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130 Cards in this Set
- Front
- Back
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T/F Cancer is the leading cause of death in the US
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False, 2nd leading cause
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What is the loss of the ability of a cell to differentiate (or a reversion to a primitive form)?
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anaplasia
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What is the point at which a cell no longer responds to the normal controls for growth? What is the process by which a cell acquires the properties of cancer?
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transformation
malignant transformation |
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What is a normal gene that can become an oncogene through mutation or over-expression?
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Proto-oncogene
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Proto-oncogenes code for proteins that help to regulate _______ & ________
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cell growth
differentiation |
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What is a modified gene, or set of nucleotides that code for a protein believed to cause cancer?
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oncogene
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What are genes that code for anti-proliferative signals and proteins that suppress mitosis and cell growth? What is another name for them?
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tumor suppressor genes
anti-oncogenes |
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What are the 3 categories of carcinogens given in lecture?
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chemical carcinogens, radiant energy, and oncogenic viruses
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What does the Two-hit theory of carcinogenesis say? What is another name for it?
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Cancers can only be initiated when a cell contains two mutant alleles
Knudson hypothesis |
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T/F An individual who inherits one mutant allele must experience a second somatic mutation to initiate tumorigenesis.
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True
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What are the "gatekeeper" genes?
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oncogenes and anti-oncogenes
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What is the difference btw a "gatekeeper" gene and a "caretaker" gene?
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gatekeeper directly controls tumor growth
caretaker do not directly control tumor growth, but affect genomic stability |
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What are the 3 steps of carcinogenesis?
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1. initiation
2. promotion 3. progression |
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What step of carcinogenesis occurs when the initiated cell is exposed to an agent that enhances growth into a larger mass (aka clonal expansion)?
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promotion
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What is the step of carcinogenesis where a carcinogen causes genetic change making a cell vulnerable to other genetic changes?
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initiation
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What step of carcinogenesis occurs when a malignant tumor grows uncontrollably and can eventually interfere with organ function?
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progression
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What gene is mutated or expressed at greatly elevated levels in many tumor cells?
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p53
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Why do mutant p53 proteins not act as a "stop signal" for cell division?
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they can't bind to DNA in an effective way
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What is the cascade of events from p53 being produced to stopping the cell division cycle?
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p53 binds DNA, activating p21 which complexes with cdk2, these together stop the cell from passing to the next stage of cell division
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What acts as a negative regulator for p53, keeping p53 inactive?
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mdm2
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What gene is the "guardian of the genome"?
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p53
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More than 95% of oral cancers arise in people what age? What decade sees the highest incidence?
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40+
6th decade |
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What type of cancer accounts for 96% of all oral cancers? What accounts for the other 4%?
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carcinomas
sarcomas |
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What is the most common sites in the mouth for oral cancer?
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tongue, oropharynx and floor of mouth
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What is the most common first complaint of oral cancer pts?
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pain followed by "a lump"
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Improved survival of oral cancer is attributable to what?
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early diagnosis
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The risk of developing a second primary cancer is highest in what type of pts?
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those who drink and/or smoke
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What are 3 of the main causes of oral cancer?
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advanced age, male, african american
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What's the most common oral malignancy?
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SCC
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Where do squamous cell carcinomas most commonly occur?
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lateral or ventral tongue, floor of mouth, retromolar trigone
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What salivary gland most commonly has malignancies?
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parotid
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When a pt has a minor salivary gland malignancy, where in the mouth does it commonly occur?
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hard palatal mucosa
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Where is melanoma most commonly seen in the mouth?
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hard palatal mucosa or anterior maxillary gingiva
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Where is osteosarcomas most commonly seen?
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mandible
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Where is Kaposi's sarcoma most commonly seen?
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hard palatal mucosa or maxillary gingiva
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Where is lymphoma most commonly seen?
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on gingiva or in jawbones
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T/F In secondary metastatic malignancies, the soft tissue of the mandible is more commonly affected than hard tissue.
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False, hard tissues more common than soft tissues, but most are in mandible
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Where sites are secondary metastases most likely coming from?
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lung, kidney, skin in both sexes
prostate in men breasts in women |
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What age/sex is most at risk for oral cancer?
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older men
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What are the major controllable risk factors for oral cancer?
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smoking and drinking
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Which lymph node is often first affected in regional metastasis?
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submandibular
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What is the most common form of minor salivary gland malignancies?
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mucoepidermoid carcinoma
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The clinical staging of oral cancer has 2 of these 3 grouped together, which is it? SCC, major salivary gland malignancies, minor salivary gland malignancies
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SCC and minor glands
major is by itself |
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Tumors grow locally, then metastasize to where? After that where do they metastasize to?
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regional lymph nodes
systemically |
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From levels 1-7, what area is involved in each for lymph nodal involvement?
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1 - sumbmental/submandibular nodes
2 - upper jugular nodes 3 - middle jugular nodes 4 - lower jugular nodes 5 - posterior triangle nodes 6 - lymph nodes of anterior central compartment 7 - lymph nodes inferior to the suprasternal notch in the superior mediastinum |
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In nodal involvement...what is N0 and N1?
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N0 - no palpable nodes
N1 - single nodes on same side, less than or equal to 3 cm |
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In nodal involvement...what is N3?
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Nodes greater than 6 cm
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In nodal involvement for SCC and minor salivary glands....what is N2A, N2B and N2C?
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N2A - single ipsilateral node 3-6 cm
N2B - multiple nodes, same side less than or equal to 6 cm N2C - contralateral or bilateral nodes less than or equal to 6 cm |
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Tumors toward the front of the mouth tend to be _____ differentiated and tumors toward the back of the mouth tend to be ____ differentiated.
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front - well
back - less |
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When breaking down the grading of SCC, what is G1, G2, G3, and G4?
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G1 - well differentiated
G2 - moderately well differentiated G3 - poorly differentiated G4 - undifferentiated |
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When staging tumors (T1, T2, T3, T4) for SCC and minor salivary gland tumors...how is this determined?
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T1 - tumor < 2 cm
T2 - tumor 2-4 cm T3 - tumor > 4 cm T4 - tumor invades deep subjacent structures |
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Stage 1 for SCC and minor salivary glands involves what TNM?
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T1
N0 M0 |
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Stage 2 for SCC and minor salivary glands involves what TNM?
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T2
N0 M0 |
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Stage 3 for SCC and minor salivary glands involves what TNM?
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T3, N0, M0 or
T1, N1, M0 or T2, N1, M0 or T3, N1, M0 |
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What talking about Stage 4A, 4B and 4C for SCC and minor salivary glands, which ones are described as disseminated and unresectable, resectable, and unresectable
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4A - resectable
4B - unresectable 4C - disseminated and unresectable |
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Stage 4C for SCC and minor salivary glands involves what TNM?
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Any T, Any N, M1
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Stage 4A for SCC and minor salivary glands involves what TNM?
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T4, N0, M0 or
T4, N1, M0 or Any T, N2, M0 |
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Stage 4B for SCC and minor salivary glands involves what TNM?
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Any T, N3, M0
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What is T1 for major salivary gland malignancies?
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tumor less than or equal to 2 cm without extraparenchymal extension
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What is T2 for major salivary gland malignancies?
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tumor greater than 2 cm but less than or equal to 4 cm without extraparenchymal extension
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What is T3 for major salivary gland malignancies?
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tumor greater than 4 cm and or tumor having extraparenchymal extension
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What is T4a and T4b for major salivary gland malignancies?
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T4a - tumor invades skin, mandible, ear canal and/or facial nerve
T4b - tumor invades skull base and or pterygoid plates and/or encases carotid artery |
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What is TMN for stage 1 for major salivary gland malignancies?
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T1, N0, M0 or
T2, N0, M0 |
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What is TMN for stage 2 for major salivary gland malignancies?
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T3, N0, M0
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What is TMN for stage 3 for major salivary gland malignancies?
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T1, N1, M0 or
T2, N1, M0 |
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What is TMN for stage 4 for major salivary gland malignancies?
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T3, N1, M0 or
T4, N0, M0 or T4, N1, M0 or Any T, N2, M0 or Any T, N3, M0 or Any T, Any N, M1 |
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For the 1st year post-treatment, how often does the pt return for follow-up intervals? 2nd year? 3rd year? Beyond 3 years?
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1st year - 6-8 weeks
2nd year - 2-3 months 3rd year - 3-4 months Beyond 3 years - 6-12 months for life |
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T/F Metastatic tumors to the oral cavity, either soft tissues or bone, are not classified as "oral cancers".
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True
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T/F Cancer that metastasizes to the oral region is staged according to the rules for the 2ndary site.
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false, staged for rules for primary site
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What is a benign, morphologically altered tissue that has a greater than normal risk of malignant transformation?
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precancerous lesion
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What is defined as a "white patch or plaque that cant be characterized clinically or pathologically as any other disease"?
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leukoplakia
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What is the most common oral precancer?
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leukoplakia
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T/F Leukoplakia is describing a hitstological tissue alteration
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False, just a clinical term
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What causes leukoplakia to appear white?
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thickened surface keratin layer or a thickened spinous layer
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Leukoplakia has a gender predilection for who?
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males
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What is the cause of leukoplakia?
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unknown
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T/F The use of alcohol seems to be most closely associated with leukoplakia development.
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false, smoking
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Ultraviolet radiation has been associated with leukoplakia of the vermilion of the lower lip, what is this leukoplakia associated with?
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actinic cheilosis
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What two microorganisms have been implicated in certain types of leukoplakia?
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treponema pallidum
candida albicans |
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What virus has been identified in some oral leukoplakias?
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HPV 16 and 18
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T/F Nicotine stomatitis and frictional keratosis, 2 keratotic lesions, are considered premalignant.
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False, not premalignant
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At what age does leukoplakia incidence increase? What sex is more common?
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40 years
males |
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What area of the mouth are leukoplakias most common?
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lip vermillion, buccal mucosa and gingiva
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What areas of the mouth account for more than 90% of those that show dysplasia?
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tongue, lip vermillion and floor of mouth
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What is the special high-risk form of leukoplakia? What does it usually transform into in about 8 years?
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proliferative verrucous leukoplakia
SCC |
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What gender does proliferative verrucous leukoplakia have a predilection for?
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female
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When histologically looking at a leukoplakic lesion, what types of cells may be noted within the underlying connective tissue?
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chronic inflammatory cells
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What are common signs of dysplastic epithelial cells?
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enlarged nuclei & cells
large, prominent nucleoli increased nuclear-cytoplasmic ratio hyperchromatic (dark-staining) nuclei pleomorphic (abnormally shaped) nuclei and cells dyskeratosis (premature keratinization) increased mitotic activity & abnormal mitotic figures loss of polarity |
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After biopsy and histologic exam, what type of epithelial dysplasia warrants complete removal if possible?
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moderate epithelial dysplasia
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If leukoplakia isn't exhibiting dysplasia, what is the next step of action?
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clinically evaluate every 6 months
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What is defined as a red patch that can't be clinically or pathologically diagnosed as any other condition?
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erythroplakia
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T/F Almost all true erythroplakias demonstrate significant epithelial dysplasia, carcinoma in situ or invasive SCC
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True
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Which has a much greater potential to be severely dysplastic? Leukoplakia or erythroplakia?
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erythroplakia
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What age/sex are erythroplakia most commonly seen?
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older males (60's-70's)
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What are most common sites of erythroplakia?
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floor of mouth, tongue, soft palate
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What gives erythroplakia its red color?
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lack of keratin, allows underlying microvasculature to show through
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T/F Erythroplakic lesions showing moderate dysplasia or worse should be completely removed
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True
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What is the term for lesions that have both red and white components?
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erythroleukoplakia
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What is a syndrome characterized by an iron-deficiency anemia with an associated glossitis and dysphagia?
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Plummer-vinson syndrome
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What is another name for Plummer-Vinson Syndrome?
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Paterson-Kelly Syndrome
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Why is Plummer-Vinson syndrome of significance to us?
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has high frequency of oral and esophageal SCC
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What age/sex/ethnicity are common with Plummer-Vinson syndrome?
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females 30-50
Scandinavianish |
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What is the name of the spoon-shaped nails seen in Plummer-Vinson syndrome?
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koilonychia
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What are symptoms of Plummer-Vinson syndrome?
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burning tongue
angular cheilitis smooth red tongue pain on swallowing from esophageal webs spoon-shaped nails (koilonychia) anemic signs |
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What does treatment for Plummer-Vinson syndrome typically entail?
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correcting the iron-deficiency anemia
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What is a disease entity with oral lesions that appear as areas of opacification with loss of elasticity and fibrous bands may occur? What is the significance of this disease?
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oral submucous fibrosis
high-risk precancerous condition |
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Next to metastases, what is the most reliable feature that differentiates malignant from benign tumors?
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invasiveness
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T/F Verrucous carcinomas and basal cell carcinomas rarely metastasize
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True
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Squamous cell carcinoma of the oral cavity spreads largely by local extension and through what?
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the lymphatics
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Which offers a better barrier to invasion of cancer, muscle or periosteum?
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periosteum
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SCC invades the local lymphatic supply and then travels where?
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regional lymph nodes
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Usually oral squamous cell carcinoma spreads to cervical lymph nodes on which side of the face?
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ipsilateral
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T/F Lymph nodes are fixed at first but as the tumor breaks through the capsule, the node becomes movable
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False, movable and then fixed
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If a tumor is most posterior in the oral cavity, does this mean there is a greater or lesser likelihood of lymph node involvement?
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greater
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If a tumor is poorly differentiated, does this mean there is a greater or lesser likelihood of lymph node involvement?
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greater
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According to a study done at a cancer hospital, what is the most commonly involved lymph node in cases o foral and pharyngeal cancers?
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subdigastric or jugulo-digastric
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What are the most common sites of distant metastases?
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lungs, liver, bones
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What are the best indicators of pt prognosis when dealing with oral squamous cell carcinoma?
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tumor size and extent of metastasis
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If there were to be metastasis to the oral soft tissues, what sites are most common? What organs did these metastases most likely arise from in men and women?
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gingiva followed by the tongue
men...lungs, kidney and skin....not prostate b/c that has an affinity for bone women...lungs, kidney, breasts, genitals, bone |
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If a primary tumor is to metastasize into bone, what are the most common sites?
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vertebrae, ribs, pelvis, skull
jaw is considered uncommon |
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If a tumor is to spread to the jaw, what route does it get there?
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hematogenous
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What is the only method of definitively diagnosing an oral cancer?
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biopsy
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T/F Exfoliative cytology is able to be used as a substitute for biopsy
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false, just an adjunct
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What is the most satisfactory biopsy of an intraoral lesion? What if the lesion is small?
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incisional biopsy
excisional biopsy |
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When should the surgical specimen be placed in an appropriate fixative solution?
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immediately
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What is the most common fixative used for biopsy?
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10% buffered formalin
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How much fixative should be used in relation to biopsy size?
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specimen should be completely submerged in 5-10 times its volume of fixative
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If using toluidine blue solution on a premaligant or malignant lesion, what color would it be after application of acetic acid (the wash)? What if the lesion was not malignant?
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blue
it would be decolorized |
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When is brush biopsy contraindicated? When is it indicated?
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contra - lesions w/ intact normal epithelium
indicated - all epithelial abnormalities |
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T/F All Oral CDx (brush biopsy) with "atypical" and "positive" results should be referred for scalpel biopsy and histology to completely characterize the lesion
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True
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