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86 Cards in this Set
- Front
- Back
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What is the loss of the ability to differentiate (or a reversion to a primitive form). A common characteristic of cancer cells?
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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. The point of autonomy or self-sufficiency in growth signalin. a property shered by all neoplasms?
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Transformation
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What is the process by which cells acquire the properties of cancer?
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Malignant transformation
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What is a normal gene that can become an oncogene through mutation or over-expression. These code for proteins that help to regulate cell growth and differentiation?
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Protooncogene
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What are the 3 categories of carcinogens?
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1. Chemical carcinogens
2. Radiant energy 3. Oncogenic viruses |
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What is the difference between oncogenes and proto-oncogenes?
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Oncogenes are gene sequences associated with nucleic acid of viral origin that incorporate into the host genome.
Proto-oncogenes are normal human genome identical sequences present but repressed |
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What is the knudson hypothesis?
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Two hit theory of carcinogenesis where cancers can only be inherited when a cell contains two mutant alleles
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Oncogenes (____________) and anti-oncogenes (___________) directly control tumor growth by functioning as accelerators and brakes for cellular proliferation. Known as gatekeeper genes.
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Growth promoting and tumor suppressor genes
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Genes that do not directly control tumor growth but affect genomic stability are called ________ genes. In this category are mismatch repair genes, apoptosis and other putative DNA repair genes
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Caretaker
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T/F
No single oncogene fully transforms non-immortalized cells in vitro |
True
But such cells can generally be transformed by combinations of oncogenes |
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RAS oncogene induces secretion of growth factors/enable cell to _____________, Whereas MYC oncogene renders cells ___________. Acting together, they can transform.
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RAS grow without anchorage (anchorage independence)
MYC more sensitive to growth factors |
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What percent of all cancers is oral and oropharyngeal cancer?
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4%
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Who is affected more in oral cancer men or women?
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Men 2:1
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What is the average age of oral cancer?
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63 years old
(more than 95% of cases occur in people 40+, risk of oral cancer continues to increase with age, it never levels off) |
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What type of cancers are oral cancer?
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Carcinomas account for 96% (most scc and some salivary glands)
Sarcomas account for 4% |
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What is the most common sites of oral cancer?
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Tongue
Oropharynx Floor of the Mouth |
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What is the most common first complaint of oral cancer?
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Pain, followed by a lump
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What race has the highest incidence of oral cancer?
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Blacks have 2x greater chance than whites
(Black Men specifically) |
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Having developed an oral cancer, patients are at risk of a second _______________ estimated at 15%
Risk of a second _____________ is estimated at 4% per year and higher for those who continue to smoke and drink. |
Synchronous Primary
Metachronous Primary |
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What is the increased risk for Smokers, Drinkers, Both Smokers and Drinkers, and Chewing Tobacco?
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Smokers 8x
Alcohol 8x Smoking & Alcohol 149x Chewing Tobacco 50x (VERRUCOUS CARCINOMA) |
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T/F
Coffee may protect from oral cancer. |
True
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What are the two categories of salivary gland malignancies?
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Major Glands - Not Oral Cancer 80% of salivary gland malignancies. 90% in Parotid
Minor Glands (Oral cancer) 20% of salivary gland malignancies. Most in hard palate. |
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What is the frequency of occurance of melanomas in the oral cavity and where?
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<1%
Hard Palate Anterior Maxillary Gingiva |
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What is the frquency of occurance, type, and locations of Sarcomas in the oral cavity?
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<2%
Osteosarcoma - mandible Kaposis sarcoma - Hard Palate. Maxillary Gingiva Lymphoma - Gingiva or Jawbones |
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What is the frequency of occurance of secondary (metastatic) malignancies and distribution in the oral cavity?
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<1%
Metastatic to Hard tissues (more common than soft) - Mandible Metastatic to soft tissues - gingiva or tongue Most originate from common primary sites including Lung, Kidney, Skin (melanoma), Prostate in men and Breast in women |
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T/F
Cancer is the #1 leading cause of death in the U.S. |
False
#2 cause of death |
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Why do cancers of the lip usually have a good prognosis?
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Because they are slow to metastasize
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Which lymph node is usually the first to be involved in regional metastasis of oral cancer?
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Submandibular
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What does bilateral enlargement of cervical lymph nodes do to progosis?
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Worsens prognosis further
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Where are the most common areas for melanoma?
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Anterior Maxillary Gingiva
Hard Palate |
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What is Amelanotic Melanoma?
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Melanoma that doesn't produce malanin pigment
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What is the most common form of minor salivary gland malignancy?
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Mucoepidermoid Carcinoma
(can produce mucous. Clinically can look like a mucocele. |
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What are the main types of sarcomas of bone?
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Osteosarcoma
Chondrosarcoma Ewing sarcoma ((When Alveolar bone is involved often causes widening of PDL, although not pathoneumonic) |
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What is an osteoblastic reaction to tumor?
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Some tumors will stimulate bone growth rather than destroy bone
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What lymph nodes are located in the oncologic lymph node levels of the neck?
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I: Submental/submandibular
II: Upper jugular nodes III: Middle jugular nodes IV: Lower jugular nodes V: Posterior triangle nodes |
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EXAM Question
T/F Cancer metastatic to the oral region originating from a remote site, are staged from a remote stie, are staged according to the rules for the primary site (e.g. breast, lung, prostate, etc.) |
True
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What is the most common oral precancer?
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Leukoplakia
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Why is leukoplakia white?
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Thickened surface Keratin layer (hyperkeratosis) or a thickened Spinous layer which masks the normal vascularity (acanthosis)
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EXAM Question
T/F Cancer metastatic to the oral region originating from a remote site, are staged from a remote stie, are staged according to the rules for the primary site (e.g. breast, lung, prostate, etc.) |
True
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What is the most common oral precancer?
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Leukoplakia
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Why is leukoplakia white?
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Thickened surface Keratin layer (hyperkeratosis) or a thickened Spinous layer which masks the normal vascularity (acanthosis)
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In staging of oral squamous cell carcinoma and minor salivary glands Which Regional lymph node (N) category has:
No regional lymph node metastasis? |
N0
no palpable nodes |
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In staging of oral squamous cell carcinoma and minor salivary glands Which Regional lymph node (N) category has:
Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension? |
N1
single ipsilateral node <=3cm |
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In staging of oral squamous cell carcinoma and minor salivary glands Which Regional lymph node (N) category has:
Metastasis in a single ipsilateral lymph node more than 3 cm byt not more than 6 cm in dimension? |
N2a
single ipsilateral node 3-6 cm |
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In staging of oral squamous cell carcinoma and minor salivary glands Which Regional lymph node (N) category has:
Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension? |
N2b
multiple ipsilateral nodes <= 6cm |
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In staging of oral squamous cell carcinoma and minor salivary glands Which Regional lymph node (N) category has:
Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension? |
N2c
contralateral or bilateral nodes <=6cm |
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In staging of oral squamous cell carcinoma and minor salivary glands Which Regional lymph node (N) category has:
Metastasis in a lymph node more than 6 cm in greatest dimension? |
N3
Node > 6cm |
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In staging of oral squamous cell carcinoma and minor salivary glands Primary Tumors (T):
What is a tumor of 2 cm or less in greatest dimension? |
T1
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In staging of oral squamous cell carcinoma and minor salivary glands Primary Tumors (T):
What is a tumor more than 2cm but not more than 4 cm in greatest dimension? |
T2
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In staging of oral squamous cell carcinoma and minor salivary glands Primary Tumors (T):
What is a tumor more than 4cm in greatest dimension? |
T3
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In staging of oral squamous cell carcinoma and minor salivary glands Primary Tumors (T):
What is a tumor (oral cavity) invading adjacent structures like cortical bone, deep muscles of tongue, maxillary sinusm skin. Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify as ___ |
T4
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In staging of oral squamous cell carcinoma and minor salivary glands Primary Tumors (T):
What is a tumor (lip) invades adjacent structures (through cortical bone, inferior alveolar nerve, floor of mouth, skin of face) |
T4
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In staging of oral squamous cell carcinoma and minor salivary glands Primary Tumors (M):
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M0 no metastasis
M1 metastasis (does not include lymph nodes) |
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What is the modified broders classification of SCC?
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G1 well differentiated BETTER PROGNOSIS
G2 Moderately well differentiated G3 Poorly differentiated G4 Undifferentiated WORSENED PROGNOSIS Tumors towards the front of the mouth tend to be well differentiated Tumors towards the back of mouth tend to be less differentiated |
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In AJCC stage groupings, what is stage I?
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T1, N0, M0
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In AJCC stage groupings, what is stage II?
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T2, N0, M0
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In AJCC stage groupings, what is stage III?
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T3, N0, M0
T1, N1, M0 T2, N1, M0 T3, N1, M0 |
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In AJCC stage groupings, what is stage IVA (resectable)?
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T4, N0, M0
T4, N1, M0 any T, N2, M0 |
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In AJCC stage groupings, what is stage IVB (unresectable)?
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Any T, N3, M0
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In AJCC stage groupings, what is stage IVC (disseminated and unresectable)?
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Any T, Any N, M1
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What are the post treatment follow up intervals for oral cancer?
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6-8 weeks 1st yr
2-3 months 2nd yr 3-4 months 3rd yr 6-12 months thereafter for life |
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What is the 5 yr survival for lip cancer?
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Stage I 83%
Stage II 73% Stage III 62% Stage IV 47% |
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What is the 5 year survival rate for Oral squamous cell carcinoma?
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Stage I 85%
Stage II 66% Stage III 41% Stage IV 9% |
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What is the 5 yr survival rate for Salivary Gland Cancers?
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Stage I 86%
Stage II 66% Stage III 53% Stage IV 32% |
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T/F
Cancer metastatic to the oral region originating from a remote site, are staged according to the rules for the primary site (e.g. breast, lung, prostate) |
True
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A precancerous lesion is defined as a benign, morphologically altered tissue that has a greater than normal risk of malignant transformation. What are 3 precancerous lesions?
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Leukoplakia
Erythroplakia Erythroleukoplakia |
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What is the most common oral precancer?
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Leukoplakia
The term is strictly CLINICAL |
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What is the frequency of dysplastic epithelium or invasive carcinoma in leukoplakia?
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5-25%
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What is the malignant transformation potential of leukoplakia?
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4%
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T/F
There is a strong Male predilection (70%) for developing leukoplakia |
TRUE
Except in parts of the country where females use tobacco products more than males |
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What is the cause of leukoplakia?
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UNKNOWN
Although, tobacco, alcohol, sanguinaria, UV radiation, microorganisms and trauma have been considered |
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T/F
Alcohol, which seems to have a Strong synergistic effect with tobacco in oral cancer development, has NOT been associated with leukoplakia |
True
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What leukoplakia is usually associated with actinic cheilosis?
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Leukoplakia of the vermillion associated with radiation
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What are some microorganisms that have been implicated in leukoplakia?
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Treponema Pallidum
Candida Albicans HPV 16 &18 |
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In the etiology of leukoplakia what are lesions that can be caused by trauma?
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Nicotine stomatitis
Frictional keratosis |
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Where do 70% of the oral leukoplakias arise?
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Lip vermillion
Buccal mucosa Gingiva |
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T/F
Leukoplakia Not Exhibiting Dysplasia is excised |
FALSE
Leukoplakia not exhibiting dysplasia often is not excised but clinical evaluation every 6 Months is recommended |
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What leukoplakia has the highest malignant transformation potential?
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Proliferative Verrucous Leukoplakia
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Where does Erythroplakia occur most frequently?
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Floor of Mouth, Tongue, Soft palate of older males 65-74
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Why is erythroplakia red?
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Lack of keratinization coupled with epithelial thinness allows the underlying microvasculature to show through imparting the red appearance
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What is erythroleukoplakia?
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Lesions that have both a red and white component
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Where is Plummer-Vinson syndrome (paterson-kelly syndrome) manifest most frequently?
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Posterior part of oral cavity
Iron-deficiency anemia with associated glossitis and dysphagia associated with oral and esophageal SCC |
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The most commonly involved node in case of oral and pharyngeal cancer is the ?
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subdigastric (juglo-digastric) lymph nodes
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Where is the site predilection for metastases to the oral soft tissues?
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Gingiva then tongue
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Which is more common, metastasis to the mandible or the maxilla?
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Mandible is much more common with 80% of metastatic lesions
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How do jaw metastases travel?
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via the hematogenous route
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