Oral Path Cudental Squamous Cell Carcinoma

Front 1

T/F An ulcer is defined as the full thickness loss of epithelial covering; elevated margins often appear with acute ulcers.

Back 1

T, F elevated margins=chronic

Front 2

SCCA comprise _____% of all oral cancers.

Back 2

90-95

Front 3

SCCA is caused by loss of cell cycle control due to the activation of _____ and inactivation of ________ genes resulting in increased proliferation and decreased apoptosis. Increased angiogenesis and degredation of basement membrane lead to ________ and invasion.

Back 3

oncogenes, tumor suppressor, metastesis

Front 4

SCCA incidence is_____ cases/year. ___% die from their disease.

Back 4

31,000, 25-30

Front 5

List from most to least risk for SCCA: alcohol, reverse smoking, smokeless tobacco, cigar/pipe, cigarette

Back 5

reverse smoking > cigar/pipe > cigarette > smokeless tobacco > alcohol (additive effect)

Front 6

Smokers increase their risk of SCCA __X while heavey smoking and alcohol consumption increased the risk __X.

Back 6

10, 40

Front 7

Other SCCA risk factors include UV light (SCCA lower lip), _________ syndromes (Plummer-Vinson), DNA repair deficiency syndromes, HPV, candidiasis, chronic irritation and male : female ratio is _:_.

Back 7

iron deficiency, 3:1 (high in African Americans)

Front 8

EBV and HIV are risk factors for SCCA? T/F

Back 8

False, for lymphomas

Front 9

The ____________ is the most common intraoral site for SCCA which can manifest themselves as red, white, mixed or ulcerated aggressive lesions capable of metastasis to regioinal ______ ______.

Back 9

lateral tongue, lymph nodes

Front 10

The ____________ is the 2nd most common intraoral site for SCCA causing painless non-healing ulcers.

Back 10

floor of the mouth (especially w/ smoking/drinking Hx)

Front 11

Which is not an area where SCCA is normally found: buccal mucosa, gingiva, hard palate, lower lip, soft palate.

Back 11

hard palate (usually adenocarcinoma)

Front 12

SCCA of the gingiva can resemble localized ___________.

Back 12

periodontal disease

Front 13

SCCA of the lower lip is more common in males than females and is caused mainly by ______ and ______.

Back 13

sun exposure, pipe smoking

Front 14

T/F Usually there is an epithelial change evident due to SCCA?

Back 14

TRUE

Front 15

Considering all the following possibilities, which clinical presentation of SCCA is most uncommon: non-healing ulcer, exophytic mass, red, white, mixed red/white, verrucopapillary mass, submucosal/intraosseous mass.

Back 15

submucosal/intraosseous mass

Front 16

Which is not a warning sign for SCCA: persistant lesions with no obvious cause, isolated perio defects, tingling / numbness, unexplained cervical lymphadenopathy, dysphonia, dysphagia, dyspnea.

Back 16

dyspnea in not a warning sign. Tingling/numb, lesions w/o cause are most important

Front 17

T/F Histologic grading is the most important parameter for the prognosis and treatment planning of SCCA.

Back 17

False, Clinical staging is most important

Front 18

Staging is used to identify the extent of the disease before treatment and is based on the TNM system which stands for _____________.

Back 18

Tumor size, Nodal involvement, Metastesis.

Front 19

Tumors can be spread by all the following except: local extension, lymphatic spread, hematogenous spread.

Back 19

all are true

Front 20

T/F Posterior tumors are more prone to early metastesis.

Back 20

TRUE

Front 21

If a lymph node is ______ to tissue, it implies that the cancer has perforated the capsule of the lymph node resulting in a bad prognostic indicator.

Back 21

fixed (along with enlarged, hard and non-tender)

Front 22

T/F Improvement in early stage detection of SCCA has improved in the last 25 years.

Back 22

FALSE

Front 23

Treatment for SCCA includes ______, the primary modality, radiation and chemo.

Back 23

surgery

Front 24

External beam radiation treatment typically last ___ weeks 5 days/week using 5000 cGy to the tumor. Other forms of radiation include hyperfractional therapy (2 times/day), IMRT (intensity-modulated radiotherapy - spares normal tissue) and __________ (radioactive implants placed in tumor bed.0

Back 24

5 to 6, brachytherapy

Front 25

Pretreatment planes for SCCA include all the following except: indicated extractions (esp. mandibular), alveoloplasty, 14-21 day healing time prior to radiation, complete restorations, impressions for fluoride carriers, daily fluoride for 6 weeks, jaw exercises to reduce trismus.

Back 25

daily fluoride should be administered for life to avoid radiation caries

Front 26

Which is not a short term side effect of head and neck radiation therapy: mucositis, loss of taste, pain, radiation dermatitis, xerostomia, redness, hypersensitivity.

Back 26

xerostomia is a long term side effect

Front 27

Time frame for head and neck radiation: 1-2 weeks ____________, 3 weeks ___________, 4-5 weeks __________.

Back 27

loss of taste + thick saliva, mucositis of pharynx, mucositis of buccal mucosa and tongue

Front 28

All are long term effects fo head and neck radiation except: xerostomia, radiation caries, dysphagia, bone changes, trismus, hyperpigmentation of skin, altered development of jaw/teeth in young patients, carotid atheromas.

Back 28

all are true

Front 29

______________ occurs more frequently in the mandible when radiation exceeds 6500 cGy causing avascular necrosis.

Back 29

Radiation osteonecrosis

Front 30

Treatment for osteoradionecrosis includes surgical removal of bone and ________.

Back 30

hyperbaric O2

Front 31

The five year survival rate for SCCA on the lower lip is __% while the tongue is __%.

Back 31

94, 48

Front 32

Reasons for poor prognosis of oral SCCA are: late diagnosis, difficult anatomy and _____________, which describes the concept of the remaining tissue surrounding the SCCA had already undergone some genetic change and is more prone to developing additional cancers.

Back 32

field cancerization

Front 33

Clinical signs of maxillary sinus SCCA include: dull ache, referred pain to teeth, failure of an extraction site to heal, palatal ulcer and most importantly ________.

Back 33

parasthesia