1. Preanaesthetic evaluation prior to surgery esp in increased age and smokers 2. Pretreatment baseline 3. Screening for lung ca or lung lesions (frequently requires chest ct)

SCC Flashcards by Learn Academia

Differential diagnosis of ulcerative lesion (chronic >3months)

Recurrent long standing traumatic ulcer (causative factor)
Erosive lichen planus (may have white striations)
Mucous membrane pemphigoid (assoc with ocular or genital lesions)
SCC (ulcerated and indurated with rolled margins)
Behcets syndrome (triad of oral, ocular, genital)

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Give conditions/lesions with malignant potential and the risk of scc

Lesion:
Erythroplakia 25%
Leukoplakia 1% - ^^ up to 16% with dysplasia
Proliferative verrucous leukoplakia - 75%
Chronic hyperplastic candidiasis

Conditions:
Lichen planus - esp erosive type (1-3%)
Oral submucous fibrosis - 10%
Syphillitic glossitis
Sideropenic dysphagia
(They have potential to turn malignancy due to the atrophy within the mucous membrane)

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What is proliferative verrucous leukoplakia

Veruciform white lesion that has mutifocal papillary like growth.
Which has 75% risk of transforming into verrucous carcinoma or SCC

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Histopath of leukoplakia

Parakeratosis
Loss of rete ridges
Epithelial dysplasia with cellular pleormorphism
- Hyperchromatism
- Increase mitotic figures
- Increase nuclear cell ratio
- anisocytosis
- koilocytosis
Loss of basal cell polarity
Intact basement membrane

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what is aim of tx for leukoplakia

To prevent malignant transformation

To resolve the lesion

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Tx modalities for dysplasia (leukoplakia/erythroplakia)

Carbon dioxide laser ablation
Surgical excision

Chemoprevention:
Beta carotene
Retinoids

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Adv of co2 laser

Minimal damage to adjacent tissues
Minimal scarring
Minimal wound contraction

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Clinical features of SCC include

Symptoms 
Painless ulcer with swelling
Lump in the neck
Throat swelling, or discomfort with sensation of a foreign body
Dysphagia
Dysphoria
Otalgia
Weight loss

Signs
Indurated ulcer
Exophytic mass
Red lesions
Cervical lymphadenopathy (reactive or metastatic) mets nodes: 
- hard, nontender, fixed, nonmobile
CN involvement
CN V - paraesthesia
CN IX - soft palate paresis/paralysis
CN XII - deviation of tongue to affected side with wasting and fasciculations

Must include NASOENDOSCOPY in all oropharyngeal tumors

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Whats the role of OPG in OSCC

To assess bony involvement - signs of bony destruction/ decalcification as a result of direct pressure or invasion - scc invasion will show loss of cortical outlines and irregular areas of radiolucency
Dental assessment prior to definitive treatment of surgery or RT to ensure appropriate dental treatment can be undertaken including exos
Planning of bony resection or access osteotomies
Post op for assuring adequate reduction and fixation of access mandibulotomies or where reconstruction done - to confirm bony continuity, plates position and condyle in glenoid fossa

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Role of CXR in OSCC

Preanaesthetic evaluation prior to surgery esp in increased age and smokers
Pretreatment baseline
Screening for lung ca or lung lesions (frequently requires chest ct)

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Role of CT primary tumor and neck in OSCC

To see size and extension of lesion
To see potential involvement of surrounding structures
To detect positive nodal mets
- increase in size (>1cm)
- central necrosis
- rim contrast enhancement
- exttacapsular extension
- onliteration of surrounding fat planes
For clinical tnm staging to decide on definite treatment plan
To allow for planning of surgical resection
To allow surgical guide in reconstruction
To assess for vessel patency in recons

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Signs if nodal involvement in OSCC

Clinically
- enlarged palpable nodes
- nontender
- hard
- fixed to underlying structure
CT scan with contrast
- enlarged nodes >1cm
- central necrosis with contrast enhancement at the rim 
- extracapsular extension
- obliteration of fat planes

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Role of MRI in SCC investigation

With contrast (gadolinum)

Indicated in soft tissue oropharyngeal tumor (tongue, soft palate, tonsil, posterior pharyngeal wall)
Indicated in salivary gland ca
to see size and depth of tumor
to detect vascular or perineural involvement
detect nodal mets (similar accuracy with ct)
for clinical tnm staging
to allow planning of resection
to assess vessel patency for reconstruction

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Role of USS in neck mass

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Can you decide on a definite therapy upon diagnosis of FNAC/FNAB

Fine needle biopsy or cytology POSITIVE

> excisional biopsy of the lesion thru a “denfensive neck incision”
> if ca + then proceed to END, SND, RND

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What is the role of SNB in OSCC?

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How is SNB done in H&N SCC

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Whats the role of FDG-PET/CT in oral scc

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Indicated in high risk patients and advanced dz

Detect synchronous primaries
Detect distant mets in advanced dz
Upstaging of dz - to ensure adequate tx to improve overall survival
Detect recurrence if suspected but cannot be detected by other methods

Increase metabolic activity of ca cells will increase FDG uptake - detection of ca
- not permissable to do after biopsy or surgical tx as it will cause false positive due to increase inflammatory response post op

How does HPV positive SCC has better prognostic value compared to negative HPV

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those with HPV-positive tumors typically exhibit a better response to chemotherapy and/or radiation therapy, with an approximately 60% reduction in risk of death and 30% greater 5-year absolute survival rate.

Improved survival may reflect the unique biology of HPV- positive carcinomas as well as the low rate of comorbidity among the relatively young age group typically affected.

Possible biologic reasons for favorable prognosis include an intact p53-mediated apoptotic response to radiation and a lack of field cancerization (see next section).

How is oral cancer tx based on TNM staging

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What are adverse features in cancer?

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Extranodular extension pN+ with ENE (+)
Positive margin
T3 and T4 tumors
N2 or N3
Nodal mets at level IV or V
Perineural invasion
Vascular embolism

What are indications of elective neck dissection?

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In cases without neck mets, certain cancer staging still requires the neck to be selectively dissected - to prevent further neck mets.
has said to improve survival rates (%)
elective neck dissection in oral scc includes level 1,2,3.

Indicated in cases where occult mets are at higher risk

T2 or T3 with N0
Location of tumor at tongue and FOM
DOI > 3mm in tongue or FOM at any T size
Poorly differentiated tumor (G3)

When and what is SND?

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Selectively dissecting neck according to most likelihood lymphatic drainage.
Oral ca - level 1,2,3
Oropharyngeal - level 2,3,4

Done on cN0 but has risk of occult mets

T2 or higher
location tongue, FOM, RMT
DOI > 3mm in tongue at any size
DOI > 5mm anywhere else

What is RND and MRND and when is it indicated

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Removal of ALL neck nodes from level I-V together with IJV, SCM, SAN

MRND removes nodes at level I-V but preserving the IJV, SAN, SCM

Indicated when cN+

Adjuvant therapy. When is it indicated?

adjuvant therapy involves RT +/- CT when adverse features are present 1. ENE (+) 2. Margin (+) 3. T3, T4 4. N2, N3 5. Nodal disease at level 4,5 6. Perineural invasion 7. Vascular embolism

What is RT?

What is Cancer therapy?

Prescription of chemotherapeutic drugs such as platinum based, 5-FU, Methotrexate, Taxane, Monoclonal antibodies To induce cell death including cancer cells ``` 3 types Neoadjuvant - before surg/rt Concurrent - during rt Adjuvant - after surgery or rt Chemo alone. ```

Possible complications for RADICAL RESECTION?

Possible complications for NECK DISSECTION?

Possible complications fir RADIOTHERAPY?

Acute effects RT - mucositis - skin erythema/ulceration - loss of taste - infection - bleeding - lymphoedema Late - fistula - impaired healing - orn - xerostomia - radiation caries - radiation induced tumors (sarcoma) - neuropathies - fibrosis

Postop management of cancer patients include?

Postchemo or postradio, patients will be neutropenic/leukocytosis. How do you manage?

They are prone to infection May present with febrile neutropenia Mx: prevent infection Antibiotic prophylaxis Neupogen (G-CSF: Filgrastim) - effective for 5 days.

SCC Flashcards

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