosis

TNM:

• T- size of primary tumor in cm

• N- involvement of local lymph nodes

• M- distant metastasis

how many stages are there in TNM classification, how does prognosis change

4; prognosis will worsen as you inc in stage

stage I in TNM classification

T1 N0 M0

stage II in TNM classification

T2 N0 M0

stage III in TNM classification

T3 N0 M0 OR any T, N1, M0

stage IV in TNM classification

lymph node involvement and metastasis: any M or T4 or N1

is clinical grading or staging a better prognostic indicator

staging is better than histological grading

how many grades are there in OSCC

3

grade 1 in OSCC

• low grade

• well-differentiated

• resemble their parent tissue

grade II OSCC

• tumors less resemble parent tissue

• moderately-differentiated

• intermediate grade

grade III OSCC

• tumors have v little resemblance of their parent tissue; tend to enlarge

• poorly differentiated

• high grade

• metastasize early

what distinguishes OSCC of the lip from intraoral OSCC:

lip OSCC metastisizes more frequently

intraoral OSCC has a better prognosis

lip OSCC often arises from actinic cheilitis

lip OSCC can’t be tx surgically

Lip OSCC often arises from actinic cheilitis

which of the following has the best prognosis for oral cancer

T4 N1 M1

T2 N0 M0

T3 N1 M0

T1 N1 M0

T2 N0 M0

which of the following is NOT true of metiastatic disease

painless lymphnodes

spread through lymphatics

lymph nodes are mobile and soft

enlarged lymph nodes

lymph nodes are mobile and soft

OSCC v lip SCC 5 yr survival rate

lip has higher survival rate overall

which lip is more common in SCC

lower lip; upper lip is rare

causes of lip SCC

• chronic sun exposure

• arises in a setting of actinic cheilitis

clinical presentation of lip SCC

• slow, non-healing ulcer

• rough and scaly

• can be mistaken for an ulcer

dx

lip SCC

cutaneous SCC tx

surgical excision- good prognosis if detected early

lip carcinoma tx

wedge resection w excellent results

OSCC clinical stage guide txs

• wide surgical excision and/or radiation therapy

• chemo is sometimes administered

  • does NOT improve survival rate

pts w intraoral tumors that have a 4 mm depth of invasion recieve…

radical neck dissection

pts w one carcinoma of the mouth or throat are at an inc risk for…

additional SCC

concurrently

pt can synchronously develop an additional SCC

metachronous

pt can develop additional SCC at a different time, usually within 3 yrs

what is field cancerization

tendency toward development of multiple mucosal cancers

gorlin syndrome is most commoly associated w which type of neoplasm:

BCC

verrucous carcinoma

SCC

merkle cell carcinoma

BCC

which is the highest risk factor for OSCC:

smoking cigs

radiation therapy

chewing tobacco

alcohol consumption

smoking cigs

which clinical appearance is NOT typically associated w OSCC:

leukoplakia

generalized ulcers

erythroplakia

exophytic mass

generalized ulcer (not generalized)

what is the most common site for OSCC to metastasize:

kidney

brain

liver

lung

lung (or bone)

which of the following is FALSE regarding SCC:

most common intra-oral cancer

HPV+ has worse prognosis

stage III includes lymph node involvement

cutaneous SCC resembles BCC

HPV+ has a worse prognosis

what is high risk type of HPV w OSCC

HPV 16 is most common

what are the common sites of HPV + OSCC

oropharyngeal: soft palate or tonsillar area or base of the tongue

________ is NOT the cause of HPV + OSCC, __________ is

tobacco is not the cause; inc in sexual partners is

is there a male or female predilection for HPV + OSCC

male

what is the clinical presentation of HPV + OSCC

a mass or an erythroplakia

is there a better or worse prognosis of HPV+ OSCC compared to just OSCC

better prognosis of HPV+ OSCC than just OSCC

primary clinical feature of OSCC

leukoplakia, erythroplakia, erythroleukoplakia, ulcer

primary clinical feature of HPV+ OSCC

enlarged lymph node in neck, dysphagia, very subtle, asymptomatic initially

is the incidence of HPV+ OSCC inc or dec

inc

is the incidence of OSCC inc or dec

dec

list the prognosis of these cases from best to worse:

HPV-, nonsmoker

HPV+, smoker

HPV-, smoker

HPV+, nonsmoker

HPV+ nonsmoker → HPV+ smoker → HPV- nonsmoker → HPV- smoker

tx for HPV+ OSCC in early disease

• platinum-based chemoradiotherapy

• surgery

tx for HPV+ OSCC in late disease

• surgery

• chemotherapy

• radiation

what does the vaccine GARDASIL target

HPV types: 16, 18