OSCC

Question 1

what is the epidemiology of OSCC?

Answer 1

the commonest intramural cancer
>90% of intraoral malignancies
> others include NHL, salivary, mets, melanona, sarcoma

1-2% of all cancers world wide
>range = <5% - 40%+
>100 new cases per year in NI

Question 2

what patients are affected?

Answer 2

> 80% of patients aged 40+ years
2M : 1F (suggestion of increase in younger males)
50%+ will die of disease, survival unchanged for 25 years

Question 3

what are the main risk factors of OSCC?

Answer 3

TOBACCO X4
>all forms of tobacco
>related to quantity and duration

ALCOHOL X2
>all forms
>related to dose (not concentration)
>synergy with tobacco (multiplicative effect)

Question 4

what are other possible causes of OSCC?

Answer 4

UV-light/ sun exposure
> vermilion border of lip (not intraoral)

betel quid
>Areca nut (with additives..)

malnutrition

infections
>syphilis, candida, HPV

immunosuppression

Question 5

what are some key risk factors if the patient never smoked?

Answer 5

1. potentially malignant oral lesion (PMOL)
   >pre excisting unstable mucosa
2. elderly female
   >verrous plaque - perhaps PVL
3. 50 year old female
   >speckled leukoplakia on tongue
   > usually with dysplasia

Question 6

what are the main anatomical locations of OSCC?

Answer 6

1. tongue
   >anterior (65%)
   >posterior (35%)
   > accounts for 30-40%
   > M:F = 2:1
2. FOM
   >accounts for 15-30%
   >M:F = 2:1
3. gingiva
   >lower (60%)
   >upper (40%)
   > accounts for 10%
   > 1:1
4. palate
   >accounts for 5-10%
   > 2:1
5. cheek
   > accounts 5-10%
   > 2:1
6. lip
   >lower (95%)
   >upper (5%)
   >accounts for 25%
   > 8:1

Question 7

what are the most common sites?

Answer 7

tongue
>lateral border
>ventral surface

Floor of the mouth
>anterior or posterior

lower gum (including retromolar pad)

the sump

Question 8

what are the clinical features of an OSCC?

Answer 8

a lump
>usually firm, not very mobile

a white patch
>thickened wart plaque

an ulcer
>raised, rolled, everted edge
>not a fibrinous floor

Question 9

what is the behaviour of an OSCC like?

Answer 9

1. local invasion
   >relentless growth
   >deeper structures
2. Metastasis (30-50%)
   >check lymph nodes in the neck
3. check distant sites (10%)

Question 10

what are the survival chances of an OSCC?

Answer 10

early stage of disease = 80% three year survival
>shallow tumours <10mm deep and without nodal metastasis

later stages = 50% three year survival
> with nodal metastasis or very large tumours

Question 11

what factors influence prognosis?

Answer 11

1. site
2. age (over 80) x7-8
3. co-morbidity x2-3
4. stage, especially LN x2-3
5. surgical clearance
   >if margins over 2mm, 33% recurrence
   >if margins under 2mm, 66% recurrence
6. histopathology (very poorly differentiated cells)

Question 12

what is the treatment options of an OSCC?

Answer 12

> surgery
radiotherapy
chemotherapy
none of the above

Question 13

what can dentists do?

Answer 13

> vigilance
follow up
educate

Question 14

why are small ones tricky to spot?

Answer 14

> mimic other lesions
symptomless until advanced
no chance with late diagnosis

Question 15

what is a good outcome?

Answer 15

3 year survival

Question 16

what affect can OSCC treatment have on oral health?

Answer 16

> mucosititis
drug reactions
xerostomia
radiation caries
ORN

Question 17

what is a significant risk of OSCC?

Answer 17

new primary lesion
recurrence

Question 18

prevention in OSCC?

Answer 18

> primary and secondary
increase awareness of = tobacco use, alcohol consumption, oral health

> screen in identifiable at risk groups (known history, curative treatment)