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63 Cards in this Set

  • Front
  • Back
What is squamous cell carcinoma?
A malignant epithelial neoplasm
Epidemiology of squamous cell cancer?
4% of all cancers

>90% of oral cancers

male>female

5th-9th decades
Etiology of squamous cell canrcinoma?
tobacco
alcohol
(betel nut, HPV)
Precursor lesions to squamous cell carcinoma?
LEUKOPLAKIA
-- most are reactive keratosis
-- 20% are dysplastic
-- 4% are carcinoma

ERYTHROPLASIA
-- 80% in high-risk areas are carcinoma
Common sites of squamous cell carcinoma?
ventrolateral tongue - 50%

floor of mouth - 20%

soft palate-tonsillar pillar complex - 6%

gingiva-alveolar ridge
Clinical presentation of squamous cell carcinoma?
dysphagia

odynophagia

otalgia
Gross presentation of squamous cell carcinoma?
painless undurated ulcer OR

exophytic fungating mass
Histology of squamous cell carcinoma?
-- invasive neoplastic nests of squamous epithelial cells
-- pleomorphism
-- hyperchromatism
-- increased nuclear:cytoplasm
-- mitotic figures
-- intercellular bridges
-- keratinization "PEARLS"
Treatment for squamous cell carcinoma?
surgical resection

radiation therapy

chemotherapy
Prognosis for squamous cell carcinoma?
poor

overall 40-50% 5 year survival
Therapeutic morbidity of squamous cell carcinoma?
pain
dysfxn (mastication, deglutition, speech/communication)
malnutrition, esthetics
xerostomia, caries
mucositis, candidiasis
sensory deficit, trismus
osteoradionecrosis
aspiration/airway compromise
psychosocial inpact
List other cancers of the head and neck.
Adenocarcinomas

Lymphoma

Bone Sarcomas

Soft tissue sarcomas

Neuroendocrine tumors

Skin cancer/melanoma

Metastatic disease to head/neck
Name the three different types of odontogenic cysts.
1. Radicular Cyst

2. Dentigerous Cyst

3. Odontogenic Keratocyst
Describe the radicular cyst
- inflammatory

- common incidence

- arises in periapical granuloma/abcess assoc w/ non-vital tooth

- periapical unilocular radiolucency
Treatment and prognosis for radicular cyst?
endodontic therapy

extraction/curettage

Prognosis: good
Describe the dentigerous cyst.
- developmental cyst

- common incidence

- arises from dental follicle assoc w/ impacted/unerupted tooth

- pericoronal unilocular radiolucency

- may reach destructive size
Treatment and prognosis of dentigerous cyst?
surgical removal/curettage

Prognosis: good
-- rare neoplastic transformation
Describe a odontogenic keratocyst.
- developmental vs. neoplastic cystic lesion

- incidence in 3-11% of odontogenic cysts

- arises from odontogenic epithelium

- aggressive/destructive lesion
Treatment and prognosis of odontogenic keratocyst?
Curettage w/ peripheral ostectomy, resection

High recurrence rate - assoc w/ nevoid basal cell carcinoid syndrome (Gorlin syndrome)
List the two types of odontogenic tumors.
1. Odontoma

2. Ameloblastoma
Describe the odontoma.
- most common odontogenic tumor

- hamartomatous malformation of tooth structure

- may interfere w/ tooth eruption
Treatment and prognosis of odontomas?
surgical removal

prognosis: good
Describe an ameloblastoma.
- epithelial odontogenic neoplasm

- uncommon incidence

- found at the posterior mandible in the 4th decade

- expansile multiocular radiolucency

- locally invasive/destructive
Treatment and prognosis of ameloblastomas?
resection

prognosis: high recurrence rate, rare malignant behavior
List the common problems with salivary glands.
1. mucocele

2. sialolithiasis

3. siadadenitis

4. xerostomia

5. sjogren's syndrome

6. salivary gland tumors
Describe a mucocele.
(mucous extravatation phenomenon)

- bluish submucosal swelling

- mucin spillage

- ruptured salivary excretory duct secondary to trauma

- very common

- found in children and young adults

- lower lip or ranula (lesion in floor of mouth)
Treatment and prognosis of a mucocele?
excision

prognosis: good
Describe sialolithiasis.
- calcium salt deposition in salivary duct system - nidus

- submandibular gland most commonly involved

- obstruciton w/ episodic pain and swelling related to meals

- salivary gland inflammation and atrophy
Treatment for sialolithiasis?
surgical removal
Describe sialadenitis.
- inflammation of salivary glands

- viral - mumps

- bacterial - acute parotitis (perioperative period)

- chronic sclerosing sialadenitis -- obstruction
Describe xerostomia.
- reduced salivary flow -- dry mouth

- common incidence
What are common causes of xerostomia?
medications

radiation therapy

Sjogren's syndrome

DM

Sarcoidosis

HIV infection

Smoking

Mouth breathing
What are complications of xerostomia?
mucositis

dental caries

candidiasis

difficulty w/ mastication

dysphagia

speech problems

altered taste

difficulty wearing denture prostheses
How do you manage xerostomia?
-- correct underlying cause

-- saliva replacement: water rinses, artificial saliva

-- sialogogues - parasympathomimetic drugs

-- dental preventive care

-- antifungal medication
Describe Sjogren's syndrome.
- autoimmune exocrinopathy

- xerostomia -- salivary glands

- keratoconjuntivitis sicca (dry eyes) -- lacrimal glands

- 0.2-0.3% of population and 80-90% of those affected are middle-aged females

- associated autoimmune disease -- RA
Complications of Sjogren's?
ocular dryness -- blindness

mucositis

dental caries

candidiasis

dysphagia

speech difficulties

altered taste

enlarged salivary glands

increased risk of lymphoma
Extraglandular manifestations of Sjogren's syndrome?
nephritis

pneumonitis

vasculitus

neuropathy

biliary cirrhosis

Reynaud's phenomenon

fatigue

depression

lymphadenopathy
How do we diagnose Sjogren's?
DRY EYES - Schirmer test, Rose Bengal staining

DRY MOUTH - reduced salivary flow rate, "cracker" sign

Labial salivary gland/parotid biopsy -- focus score >1.0

Serologic evidence of autoimmune disease -- RA, ANA, SS-A, SS-B
How do we manage Sjogren's?
rheumatologist

opthalmologist - eye care

dentist - preventive dental care

supportive care: saliva substitutes, sialogogues, antifungal therapy

Moisture Seekers support group -- Sjogren's Syndrome Foundation
List the 4 types of salivary gland tumors.
1. Pleomorphic Adenoma (benign mixed tumor)

2. Papillary Cystadenoma Lymphomatosum (Warthin's tumor)

3. Mucoepidermoid Carcinoma

4. Adenoid Cystic Carcinoma
General features and epidemiology of pleomorphic adenoma (benign mixed tumor)?
- benign neoplasm of salivary gland origin

- most common salivary gland neoplasm (70%)

- female>male

- 3rd - 6th decade

- found on the parotid gland
Clinical presentation of the pleomorphic adenoma (benign mixed tumor)?
slow growing painless mass
Gross pathology of the pleomorphic adenoma (benign mixed tumor)?
well demarcated firm tan white solid/cystic mass
Histopathology of the pleomorphic adenoma (benign mixed tumor)?
ductal epithelial cells

myoepithelial cells

stroma -- myxoid, chondroid, fibrous, hyaline
Treatment and prognosis of the pleomorphic adenoma (benign mixed tumor)?
surgical excision (superficial parotidectomy)

Prognosis: excellent
Complications of pleomorphic adenoma (benign mixed tumor)?
recurrence -- multifocal

malignant transformation - carcinoma
General features and epidemiology of the papillary cystadenoma lymphomatosum (Warthin's tumor)?
- benign salivary gland tumor

- common incidence

- male>female

- 5th - 7th decades

- found at the parotid

- multifocal/bilateral in 14%
Symptoms and etiology of papillary cystadenoma lymphomatosum (Warthin's tumor)?
symptoms: painless mass

etiology: smoking (8x risk)
Gross pathology of the papillary cystadenoma lymphomatosum (Warthin's tumor)?
well circumscribed cystic mass - "machine oil fluid"
Histopathology of the papillary cystadenoma lymphomatosum (Warthin's tumor)?
cystic lesion w/ papillary fronds lined by bilayered oncocytic epithelial cells w/ associated lymphoid stroma
Treatment and prognosis of the papillary cystadenoma lymphomatosum (Warthin's tumor)?
surgical excision

prognosis: excellent
Complications from papillary cystadenoma lymphomatosum (Warthin's tumor)?
recurrence

malignant transformation is very rare
General features and epidemiology of mucoepidermoid carcinoma?
- malignant salivary gland neoplasm

- most common malignant salivary gland tumor (30%)

- male = female

- wide age range, 3-6th decades

- found at the parotid, palate
Gross pathology of the mucoepidermoid carcinoma?
unencapsulated tan white solid and cystic tumor
Histopathology of the mucoepidermoid carcinoma?
- epidermoid cells

- mucous cells

- intermediate cells

- cystic/solid growth patterns

- low - intermediate - high grades
Treatment of mucoepidermoid carcinoma?
surgical excision

neck dissection

radiation therapy
Prognosis of mucoepidermoid carcinoma?
Low to intermediate grade - 90% 5-year survival

High grade - 40% 5-year survival

Metastasis --> lymph nodes, lung, bone
General features and epidemiology of adenoid cystic carcinoma?
- malignant epithelial cell neoplasm

- 12% of malignant salivary gland tumors

- male = female

- 5th-7th decades

- found at parotid, submandibular gland, palate
Clinical symptoms of adenoid cystic carcinoma?
painful mass

cranial nerve deficit
Gross pathology of adenoid cystic carcinoma?
solid firm tan mass
Histopathology of adenoid cystic carcinoma?
highly infiltrative

cribriform ("swiss cheese"), tubular and solid growth patterns

perineural invasion

mucohyaline stroma
Treatment for adenoid cystic carcinoma?
surgical excision

radiation therapy
Prognosis for adenoid cystic carcinoma?
protracted relentless course

5-year survival - 75%
20-year survival - 13%

Multiple local recurrences

Metastasis - late in clinical course to lymph nodes, lung, bone