A Closer Look
Unlock all answers in this set
Unlock answersquestion
Wipes off white spot
answer
Candida
question
White patch that cannot rub off and that cannot be identified as any other lesion. Clinical description only, not a diagnosis! Check under your dentures! -Cheek -Ventral Tongue (carcinoma!) around gingiva -FOM (carcinoma!)
answer
Leukoplakia
question
Top to bottom cellular abnormalities. **PLEOMORPHISM and HYPERCHROMATISM**
answer
Carcinoma In Situ
question
Patient has a red area with white speckled areas in it along the palate and buccal mucosa
answer
Speckled Leukoplakia: Send to oral surgeon right away!!! CAN KILL YOU
question
Lateral lump on base of tongue. Or huge outer part of cheek. INVASION on the microscopic slides. You see a lump, an ulcer and a leukoplakia.
answer
Squamous Cell Carcinoma : Cut it out quick! Before it gets too big and invades into other cavities!
question
What is a prerequisite for diagnosis of SCC?
answer
INVASION : Breach of the Basal Membrane into CT.
question
An fair skinned middle-aged patient has a dark spot on the SKIN of their face and at the top of their ear (not in the mouth). The ulcer has rolled margins, with a ***'rodent ulcer' appearance. You look near the eyes and at the scalp since this is also where they go (at hair follicles/sweat glands/sebacious glands). Malignant cells are dark purple and seem to have came off the basal cell layer. Resembles an ameloblastoma.
answer
Basal Cell Carcinoma: Might burrow into the bone through LOCAL invasion. Does NOT metastesize but can invade a local structure like the brain.
question
Patient has a skin lesion that is dark red in color, larger than 6 mm with uneven borders and has reported it getting bigger over the past year.
answer
Melanomas: Poor prognosis A : Asymmetrical B : Border uneven C : Color (both red, dark, black, achromatic D : Diameter >6 mm E : Evolution:
question
Which country develops the most oral and pharyngeal cancer?
answer
India! They have tobacco in their mouths all the time.
question
Which area has the most oral cancer?
answer
Tongue > Lip > FOM (And men are more likely to get it on their lips)
question
At the time of detection, what percentage are localized?
answer
36%
question
If it has metastasized to a lymph node, what is your survival rate?
answer
50%
question
If you have something on your lip, will you be ok?
answer
Most likely
question
If you have something on your tongue, will you be ok?
answer
Not likely
question
Do oral cancers resemble benign lesions?
answer
YES! This might delay in diagnosis. If a sore doesn't heal, get it checked out! Waiting makes it non-curable.
question
Common themes in advanced cancers
answer
-Patients used tobacco and drank alcohol -Diagnosis delayed more than 5 months -Aggressive tx was needed -Patients survived less than 6 months
question
Patient's tongue is lifted up due to lesion.
answer
Advanced SCC : need to cut out a lot. Radiation needed too.
question
Pleomorphism Hyperchromatosis Mitosis
answer
Dysplasia / Pre-Cancer
question
Epithelium that is invading is making layers** once cells start invading. It is called what?
answer
Keratin Pearls
question
Snuff Dipper's Cancer is associated with which Carcinoma?
answer
Verrucous Carcinoma
question
Dark pink or white (with keratin) lesion. Warty like! It invades as a moving front. Patient uses smokeless tobacco. It is much more differentiated than SCC.
answer
Verrucous Carcinoma
question
Which is worse SCC or Verrucous Carcinoma?
answer
SCC
question
Highest cancer
answer
Lung
question
#2 for cancer for women
answer
Breast
question
#3 for both men and women
answer
Colon
question
#2 for men cancer
answer
Prostate
question
% of oral malignancies as SCC
answer
91%
question
Potential Mutagens
answer
Whitening chemical : Hydrogen Peroxide, you get free radicals with this. Alcohol
question
Biological processes that may result in mutations
answer
DNA repair activity Enzymatic changes Metabolic factors Immunologic factors
question
Most common site
answer
Posterior Lateral Tongue
question
** Which gender has more oral cancer?
answer
Men
question
**Which gender has more drastic decreases?
answer
Men
question
**Metastasis + rates?
answer
Spread to a distant site. Prognosis / outcome declines rapidly. 78% of posterior 1/3 tongue lesions had regional metastases at the time of diagnosis. Only ENT's can see this far back though, they escape our detection. Refer if pt. has difficulty swallowing.
question
Indurated
answer
Hard borders
question
Does smoking filtered cigarettes make you healthier?
answer
You actually have MORE chemicals with filtered. You just don't get as much nicotine and you end up smoking more cigarettes.
question
Nasopharyngeal Carcenoma ethnicity?
answer
Chinese -- related to the EBV.
question
Field Cancerization
answer
If you get 1 oral cancer you're 19x more likely to get oral cancer.
question
When comparing tonsils during your intraoral examination, you see that there is a really big right tonsil. What could this be?
answer
Carcinoma Tonsil
question
How can you pick up cancer?
answer
Incisional biopsy (definitive diagnosis!) -scalpel -punch (easy to use) Adjunctive techniques : -Toluidine blue (vital stain) -Chemiluminescence (vizilite plus) -Brush Biopsy (Oral brush test)
question
When to do elective adjunctive techniques (not substitutes)
answer
Scheduling problems, patient resistance, medical reasons (on cumadin), delays in referral, low degree of suspicion that it will be a cancer. Problems with them: You can get a false positive or false negative.
question
Which elective technique binds to DNA and sulfated mucopolysaccharides? This also shows an electrical potential of mitochondrial membranes. Water, ____, Water, Acetic Acid, Water. Tells you where to biopsy.
answer
Toluidine Blue Technique (Visalite Plus)
question
How effective was Toluidine Blue Staining?
answer
It is good 93% of the time. However this was not compared to the direct visual scan of the same patient.
question
What elective technique is a light stick. You first pretreat the epithelium with acetic acid (to make it more dense), it is 'safe' to put in your mouth.
answer
Chemiluminescence (ViziLite)
question
Type of technique where a brush is held and twirled. Cells stuck on brush then walk the brush across the slide. You can't see what the tissue is like you can only see if it's normal or not (+,-, atypical).
answer
Brush Biopsy Don't do it on an ulcer, lump, white or red changes. Go straight to incisional biopsy!
question
Where do you assume that there is a cancer if you find something there?
answer
Posterior lateral border of the tongue. Probably a squamous cell carcinoma.
question
SCC is thought to be
answer
Infection and Trauma Chronic Irritation Gingival Inflammation Fibrous Response to Irritation Denture Injury Chronic Trauma Chronic Candidiasis
question
What percentage of oral cancers are SCC
answer
90%
question
Can cancer have no invasion?
answer
No! It MUST HAVE INVASION!!!
question
Leukoplakia Forms
answer
Homogeneous Erythroleukoplakia Dysplasia Frictional Candidal Proliferative verrucous
question
PVL
answer
Proliferative Verrucous Leukoplakia
question
Should al leukoplakias be followed?
answer
Yes! And she says that most should be cut out!
question
Lab Que: the most common site of SCC
answer
Posterior Lateral border of the Tongue
question
Lab: What does oral SCC look like? Is it's appearance pathognomonic (you can tell what it is by looking at it)
answer
White patch (Leukoplakia) Ulcer Lump Red patch No! It's tough to manage so have a high index of suspicion
question
Lab: Explain current trends for incidence of SCC in men and women
answer
More women are smoking and more men are quitting smoking
question
Lab: What does indurated mean? Is an ulcer on the tongue that is indurated more serious?
answer
Hard,! and Yes!
question
Lab: Highest rate of cancer country
answer
India; has high rate of tobacco exposure.
question
Lab: If an oral cancer has metastesized at the time of recognition at 5 years
answer
50% or less survival rate.
question
Lab: How does snuff compare with cigarettes in terms of carcinogenicity
answer
It is NOT more, it is LESS.
question
Lab: Which systemic medication can be used in combo with a nicotine replacement replacement therapy?
answer
Zyban
question
Lab: Which NCT would be addictive itself?
answer
Nasal Spray
question
Is smokeless tobacco a safe alternative to smoking?
answer
No! Especially Skoal
question
Is the delivery of the nicotine to the user higher in smokeless tobacco than cigarettes?
answer
Yes! Because it has silicates in it, it will most likely cut your mucosa. This gives the tobacco juice access to your capillaries.
question
******Which is worse to use from an oral cancer standpoint smoked or smokeless tobacco?
answer
Cigarettes. Because you are adding HEAT to it. = Combustion products combine with the nicotine and the tars which give you more mutations
question
Mild dysplasia: if you move the quid around or stop using it, can the cancer be avoided?
answer
Yes!
question
How many people are diagnosed with Head and Neck Cancer every hour?
answer
4 people every hour
question
Type of cancer that develops with topical tobacco use (Snuff and chewing tobacco)
answer
Verrucous Carcinoma. Up to 20% have been associated with SCC.
question
What does nicotine to have the addictive effect?
answer
- Increases in Heart Rate and Blood Pressure. - Enhances Information processing -Reduces Fatigue - Sedative Action - Reduces Anxiety -Induces euphoria
question
What sort of withdrawal effects can happen with Nicotine?
answer
-Difficulty concentrating -Irritability -Insomnia -Increased appetite -Weight gain -Depression -Drowsiness -Nervousness -Fatigue -Headache
question
What 2 types of intervention are needed to help patient break the smoking habit?
answer
Behavioral and Pharmacotherapy
question
Is tobacco + whitening agent worse?
answer
YES.
question
Can you charge for visits that you just talk about tobacco cessation?
answer
Yes. #D1320
question
What factors should we consider when talking to patients about pharmacotherapy?
answer
-Patient preference -Patient's previous experience with medications -Patient characteristics: Co-morbidities (Alcohol and drug use), History of depression, Concern about Weight Gain)
question
Nicotine replacement therapy is not recommended in ---
answer
Adolescents Women who are pregnant or breastfeeding
question
What strength of gum should the patient use if they have more than 25 cigarettes a day? How frequently?
answer
4 mg strength. 1 piece every 1-2 hours for the first 6 weeks (10 a day), then spread it out more.
question
Nicotine Lozenges can't be used with
answer
Any Acidic beverages 15 minutes before their use. And no more than 20 lozenges a day!
question
Nicotine patch dosages depends on :
answer
How much they smoke. It gives a STEADY stream of the nicotine.
question
What do you need for an oral inhaler?
answer
A prescription. Delivers 2 mg of nicotine through puffing through the buccal mucosa. Use for a minimum of 3 weeks.
question
What are the contraindications for oral inhalers?
answer
Any respiratory problems or Type II Diabetes. Common side effects of the inhaler are: irritations, coughing and runny noses.
question
**** What has the highest addiction potential of all nicotine replacement therapies?
answer
Nicotine Nasal Sprays. Since the mucus membrane of the nose is really thin. You need a prescription because of this!
question
What do we prescribe for smoking cessation? What's the name for the anti-depressant form of it?
answer
Zyban; Wellbutrin SR It's better than the nicotine replacement therapy! This blocks the neuronal reuptake of dopamine and/or NE.
question
What is the only pill / non-nicotine replacement therapy that you can combine with nicotine replacement therapy?
answer
Bupropion/Zyban.
question
When should you NOT take Zyban?
answer
If you have a history of seizures or anorexia
question
Chantex is used for
answer
Nicotine replacement therapy pill/medication. This targets the receptors in the brain and attaches to them so that the nicotine cannot attach. You can't get pleasure from nicotine.
question
What are the Quit Rates with pharmacotherapy?
answer
1/5 of patients
question
Which cancer technique device has a fluorescent light that is helpful in the operation room? Abnormal tissue shows up as DARK.
answer
Velscope Shows inflammation which can show a positive finding of darkness. Perhaps not that beneficial.
question
Which cancer detection technique uses glasses and has 3 different colors of light? Abnormal tissue shows up as WHITE.
answer
Trimira. -Brilliant White Light -Violet Light -Green/amber light Not any studies showing this is better than just an exam.
question
IF you have a problem what are the options?
answer
1) Velscope or Vizilite or Trimira 2) Brush Biopsy 3) Incisional biopsy (3 appts. vs 1 to final dx. Possible addition of up to $300). This is the cheapest option and the gold standard for defining whether or not the patient has cancer. "When in Doubt, Take it Out!"
