Orp: Non-Squamous Head And Neck Cancer

Front 1

what percent of oral cancers are squamous carcinomas?

Back 1

>90%

Front 2

SSC incidence increases with: (3 things)

Back 2

age

tobacco/ETOH use

male gender

Front 3

high risk sites for oral SSC

Back 3

lateral tongue

ventral tongue

floor of mouth

retromolar trigone

soft palate

Front 4

list 4 cancers encountered in children that may affect the head/neck:

Back 4

leukemia/lymphoma

neuroblastoma

Ewing's sarcoma

rhabdomyosarcoma

(all are small blue cell tumors)

Front 5

how does childhood leukemia w/ oral manifestations usually present?

Back 5

gingival enlargements or bleeding

generalized, diffuse, boggy, spongy gingiva

Front 6

Burkitt's lymphomas involve the jaws most commonly in what population?

Back 6

African

Front 7

discuss jaw involvement in neuroblastomas

Back 7

may involve metastasis to jaws but seldom produce jaw primary

Front 8

what is Ewing's?

Back 8

poorly differentiated sarcoma of bone

Front 9

what are embryonal and alveolar rhabdomysarcomas?

Back 9

childhood sarcomas of skeletal muscle

Front 10

systemic signs/symptoms of childhood leukemia

Back 10

myelophthisic anemia
splenomegaly
lymphadenopathy
hepatomegaly
thrombocytopenia
fever assoc. w/ infection

Front 11

list 5 non-SCC cancers encountered in adults that may have head/neck involvement

Back 11

leukemia/lymphoma
salivary gland malignancies
metastatic cancers (from elsewhere)
nasopharyngeal carcinoma
osteosarcoma

Front 12

list some oral manifestations of leukemia:

Back 12

ulcerations

candidiasis

herpetic infections

diffuse gingival enlargement (tumor-like growth)

gingival hemorrhage (platelets < 10,000)

leukemic infiltration of periapical tissues

mass in mouth is possible -- chloroma / granulocytic

Front 13

leukemia:

histology of possible oral metastasis

Back 13

loss of normal tissue architecture to large proliferation of poorly differentiated cells w/ myelomonocytic or lymphoid features (small round blue cells)

confirm diagnosis w/ peripheral blood smear

Front 14

what is Burkitt's lymphoma associated with?

Back 14

EBV

Front 15

what is the most common chromosomal translocation in Brukitt's lymphoma?

Back 15

oncogene myc (of chr 8) becomes under control of IgH enhancer on chr 14

Front 16

Burkitt's lymphoma:

African form characteristics

Back 16

50-70% present in jaws

commonly affects children < 7

Front 17

Burkitt's lymphoma:

American form characteristics

Back 17

abdominal lesion (rare in jaws)

usually older patients

Front 18

Burkitt's lymphoma:

signs/symptoms (in face)

Back 18

facial swelling
tooth mobility

Front 19

Burkitt's lymphoma:

radiology

Back 19

radiolucent

destructive

ragged, ill-defined borders

patchy loss of lamina dura

affects all four quadrants

Front 20

Burkitt's lymphoma:

histology

Back 20

sheets of small, hyperchromatic non-cleaved B-cells

macrophages in lesional tissue (starry sky appearance)

Front 21

neuroblastoma:

typically involves what in children

histology

Back 21

typically involves adrenals

histology shows proliferation of small blue cells and necrosis

Front 22

what is Ewing's sarcoma?

Back 22

poorly differentiated sarcoma of bone

chromosomal translocation t(11:22)

(possible neuroectoderm origin)

Front 23

what percent of Ewing's sarcomas originate in the jaw?

Back 23

> 3%

Front 24

Ewing's sarcoma:

typical patient

Back 24

white males

< 20 years old

mandible > maxilla

Front 25

Ewing's sarcoma:

painful or painless?

other signs

Back 25

painful (assoc. w/ swelling)

parasthesia and loosening of teeth

fever, leukocytosis, elevated erythrocyte sed. rate

Front 26

Ewing's sarcoma:

histology

Back 26

small, round, blue-cell tumor

sheets or lobules of tumor cells

glycogen granules in cytoplasm

Front 27

what is the most common soft tissue problem in children?

Back 27

rhabdomyosarcoma

Front 28

where does rhabdomyosarcoma typically present in head/neck?

Back 28

nasal cavity
nasopharynx
soft palate

Front 29

rhabdomyosarcoma:

three different types

Back 29

embryonal (<25 years old)
alveolar (<25 years old)
pleomorphic

Front 30

oral presentation of leukemia in adults

Back 30

possible gingival enlargement

constitutional signs/rapid development are characteristic

Front 31

second most common malignancy in oral cavity

Back 31

lymphoma

Front 32

how does an oral lymphoma appear clinically?

Back 32

looks like an abscess but without puss

boggy, diffuse gingival enlargement

Front 33

Hodgkins disease:

typical age

typical sex

Back 33

15-35 years, and 50+ years
(bimodal)

female

Front 34

Hodgkin's disease:

typical sites

Back 34

cervical and supraclavicular lymph nodes (70-75%)

axillary and mediastinal lymph nodes (5-10%)

Front 35

Hodgkin's disease:

signs and symptoms

Back 35

enlarging non-tender mass in lymph node region
weight loss
fever
night sweats
generalized pruritis

Front 36

Non-Hodgkin's lymphoma:

soft tissue oral manifestations / locations

Back 36

non-tender diffuse swelling
boggy consistency
buccal vestibule, gingiva, posterior hard palate

Front 37

Non-Hodgkin's lymphoma:

oral manifestations - central bone lesions (presentation)

Back 37

vague pain / toothache

parashtesia

ill-defined radiolucency

bony expansion w/ cortical perforation

Front 38

Non-Hodgkin's lymphoma:

histology

Back 38

lymphocytic appearing cells destroying normal tissue

varying degrees of differentiation

lesional tissue necrosis

vague germinal center formation

nodular or diffuse

Front 39

salivary gland malignancies:

more common in...

Back 39

older patients

Front 40

salivary gland malignancies:

presentation

Back 40

slow growing swelling

possible nerve involvement with parasthesia

Front 41

metastatic cancers (from elsewhere):

most common bony site

Back 41

posterior mandible

Front 42

metastatic cancers:

jaw vs. soft tissue presentation

Back 42

jaw metatstases are often asymptomatic

soft tissue may present with swelling

poor prognosis overall

Front 43

metastatic cancers:

most common origination sites

Back 43

breast
lung
G.I.
thyroid
prostate
kidney

Front 44

nasopharyngeal carcinoma:

age

sex

geography

risk factors

Back 44

middle age

males

Asia, Pacific Rim

chemicals, EBV

Front 45

nasopharyngeal carcinoma:

presentation

Back 45

nasal cavity mass

if advanced, other symptoms:

obstruction
dysconjugate gaze

Front 46

nasopharyngeal carcinoma:

frequent metastatic sites

Back 46

cervical nodes (possibly the earliest finding)

Front 47

nasopharyngeal carcinoma:

histo

prognosis

Back 47

poorly differentiated, immature epithelial cells

prognosis is fair (radiation/chemo)

Front 48

osteosarcoma:

what is it

Back 48

a malignancy that produces bone

Front 49

osteosarcoma:

age

sex

Back 49

3rd decade and elderly (2 peaks)

male

Front 50

osteosarcoma:

what disease is responsible for the occurrence in the elderly

Back 50

Paget's

(poor prognosis)

Front 51

osteosarcoma:

most common site in head/neck

Back 51

mandible

Front 52

osteosarcoma:

clinical features

Back 52

pain

rapid enlargement

loosening of teeth

parasthesia

nasal obstruction

Front 53

osteosarcoma:

radiology signs

Back 53

loss of lamina dura

widening of PDL

mottled lucent/opaque areas

sunburst appearance (osteophyte production on lesional surface)

dense sclerosis

Front 54

osteosarcoma:

histology

Back 54

osteoid production by mesenchymal production

subtypes: osteoblastic, chondroblastic, small cell, periosteal, fibroblastic

Front 55

osteosarcoa:

treatment

Back 55

radical excision

radiation/chemo

Front 56

osteosarcoma:

5-year survival

metastatic sites from jaw

Back 56

30-50% survival

met. to lymph nodes, lung, brain