Oral Cancer Statistics and Screening Devices – Flashcards

1. Squamous cell carcinoma ▫ ----- or more of all oral cancers ▫ ------ carcinoma (<5% of all oral cancers) 2. Non-Hodgkin lymphoma 3. Minor salivary gland carcinoma ▫ --------cystic carcinoma ▫ Mucoepidermoid carcinoma ▫ Polymorphous low-grade adenocarcinoma

1. Verrucous carcinoma is a type of squamous cell carcinoma that makes up less than 5% of all oral cancers. It is a --------------------- cancer that rarely spreads to other parts of the body, but it can grow -------- into surrounding tissue.

2. The tonsils and base of the tongue contain lymphoid tissue where lymphoma can start. These enlarged tissues will look more bulky and fleshy than usual, and typically do ---------. The photo is showing unilateral enlargement with lymphoma. 3. There are several types of minor ----- ------ cancers, including adenoid cystic carcinoma, mucoepidermoid carcinoma, and polymorphous low-grade adenocarcinoma.

Highest Risk Sites for Oral Cancer in order

Background of Oral Cancer Kills 9,570 a year in U.S. alone ▫ 48,330 cases will be diagnosed in U.S. in 2016 Affects ---- 2:1 5 year survival rate is hasn't improved much (----) during the last 30 years ▫ Death rates have been -------- over the past three decades, partly due to the downturn in the smoking epidemic and seeing more ------ cancers Early diagnosis increases this rate

HPV16 is more ---------- to treatment and this type of oral cancer is on the rise, therefore the survival rate of oral cancer is improving.

2. Local: the cancer is only in the area where it -------. This includes stages I and II, as well as some stage III cancers that haven't spread to any lymph nodes. Only --- of oral cancers are diagnosed at the local stage. 3. Regional: the cancer has spread to nearby tissues and/or lymph nodes. This includes some stage III cancers, as well as stage IV cancers that haven't ---------- 4. Distant: the cancer has spread to distant sites

Risk Factors for Oral Cancer (Over 75% of cases include---- or ------) Over 40 years of age Tobacco ▫ -----X increased risk of developing oral cancer if using ------ tobacco rather than cigarettes Excessive alcohol consumption Heavy tobacco use and excessive alcohol use ▫ Synergistic relationship ▫ ------- X risk of developing oral cancer ------- exposure to the lip Infected with Human Papillomavirus 16 Erosive lichen planus Use of betel quid or gutka

1. Is alcohol in mouthwash a contributing factor to oral cancer? 1. ------- 2. Alcoholic beverages contain numerous additives and chemicals that are known to cause cancer, which arise from the -------- and distillation processes when yeasts and plants convert pyruvate into Acetaldehyde. Acetaldehyde can be toxic to oral tissues, causing DNA damage in the cells, leading to cell mutation and carcinogenesis. This is why chronic alcoholic beverage consumption is a leading risk factor for oral and pharyngeal cancers. (Dispel the Myths from DofDH) 3. Alcohol exposure also increases the ------of oral mucosal cell membranes, allowing cellular DNA to become exposed to toxins and other carcinogens. This explains why many cases of oral cancer are observed in chronic drinkers, chronic smokers, or in people who drink socially and also smoke. Laboratory data that demonstrate increased cell permeability are based on exposure of the cells to large amounts of alcohol and exposures of 1 hour or longer, which reflects what is observed during social drinking. (Dispel the Myths from DofDH)

2. Show the video linked to HPV by clicking on HPV. It is from 10/08. HPV is the fastest growing risk factor for oral cancer. HPV 16 DNA is found in 39% of the cases of oral SCC. HPV oral cancers are mostly on the tongue and tonsils in the oral cavity. HPV causes the cells to lose control over how they are duplicated and unable them to repair themselves. People who acquire HPV-related oral cancer tend to be younger than others who have oral cancer from other causes. 3. ----- is shown in the erosive form of lichen planus. Biopsy lesions annually or if ulcerations/color changes occur 4. People who chew betel quid or gutka have an increased risk of cancer of the mouth. Gutka is a mixture of betel quid and --------. We will talk about this more in chapter 15.

Increased risk ▫ Age ----- ▫ No lifestyle risk factors ▫ --------

High risk ▫ Age -----and older ▫ No lifestyle risk factors ▫ Tobacco, alcohol, or drug users (any type, any age, within 10 years) ▫ ---------

Highest risk ▫ Age 40 and older ▫ With lifestyle risk factors ▫ ------

1. Lifestyle risk factors include tobacco use, chronic alcohol use of at least 2 oz of alcohol------- times per week, -------

Signs and Symptoms • Sore does ----- • Pain does ------ • Persistent lump or thickening of tissue • Persistent red or white patch • Persistent sore throat • Persistent halitosis • Difficulty chewing or swallowing • Lump in neck • Weight loss • Numbness of tongue or mouth • Loosening of teeth

1. Anything that doesn't heal in ---weeks should be suspicious.

Lesion Color Indicates Risk ----- of leukoplakias are precancerous or cancerous ▫ Can take up to 10 years for precancerous areas to become malignant ----- of erythroplakias are or will become cancerous

1. Of the total number of dysplastic lesions seen by the dental profession on a yearly basis, ----- of them come from leukoplakias, not erythroplakias. Therefore, even though leukoplakias have a lower chance that they are malignant, they are more abundant, so we see more dysplasia from -------- than we see from erythroplakias

Cancer Screening "A means of detecting disease ----- in asymptomatic people. • • • "Positive results of examinations in cancer screenings are usually not diagnostic but identify persons at ------risk for the presence of cancer who warrant further evaluation."

Screening Frequency American Cancer Society Recommendations ▫ a yearly oral cancer related check-up for all people ----years of age or older ▫ every ----years for people between 20-39 years of age

Many oral health professionals now believe... All individuals over the age of --- should have an annual comprehensive oral examination Ideally this examination should be: 1. Performed at every dental hygiene visit 2. Enhanced with an adjunctive technique to improve the clinician's ability to identify areas of concern that might otherwise have been missed with the conventional exam A properly trained dental hygienist may perform the screening followed by the -------

Hygienists' Actions Regarding Cancer Screenings from the August 2009 edition of HygieneTown • ---- perform a full head and neck exam every time on every patient • ---- use visual, palpation, and tongue examination with gauze • -----do not teach their patients how to do an oral cancer self-exam

1. 386 hygienists were surveyed. 2. ---- vs. visual exam only, visual and palpation exam only, or allowing the dentist to do the exam.

Monthly Oral Cancer Self-Exam High importance for those with ▫ Suspicious ---- ▫ Risk factors ------users especially ▫ Resistance to stopping their risky habits Equate this to a monthly breast exam Demonstrate with a mirror Tell client to call if something suspicious is seen

Adjunctive Screening Tools Used to improve opportunities for diagnosing oral lesions. Does not replace the manual/visual examination. • Examples • ---- ----

1. Microlux DL by AdDent and Orascoptic DK by Orascoptic are the same systems as ViziLite (chemiluminescent light-based detection systems), ViziLite was in reports in 2009 about lack of effectiveness since the vinegar solution doesn't have long term substantivity and the layer it removes comes back within seconds. 2. The ADA article was in the May 2010 issue of JADA, Evidence-Based Clinical Recommendations Regarding Screening for Oral Squamous Cell Carcinoma. "-------------" means that the panel did not find sufficient evidence to support a recommendation.

1. VELscope and Identafi are not used ------- in dental offices due to the cost. They are not considered a standard of care procedure at this time, like a mammogram, pap smear, and PSA test.

VELscope® 1-2 minute exam that evaluates oral mucosa for abnormal areas ▫ Sometimes unnoticeable Can be ------ surface exposure of the lesion ▫ Recognized by the World Health Organization (WHO)

VELscope® • High cost ▫ $5,000 plus disposable pieces ($400) ADA code 0431 for reimbursement ▫ • High tech capabilities ▫ Can attach digital or -------- ▫ Used by ------- to identify the margins of lesions

Technique Handpiece emits a safe ---- light ▫ Causing tissue ---------- ▫ Healthy tissue appears bright green ▫ Abnormal tissue appears darker due to break down of collagen Key Finding • Blood vessels and highly vascularized areas appear ------, along with pigmentation areas. • Check for blanching of tissues to rule this out. If it completely blanches, you don't worry about it. Lesions with inflammation may blanch slightly (but not completely) when pressing on them. Cancer and precancerous lesions might slightly blanch due to inflammation association. •

1. Operator ---------need to wear any special glasses. Patient wears glasses that filter out the UV light.

1. Velscope causes abnormal tissues to ------- the light. 2. The green color is a reflection of --------fluorescence. When cancer forms, collagen is broken down and so it doesn't reflect the green color from the collagen.

1. Blood vessels and highly vascularized areas ------, along with pigmentation areas. You should check for blanching of tissues to rule this out. If it completely blanches, you don't worry about it. Lesions with inflammation may blanch slightly (but not completely) when pressing on them. Cancer and precancerous lesions might -------- due to inflammation association.

IdentafiTM 3000 Enhances visualization of mucosal abnormalities unseen with the naked eye Uses w----- ------ ------- light to view tissue changes ▫ Wear filtered glasses to see the reflected light from the tissues High cost $3,400

1. The mirror slip covers are disposable. 25 come in a package. This is cordless and replaceable batteries. 2. Rose colored glasses are for the practitioner, yellow for the patient. 3. Excitation of oral tissue through white, violet, and amber wavelengths of light allowing biochemical changes to be monitored with fluorescence, while morphological changes can be monitored with reflectance. 4. White light is used while you perform the routine manual examination. 5. -----light shows a more natural appearance to the tissues, allowing abnormal tissues to appear darker. 6. Amber------ light is used when suspicious tissue is found under the violet light. Vascular changes can be seen better with the ----light on. Lesions with abnormal vascular growth (fuzzier channels from the veins) are more likely to be malignant. 7. Click on the wording about the white, violet, and amber lights to watch a video demonstration. You need to click on Identafi Process to start the video. Next, watch the 1 1⁄2 min video by clicking Identafi Results on the same page.

OncAlertTM Point of Care Assessment Test ------- • Produced by Vigiliant Biosciences ▫ Studies supported by the National Cancer Institute Early detection of oral ---------contains oral rinse and test strip Test strip detects proteins that are markers of oral cancer ▫ Possibly present before visible lesion develops

SaliMarkTM OSCC "The world's most scientifically-validated molecular DNA biomarker test for oral squamous cell carcinoma." aid in the identification and early detection of oral lesions at the highest risk for cancer The sample will be sent via ---------service to the scientific testing lab where a specific lab assay will be performed. The test results will be made available to the clinician; electronically consistent with HIPPA compliant protocols within two days

1. SaliMark is touted as the "world's most scienti....." but they are also the ONLY one! 1. Sold through -------

Risk Assessment Programs ----------- Free program for dental professionals ▫ caries, periodontal disease, pathology answer series of questions pertaining to topic creates a risk level, interventions required, and take home form