oral cancer

• What is the clinical term used to describe an idiopathic non-scrapable white lesion in the oral mucosa?

  Leukoplakia
• What is the aetiology of leukoplakia?


  Unknown
• Why is leukoplakia considered important in clinical terms?

  It is a potential premalignant lesion
• What are the predisposing factors for leukoplakia?

  • Tobacco
  • Smoking
  • Chewing tobacco
  • Alcohol
  • Candidal infection
  • Viruses (HPV-16, EBV, HIV)
  • Oral epithelial atrophy
  • Vitamin deficiency
  • Genetic factors (Tumour Suppressor Genes-P53)
• What mutation is associated with the P53 gene in leukoplakia?

  It is responsible for controlling cell division and proliferation
• What demographic factors are associated with leukoplakia?


  Older patients and males
• What are the common sites for leukoplakia lesions?

  • Floor of mouth
  • Ventral surface of the tongue
  • Posterior lateral surface of the tongue
  • Buccal mucosa
  • Lingual aspect of the lower alveolar mucosa
• What are the characteristics of leukoplakia lesions?

  They are asymptomatic, white-greyish or red, and non-scrapable
• How does erythroplakia differ from leukoplakia?

  Erythroplakia appears as a red patch surrounded by a white margin due to atrophy of the oral mucosa
• What are the clinical types of leukoplakia?

  • Homogenous leukoplakia
  • Speckled leukoplakia
  • Verrucous leukoplakia
  • Combined red & white patches
• What histopathological features are associated with leukoplakia?

  Increased thickness of oral mucosa due to hyperkeratosis and acanthosis
• What percentage of leukoplakia cases contain epithelial dysplasia?

  About 25%
• What percentage of erythroplakia cases contain epithelial dysplasia?

  About 50%
• What are the criteria for epithelial dysplasia?

  • Nuclear and cellular pleomorphism
  • Nuclear hyperchromatism
  • Change in nuclear/cytoplasmic ratio
  • Prominent nucleoli
  • Loss of intracellular bridges
  • Basal cell hyperplasia
  • Loss of polarity of basal cells
  • Increased normal and abnormal mitoses
  • Drop-shaped rete ridges
  • Loss of normal epithelial stratification
  • Abnormal keratinization
• What are the types of epithelial dysplasia?

  • Mild Epithelial Dysplasia: criteria in basal one third
  • Moderate Epithelial Dysplasia: criteria in middle two thirds
  • Severe Epithelial Dysplasia: criteria in apical one third
  • Carcinoma In-Situ: criteria throughout the full thickness without invasion
• What defines a premalignant lesion?

  • A benign lesion with a greater potential for malignant transformation
  • Examples include:
  • Leukoplakia
  • Erythroplakia
  • Oral submucous fibrosis
  • Candidal leukoplakia
  • Actinic keratosis
• What diagnostic methods are used for premalignant lesions?

  Case history, clinical examination, and cytology using the Toluidine Blue Test
• What procedures are involved in the Toluidine Blue Test?

  1. 1% Acetic acid for ½ minute, followed by water rinse
  2. 5-10 ml of 1% TB for 1 minute, followed by 1% acetic acid for 1 minute, and finally water rinse
• What laboratory investigations are performed for premalignant lesions?

  • Cytological smear & culture
  • Serological test for syphilis
  • Biopsy for epithelial dysplasia
  • Regional lymphadenopathy
• What are the treatment options for premalignant lesions?

  • Prevention and removal of predisposing factors
  • Follow-up
  • Biopsy if lesion improves or does not regress
  • Referral for surgical excision or topical treatments
• What factors influence the prognosis of premalignant lesions?

  Risk sites, nature of lesion, severity, duration of predisposing factors, and histopathological features
• Which has a higher malignant transformation potential: erythroplakia or leukoplakia?

  Erythroplakia
• What is the time frame for leukoplakia to potentially transform into squamous cell carcinoma if untreated?

  About 5 years
• What is the definition of a benign tumor?

  A histological change in tissue mainly characterized by hyperplasia
• What is the term for a benign tumor originating from squamous cells?

  Squamous Cell Papilloma
• What is the term for a malignant tumor originating from epithelial tissue?

  Carcinoma
• What are the classifications of epithelial tumors?

  • Benign Epithelial Tumors:
  • Squamous cell papilloma
  • Verruca Valgaris
  • Condyloma Acuminum
  • Focal Epithelial Hyperplasia
  • Keratoacanthoma
  • Melanotic naevi
  • Malignant Epithelial Tumors:
  • Squamous cell carcinoma
  • Verrucous carcinoma
  • Basal cell carcinoma
  • Melanoma
• What is the aetiology of squamous cell papilloma?

  Unknown and Human Papilloma Virus (HPV) types 6 & 11
• What are the clinical features of squamous cell papilloma?

  Asymptomatic soft tissue swelling, greyish-white color, and variable size
• What are the histopathological features of squamous cell papilloma?

  • Proliferation of epithelial cells in finger-like projections
  • Hyperkeratosis and acanthosis
  • Cores of vascular connective tissue stroma
• What lesions are caused by Human Papilloma Virus (HPV)?

  • Squamous cell papilloma
  • Verruca Valgaris
  • Condyloma Acuminum
  • Focal Epithelial Hyperplasia
  • Keratoacanthoma
• What is the purpose of histopathological grading of malignant tumors?

  • To evaluate the degree of differentiation
  • To assess the level of invasion
• What is the purpose of clinical staging of malignant tumors?

  • To evaluate the clinical extent of the tumor
  • To determine treatment options
• What type of lesion is characterized by finger-like projections and hyperkeratosis?

  1. like lesion
• What histopathological feature characterizes the lesion with finger-like projections?

  The lesion consists of proliferation of epithelial cells in the form of finger-like projections, formed of hyperkeratosis and acanthosis.
• What supports the lesion in its structure?

  Cores of vascular connective tissue stroma
• What lesions are caused by Human Papilloma Virus (HPV)?

  • Squamous cell papilloma
  • Verruca Valgaris (wart)
  • Condyloma Acuminatum (Venereal Wart)
  • Focal Epithelial Hyperplasia (Heck’s Disease)
  • Keratoacanthoma
  • Squamous cell carcinoma
  • Verrucous carcinoma
• What does histopathological grading of malignant tumors evaluate?

  It evaluates the degree of differentiation and the level of invasion.
• What are the categories of histopathological grading for squamous cell carcinoma?

  Well differentiated, moderately differentiated, and poorly differentiated squamous cell carcinoma.
• What is the purpose of clinical staging of malignant tumors?

  To evaluate the clinical condition and outcome of the tumor.