Oral Cavity Lesions — MCQs
All of the following are true about carcinoma of the hard palate except:
What could be the most appropriate provisional diagnosis for multiple nodular exophytic reddish lesions of oral mucosa in an AIDS patient?
All are risk factors of esophageal squamous cell carcinoma except:
N3a TNM staging of head and neck tumors (AJCC 8th edition) shows:
Which of the following is NOT considered a premalignant lesion of the oral cavity?
T3 in the TNM staging of oral malignant lesions represents:
True about tongue cancer:
Second primary tumor of head and neck is most commonly seen in malignancy of:
Which cancers can cause referred otalgia (referred pain in the ear)? Select the most comprehensive answer.
Tongue fixation in a patient with carcinoma tongue is staged as
Oral Cavity Lesions Indian Medical PG Practice Questions and MCQs
Question 1: All of the following are true about carcinoma of the hard palate except:
- A. Lymphatic metastasis is uncommon
- B. Larger tumors require maxillectomy
- C. Associated with reverse smoking
- D. Most cancers are poorly differentiated and of ulcerative variety (Correct Answer)
Explanation: ***Most cancers are poorly differentiated and of ulcerative variety*** - The majority of **hard palate carcinomas** are well to moderately differentiated squamous cell carcinomas, rather than poorly differentiated. - While some may ulcerate, the presentation is not predominantly of an **ulcerative variety**; they can also present as exophytic or endophytic masses. *Lymphatic metastasis is uncommon* - **Lymphatic metastasis** to regional lymph nodes (submandibular and deep cervical) is indeed uncommon in early-stage hard palate cancers due to the relatively dense bony barrier. - However, as the tumor size increases or if there is extensive soft tissue involvement, the risk of **nodal metastasis** significantly rises. *Larger tumors require maxillectomy* - For larger or deeply invasive carcinomas of the hard palate, **maxillectomy** (surgical removal of part or all of the maxilla) is often necessary to achieve adequate surgical margins. - This extensive surgical approach is crucial for local disease control and to prevent recurrence, especially when the tumor extends into the bone or adjacent structures. *Associated with reverse smoking* - **Reverse smoking**, a practice where the lit end of a cigarette is placed inside the mouth, generates higher heat and carcinogen exposure to the palate. - This habit is strongly linked to an increased incidence of **squamous cell carcinoma** of the hard palate, particularly in certain geographic regions.
Question 2: What could be the most appropriate provisional diagnosis for multiple nodular exophytic reddish lesions of oral mucosa in an AIDS patient?
- A. Acute pseudo-membranous candidiasis
- B. Hemangioma
- C. Kaposi's sarcoma (Correct Answer)
- D. Focal epithelial hyperplasia
Explanation: ***Kaposi's sarcoma*** - **Kaposi's sarcoma (KS)** is a common malignancy in AIDS patients, often presenting with **reddish-purple to brown nodular lesions** on the skin and **mucous membranes**, including the oral cavity. - The description of **multiple nodular exophytic reddish lesions** of the oral mucosa in an AIDS patient is highly suggestive of KS. *Acute pseudo-membranous candidiasis* - This typically presents as **white, removable pseudomembranes** that, when scraped off, reveal an erythematous or bleeding surface. - It does not present as **reddish nodular exophytic lesions**. *Hemangioma* - While hemangiomas are benign vascular lesions that can be reddish, they are typically **solitary or develop earlier in life** and are not specifically associated with HIV/AIDS in this widespread, nodular form. - The presence of **multiple, exophytic nodular lesions** in an immunocompromised patient points to a more aggressive or opportunistic pathology. *Focal epithelial hyperplasia* - Also known as **Heck's disease**, this presents as **multiple, soft, flattened or rounded papules** that are usually the color of the normal mucosa or slightly paler. - It is caused by certain strains of **human papillomavirus (HPV)** and is not typically reddish or exophytic in the manner described.
Question 3: All are risk factors of esophageal squamous cell carcinoma except:
- A. Smoking
- B. Achalasia cardia
- C. GERD (Correct Answer)
- D. Alcohol
Explanation: ***GERD*** - **Gastroesophageal reflux disease (GERD)** is strongly associated with **esophageal adenocarcinoma**, not esophageal squamous cell carcinoma. - Chronic acid reflux can lead to **Barrett's esophagus**, which is a precursor to adenocarcinoma [1]. *Smoking* - **Smoking** is a significant and well-documented risk factor for **esophageal squamous cell carcinoma**, increasing the risk in a dose-dependent manner. - Carcinogens in tobacco smoke directly damage esophageal epithelial cells, promoting malignant transformation. *Achalasia cardia* - **Achalasia cardia** involves impaired relaxation of the lower esophageal sphincter and loss of peristalsis, leading to food stasis and chronic inflammation [2]. - This chronic irritation and inflammation significantly increase the risk of developing **esophageal squamous cell carcinoma**. *Alcohol* - **Alcohol consumption**, especially heavy drinking, is a major risk factor for **esophageal squamous cell carcinoma**. - Alcohol metabolizes into acetaldehyde, a known carcinogen, which directly damages DNA in esophageal cells.
Question 4: N3a TNM staging of head and neck tumors (AJCC 8th edition) shows:
- A. Metastasis in a lymph node >6 cm (Correct Answer)
- B. Metastasis in lymph nodes >2 cm
- C. Metastasis in lymph nodes >5 cm
- D. None of the options
Explanation: ***Metastasis in a lymph node >6 cm*** - **N3a disease** in head and neck cancer staging (AJCC 8th edition) specifically refers to metastasis in a single lymph node larger than 6 cm in greatest dimension **without extranodal extension (ENE)**. - This applies to oral cavity, oropharynx (HPV-negative), hypopharynx, and larynx cancers. - **Note:** N3 staging also includes **N3b** (metastasis in any node with clinically overt ENE), but this question specifically asks about N3a criteria. *Metastasis in lymph nodes >2 cm* - Lymph nodes in the 2-3 cm range typically fall within **N1 or N2a categories**, depending on laterality and number of involved nodes. - **N3a disease** requires a single lymph node to exceed 6 cm in greatest dimension without ENE. *Metastasis in lymph nodes >5 cm* - A lymph node between 3-6 cm is usually classified as **N2 disease** (N2a if single ipsilateral ≤6 cm, N2b if multiple ipsilateral ≤6 cm, N2c if bilateral or contralateral ≤6 cm). - To be classified as **N3a**, the lymph node must be **>6 cm** without extranodal extension. *None of the options* - This option is incorrect because the first option accurately describes the size criterion for **N3a TNM staging** in head and neck tumors according to AJCC 8th edition guidelines. - While N3 staging has two subcategories (N3a and N3b), the size criterion of >6 cm correctly defines N3a disease.
Question 5: Which of the following is NOT considered a premalignant lesion of the oral cavity?
- A. Desquamative gingivitis (Correct Answer)
- B. Erythroplakia
- C. Proliferative verrucous leukoplakia
- D. Chronic hyperplastic candidiasis
Explanation: **Desquamative gingivitis** - While it can be a manifestation of certain immune-mediated conditions (e.g., **lichen planus**, **pemphigoid**), desquamative gingivitis itself is not inherently a premalignant lesion. - It is characterized by sloughing, redness, and ulceration of the gingiva, which are symptoms of inflammation and epithelial separation, not necessarily precancerous changes. *Erythroplakia* - **Erythroplakia** is a velvety red patch that cannot be characterized clinically or pathologically as any other recognizable lesion. - It has a very **high rate of malignant transformation** (up to 90% when dysplastic), making it one of the most serious premalignant oral lesions. *Proliferative verrucous leukoplakia* - **Proliferative verrucous leukoplakia (PVL)** is a distinct, aggressive form of leukoplakia characterized by multiple, often widespread, white plaques with a **verrucous or papillary surface**. - It has a high rate of recurrence and a **very high tendency for malignant transformation**, often progressing to squamous cell carcinoma. *Chronic hyperplastic candidiasis* - **Chronic hyperplastic candidiasis** (also known as candidal leukoplakia) is a form of candidiasis that appears as a persistent white plaque. - It is considered a **potentially malignant disorder** because the candidal infection can induce epithelial dysplasia, which may transform into squamous cell carcinoma.
Question 6: T3 in the TNM staging of oral malignant lesions represents:
- A. Tumor > 4 cm in greatest diameter (Correct Answer)
- B. Carcinoma in situ
- C. Tumor 2 cm or less in greatest diameter
- D. Tumor > 2 cm but < 4 cm in greatest diameter
Explanation: ***Tumor > 4 cm in greatest diameter*** - In **TNM staging** for oral malignant lesions, **T3** specifically denotes a tumor size greater than **4 centimeters** in its greatest dimension. - This classification indicates a more advanced local tumor burden compared to T1 or T2 lesions. *Carcinoma in situ* - **Carcinoma in situ (Tis)** refers to the earliest stage of cancer, where abnormal cells are present only in the very first layer of cells and have not spread deeper. - This is a non-invasive stage, unlike T3 which already implies significant invasion and size. *Tumor 2 cm or less in greatest diameter* - A tumor 2 cm or less in greatest diameter is classified as **T1** in the TNM staging system for oral cancer. - This represents a smaller, less advanced tumor compared to T3, which is significantly larger. *Tumor > 2 cm but < 4 cm in greatest diameter* - A tumor greater than 2 cm but less than 4 cm in greatest diameter is classified as **T2** in the TNM staging system for oral cancer. - T3 specifically indicates a tumor that has grown beyond this size range, exceeding 4 cm.
Question 7: True about tongue cancer:
- A. Slurring of speech is a common complaint
- B. MC site is on Lateral margin (Correct Answer)
- C. Cervical lymph node metastasis is universally present
- D. Most common type is adenocarcinoma
Explanation: ***MC site is on Lateral margin*** - The **lateral border** of the tongue is the most common site for squamous cell carcinoma (SCC) of the tongue due to chronic irritation and exposure to carcinogens. - This anatomical location makes it susceptible to tumor development due to constant friction and potential for trauma. *Slurring of speech is a common complaint* - While speech can be affected by advanced tongue cancer, **dysarthria** (slurring of speech) is not typically an early or primary complaint. - Early symptoms often include a **painless lesion**, ulcer, or lump on the tongue. *Cervical lymph node metastasis is universally present* - While **cervical lymph node metastasis** is common in tongue cancer, its presence is not universal at diagnosis. - The incidence of metastasis varies depending on tumor size, depth of invasion, and location, ranging from 30% to 50% in early stages. *Most common type is adenocarcinoma* - The vast majority of tongue cancers, over 90%, are **squamous cell carcinomas (SCCs)**, arising from the epithelial cells. - **Adenocarcinoma** is a rare type of tongue cancer, originating from glandular tissue, and is not the most common histological type.
Question 8: Second primary tumor of head and neck is most commonly seen in malignancy of:
- A. Paranasal sinuses
- B. Hypopharynx
- C. Larynx
- D. Oral cavity (Correct Answer)
Explanation: ***Oral cavity*** - Patients with **oral cavity squamous cell carcinoma** (OCSCC) have the highest incidence of developing **second primary tumors** (SPTs) in the head and neck region, often due to shared risk factors like tobacco and alcohol use. - The concept of "**field cancerization**" explains this phenomenon, where prolonged exposure to carcinogens leads to widespread genetic alterations in the mucosal lining, predisposing multiple sites to develop independent primary cancers. *Paranasal sinuses* - While paranasal sinus cancers can be aggressive, they are less commonly associated with the development of **second primary tumors** within the head and neck compared to oral cavity cancers. - The etiology of paranasal sinus cancers is often linked to specific exposures like wood dust or nickel, which are less broadly distributed across the upper aerodigestive tract compared to tobacco and alcohol. *Hypopharynx* - Hypopharyngeal cancers do carry a significant risk of developing **second primary tumors**, particularly in the esophagus and lungs, but the overall incidence of head and neck SPTs is generally considered lower than that for oral cavity cancers. - The anatomical location and typical lymphatic drainage patterns of hypopharyngeal cancers might direct SPTs to different sites compared to oral cavity cancers. *Larynx* - Laryngeal cancers, especially those of the **glottis**, are also strongly associated with tobacco and alcohol. However, the incidence of **second primary tumors** in other head and neck sites is typically reported to be lower than in oral cavity cancer patients. - While laryngeal cancer patients are at risk for SPTs in the lung and esophagus, the synchronous or metachronous development of another primary tumor *within* the head and neck region is more prevalent in oral cavity cases.
Question 9: Which cancers can cause referred otalgia (referred pain in the ear)? Select the most comprehensive answer.
- A. Cancer of the pharynx
- B. Cancer of the oral cavity
- C. Cancer of the pharynx, oral cavity, and larynx (Correct Answer)
- D. Cancer of the larynx
Explanation: ***Cancer of the pharynx, oral cavity, and larynx*** - Cancers in these locations can cause **referred otalgia** due to shared innervation of the ear by cranial nerves that also supply these areas. - Specifically, the **glossopharyngeal nerve (IX)**, **vagus nerve (X)**, and **trigeminal nerve (V3)** are involved in both sensation from these head and neck regions and the ear. *Cancer of the pharynx* - While pharyngeal cancer can cause **referred otalgia** through cranial nerves IX and X, it is not the most comprehensive answer as other sites are also involved. - This option exclusively mentions the pharynx, missing other important anatomical locations that can also refer pain to the ear. *Cancer of the oral cavity* - Cancer here can cause **referred otalgia**, primarily through the **trigeminal nerve (V3)**, which innervates parts of the oral cavity and the ear. - However, similar to pharyngeal cancer, this option is not comprehensive as it omits other regions related to referred ear pain. *Cancer of the larynx* - Laryngeal cancer can cause **referred otalgia** via the **vagus nerve (X)**, specifically its superior laryngeal branch. - This option is also incomplete as it does not include cancers of the pharynx or oral cavity, which are equally important causes of referred ear pain.
Question 10: Tongue fixation in a patient with carcinoma tongue is staged as
- A. T1
- B. T2
- C. T3
- D. T4 (Correct Answer)
Explanation: ***T4*** - **Tongue fixation** in carcinoma of the tongue indicates advanced local disease classified as **T4a stage** according to AJCC TNM staging. - This finding suggests invasion of **extrinsic tongue muscles**, which causes loss of tongue mobility and represents moderately advanced local disease. - T4a tumors invade through cortical bone, involve the inferior alveolar nerve, floor of mouth, or skin of face, or in the case of tongue, involve deep extrinsic muscles causing fixation. *T1* - **T1 tumors** are small lesions measuring **≤2 cm** in greatest dimension with **depth of invasion (DOI) ≤5 mm**. - They are superficial without invasion of deep structures or causing any functional impairment like tongue fixation. *T2* - **T2 tumors** measure **≤2 cm with DOI >5 mm and ≤10 mm**, OR **>2 cm but ≤4 cm with DOI ≤10 mm**. - While larger than T1, they do not involve deep extrinsic muscles or cause tongue fixation. *T3* - **T3 tumors** are defined as tumors **>4 cm** OR **any tumor with DOI >10 mm**. - Although T3 indicates larger tumor size and deeper invasion, **tongue fixation** specifically indicates T4a stage due to involvement of extrinsic tongue musculature.
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