DH1 OUHSC Preventive – Oral Cancer – Flashcards
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HPV can appear normal in the oral environment. T or F?
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True
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Signs of oral cancer are subtle or obvious?
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Subtle
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Primary risk factors of oral cancer (6)
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Tobacco Alcohol Chronic sunlight Age HPV Poor diet
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What is a white lesion that can be rubbed or wiped off? (4)
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Candida Tissue burns Cheek bites Toothpaste reaction
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Oral cancer accounts for approximately ___% of all cancers in the United States.
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2.2%
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Oral cancer 5 year survival rate is lower than most other cancer. T or F?
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True
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________ ____ _________ represents more than 90% of cancers of oropharynx and oral cavity.
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Squamous cell carcinoma
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Objectives of Oral cancer screenings (4)
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Identify risk factors for oral caner Differentiate oral lessions Spread awareness of Oral cancer List screening and diagnostic devices
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Malignant neoplasms "new growths" that proliferate or exceed normal growth of cells
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Cancer
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Malignant neoplasms derived from epithelial tissue
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Carcinomas
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Benign tumors are contained or not contained?
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Contained
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Metastatic tumors are contained or not contained?
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Not contained
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Oral cancer sites (6)
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Lips Gingiva Hard palate Buccal mucosa Floor of mouth Anterior 2/3 of tongue
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Oropharyngeal cancer sites (4)
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Tonsils Soft palate Oropharynx Base of tongue
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Other head and neck cancer sites (7)
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Larynx Thyroid Nasopharynx Hypopharynx Salivary glands Paranasal sinuses Nasal cavity/Middle ear
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MOST oropharyngeal sites can be viewed or palpated. T or F?
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True
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Early detection and treatment result in improved _________ for survival rate
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Prognosis
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Velscope, Vizilite, Identafi are helpful in detecting _____________ or __________.
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Abnormalities or dysplasias
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Velscope improves ability to identify suspicious _______
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Lesions
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Velscope is recognized by ADA under what dental code?
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DO431
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Insurance may or may not cover Velscope?
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Insurance may not cover
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Patient fee to have the Velscope used on them.
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$35.00
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Most Dentists would highly recommend the Velscope. T or F?
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True
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The Velscope is offered to the Dental Hygienist how often?
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Annually
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Velscope: Normal tissue produces fluorescence and appears as an _____-_____ glow.
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Apple green glow
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Velscope: Abnormal epithelial tissue and underlying stromal disruption causes loss of __________.
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Fluorescence
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Erythroplakia is less common than leukoplakia, however typically shows dysplasia __% of the time.
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85%
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What are the primary causes (environmental exposures to carcinogens) of Oral Squamous Cell Carcinoma? (3)
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Tobacco Alcohol Chronic Sunlight Exposure
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Leukoplakia is more common than oral squamous cell carcinoma, however leukoplakia shows dysplasia only about __% of the time.
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20%
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Architectural structure of the cell
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Situ
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Process of Malignant genetic transformations (3)
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Exposure to carcinogens -> cellular genetic changes -> malignant genetic transformations
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Early lesions display different grades of epithelial dysplasia
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Pre-malignant
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Pre-malignant to malignant (3) steps
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1. Early (premalignant) lesions display different grades of epithelial dysplasia 2. Mild, moderate, severe 3. Carcinoma in situ (highest grade dysplasia) abnormal cells have NOT invaded adjacent tissue
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Mild dysplasia can quickly become invasive _________.
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Carcinoma
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NOT all dysplasia develop into _________.
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Carcinoma
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Diagnosis of malignancy can be unpredictable. T or F?
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True
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______ of suspicious lesions is vital.
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Biopsy
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Malignant tumors such as malignant melanoma, rhabdomyosarcoma, fibrosarcoma, leiomyosarcoma, Kaposi's sarcoma and lymphoma are examples of ____ cancers.
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Rare
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3 most common sites of Oral Squamous Cell Carcinoma
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Border of the lip Floor of the mouth Lateral border of the tongue
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Oral Squamous Cell Carcinoma: Lip area most common, floor of the mouth occurs approximately __% of the time.
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20%
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Lateral border of tongue: Squamous cell carcinoma occurs __% of the time
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50%
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Genetic changes may present in ____________ lesions that appear as small white patches called oral leukoplakia.
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Premalignant
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Premalignant lesions cannot be removed by what action?
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Rubbing
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Eythroplakia: Clinically can appear as red macules or plaques that may bleed when rubbed.
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Red lesion
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Erythroplakia: Lateral border of tongue, retromolar pad, soft palate
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Common locations
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Oral Leukoplakia: Areas of redness interspersed with white.
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Nonhomogenous
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Oral Leukoplakia: Uniformly white
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Homogenous
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Red areas of lesions are more likely to have dysplastic changes so always include them in your biopsy. T or F?
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True
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List 2 types of biopsy
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Brush biopsy Surgical biopsy
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Increased risk associated with malignancy, especially with erosive form what?
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Oral Lichen Planus
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Non-modifiable risk factors (3)
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Age Race Gender
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Modifiable risk factors (2)
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Environmental - sunlight Behavior - tobacco, alcohol, lifestyle
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Gender parity: Males are _ times more likely to develop oral cancer than females.
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2 times more
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Gender parity: Base of tongue
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8:1
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Gender parity: Tonsil
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4:1
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Gender parity: Lip
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3:1
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Gender parity: Floor of mouth
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3:1
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Gender parity: Hard palate
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Equal opportunity
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HPV: _______ individuals are developing oral cancers at increased rate
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Younger
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89% of cases occurring in adults age __ and above
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45
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Median age for diagnosis of cancer in oral cavity and pharynx for all races, males and females is __ years
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63
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Cancers of oral cavity and pharynx is higher among blacks. T or f?
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True
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Modifiable risk factors: Sunlight
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Wear sunscreen
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Modifiable risk factors: Tobacco
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Tobacco cessation
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Modifiable risk factors: Alcohol
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Moderation
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Modifiable risk factors: HPV
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Vaccinations
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Modifiable risk factors: Nutrition
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Healthy diet
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Strategies for prevention: Identify at earlier stage to improve ________.
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Prognosis
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Strategies for prevention: Less than __% are diagnosed at early stages
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40%
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Strategies for prevention: Perform thorough _________ and _________ exams.
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Intraoral and extraoral
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Strategies for prevention: Exam ______ (if possible)
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Yearly
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Survey findings: __% of hygienists indicated that they spend more time than the dentist performing oral cancer screenings.
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60%
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Survey findings: __% of hygienists indicated that the dentist spent more time performing oral cancer screenings.
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29%
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Hygienists in Oklahoma performing OC screenings: __% in favor of recommended yearly oral cancer exam with use of diagnostic aids on all adults over 18
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71%
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Survival rate of oral cancer: Five year survival rate 80% for lesions diagnosed at _________ stage.
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Localized
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Survival rate of oral cancer: Overall survival rate for all stages is __%
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50%
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Survival rate of oral cancer: Survival rate for primary lesions with distant metastases is __%
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15%
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More than half of all oral cancers are NOT diagnoses until regional spread has occurred. T or F?
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True
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List 3 Oral squamous cell carcinomas pre-malignant changes
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Erythroplakia Leukoplakia Erythroleukoplakia
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Define Non-Homogenous lesion
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White patch with a red component
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Age group most oral cancers are diagnoses.
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50-70
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Tobacco: # of years of smoking multiplied by the number of packs of cigarettes smoked per day.
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Pack years
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Grit and sand in smokeless tobacco products scratches teeth and wears away the hard surface or enamel. Premature loss of tooth enamel can cause added sensitivity and may require corrective treatment.
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Tooth abrasion
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Constant irritation to the spot in the mouth where a small wad of chewing tobacco is placed can result in permanent damage to periodontal tissue. It also can damage the supporting bone structure. The injured gums pull away from the teeth, exposing root surfaces and leaving teeth sensitive to heat and cold. Erosion of critical bone support leads to loosened teeth that can be permanently lost.
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Gum recession
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Sugar is added to smokeless tobacco during the curing and processing to improve its taste. The sugar reacts with bacteria found naturally in the mouth, causing an acid reaction, which leads to decay.
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Increased tooth decay
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Common traits of long-term smokeless tobacco users are stained teeth and bad breath. Moreover, the habit of continually spitting can be both unsightly and offensive.
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Tooth discoloration and bad breath
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Nicotine blood levels achieved by smokeless tobacco use are similar to those from cigarette smoking. Nicotine addiction can lead to an artificially increased heart rate and blood pressure. In addition, it can constrict the blood vessels that are necessary to carry oxygen-rich blood throughout the body. Athletic performance and endurance levels are decreased by this reaction.
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Nicotine dependence
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Chewing tobacco lessens a person's sense of taste and ability to smell. As a result, users tend to eat more salty and sweet foods, both of which are harmful if consumed in excess.
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Unhealthy eating habits
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With the practice of "chewing" and "dipping," tobacco and its irritating juices are left in contact with gums, cheeks and/or lips for prolonged periods of time. This can result in a condition called leukoplakia. Leukoplakia appears either as a smooth, white patch or as leathery-looking wrinkled skin. It results in cancer in 3 percent to 5 percent of all cases.
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Oral cancer
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All forms of smokeless tobacco contain high concentrations of cancer-causing agents. These substances subject users to increased cancer risk not only of the oral cavity, but also the pharynx, larynx and esophagus.
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Other Cancers
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If you use smokeless tobacco, or have in the past, you should be on the lookout for some of these early signs of oral cancer: * A sore that does not heal * A lump or white patch * A prolonged sore throat * Difficulty in chewing * Restricted movement of the tongue or jaws * A feeling of something in the throat
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Danger signs
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____________ is key for a more positive prognosis
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early diagnosis
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what is the role of the dental team?
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Provide over the counter material to health agencies and community centers Volunteer at health fairs by screening and providing pamphlets and referrals Talk to patients Provide CE's on oral cancer for other health care providers
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What are some diagnostic aids?
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Vizilite-Utilized with acetic acid solution (blue dye) Oral VDX-brush biopsy Velscope Saliva test
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In the saliva test, four specific patterns of ______________ appeared in patients with oral squamous cell carcinoma.
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Messenger RNA
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Velescope uses _______________ that detects oral dysplasia and abnormalities.
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Fluorescent light
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When using Velescope, how does healthy tissue appear?
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With an apple green glow
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With Velescope, how are suspicious areas identified?
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By a loss or fluorescence (dark)
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Is velescope approved by the FDA?
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Yes
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Biopsy is the only way to have a definitive diagnosis. T/F
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True
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Females younger than 50 with NO history of alcohol or tobacco who have lesions are at a greater risk of malignant potential. T/F
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True
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What is the predominant risk factor for cancer of the lip?
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Chronic exposure to sunlight
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Which forms of HPV may play a role in the malignant transformation of oral precancerous lesions and are considered risk factors?
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HPV-16 and HPV-18
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_____________ are cofactors potentiating the effects of alcohol and tobacco.
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HSV-1 and 2
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Which virus can produce malignant changes and is associated with certain head and neck cancers?
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Epstein Barr Virus (EBV)
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What virus is found in AIDS associated Kaposi's sarcoma?
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Human herpesvirus 8 (HHV-8)
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High rates of oral cancer are reported in countries where vitamin ____ intake is low.
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A
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Cancers of mouth, larynx, and esophagus may be related to low intake of fruits and carotene rich vegetables. T/F
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True
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Deficiencies or excesses of dietary proteins, fats or carbohydrates are linked conclusively to development of oral cancer. T/F
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False. These have not been linked conclusively.
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Oral lichen planus increases the risk for oral cancer, especially in the erosive form. T/F
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True
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Alcohol increases oral cancer risk in the _______________ (three parts of mouth)
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Floor of mouth Palate Tonsillar fossa
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The combination of cigarette smoking and alcohol together increase the risk dramatically for _______________________ cancer.
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Oropharyngeal
