Review of cancer

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Oral Diagnosis I
Third Year

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Review of cancer

  1. 1. By 
 Dr Wael M Swelam April 14, 2014 ,Monday
  2. 2. 4/14/14 2 • Usually originate from mucosal squamous cell • Abnormal neoplasm of the mouth – Originating from salivary glands – Originating from muscles, nerves, blood vessels • Found in most cases by a dentist or the person themselves.
  3. 3. 4/14/14 3 • Recurrence: original primary comes back • Second Primary: a new cancer • Sometimes it’s hard to tell the difference: – Location – Histology – Timing – Genetic changes
  4. 4. 4/14/14 4 • 30,000 new cases diagnosed yearly • 25.6 million men (25.2%) • 22.6 million women (20.7%) • 8,000 deaths each year • 5 year survival rate: 50% • “Lag Time”
  5. 5. 4/14/14 5 ! • 5-year survival for localized disease is 76% • 5-year survival for metastatic disease is 19% ! Tissue changes in the mouth that may signal cancer can often be seen and felt easily
  6. 6. Oral & Laryngeal Cancer in 
 United States 4/14/14 6 Oral Laryngeal New Cases ! Deaths New Cases ! Deaths 1983 1985 1988 1990 1995 27,100 28,900 30,200 30,500 28,150 9,150 9,500 9,050 8,350 8,370 11,000 11,500 12,100 12,300 12,300 3,700 3,750 3,800 3,750 3,750
  7. 7. 4/14/14 7 Oral Cancer in the eastern province of according to KSA National Cancer Registry 2002 Represent 2.4 % of total cancers in eastern province Males : females ratio was 2.2 ♀:1.8 ♂ Death rate due to Oral cancer is ♀ ›♂ Incidence of Oral Cancer in KSA by 2010 is expected to increase by 0.7%
  8. 8. 4/14/14 8
  9. 9. 4/14/14 9 • 80-90% due to tobacco exposure • Cigarette Smoking – Dose-response • Cigar and Pipe Smoking – Less inhalation: oropharynx, hypopharynx, less larynx • Smokeless Tobacco – Oral cavity and pharynx • Alcohol: synergistic with tobacco • Viral – HPV: usually types 16 and 18 – EBV in NPC • UV light: lip • Geographic differences • Others
  10. 10. 4/14/14 10 Highest incidence in south and southeast 90% of cancers occur in areas of direct tobacco contact. Risk of buccal cavity cancer is directly proportional to amount of smokeless tobacco usage.
  11. 11. 4/14/14 11 • Most who get HNSCC are smokers, but most smokers do not get HNSCC: Why? • Metabolic Polymorphisms: carcinogen absorption, distribution, accumulation (activation, clearance) – Cytochrome P450 – Glutathione S transferases • DNA repair: mutagen sensitivity
  12. 12. 4/14/14 12 • Hoarseness • Erythroplakia • Referred otalgia • Persistent sore throat • Epistaxis • Nasal obstruction • Serous otitis media • Neck mass • Non-healing ulcer • Dysphagia • Submucosal mass
  13. 13. 4/14/14 13 Leukoplakia: – Usually due to hyperkeratosis – 2 to 4% are carcinoma – 6% are precancerous Erythroplakia: – 80% of red lesions in high risk areas are carcinoma
  14. 14. 4/14/14 14 • Patient procrastination in seeking medical attention • Physician delay in diagnosis • Patient remains asymptomatic for a prolonged period
  15. 15. 4/14/14 15 1. Identify patients who use tobacco and alcohol products. 2. Maintain high index of suspicion. 3. Conduct comprehensive exams. 4. Attend to common symptoms. 5. Evaluate symptomatic patients. 6. Maintain close medical surveillance of patients in high-risk occupations. 7. Refer high-risk patients with persistent symptoms and no findings to a head and neck surgeon.
  16. 16. 4/14/14 16 • Floor of mouth • Ventrolateral tongue • Soft palate complex – Soft palate – Anterior tonsilar pillar – Lingual side of the retromolar trigone
  17. 17. 4/14/14 17 • People over the age of 40 •Men vs. Women •Ethnicity •Socioeconomic Status (SES) • Being a heavy smoker and drinker • People with HPV-16 and HPV-18 are at slightly higher risk
  18. 18. 4/14/14 18 • Sores or lesions that won’t heal • Lump or thickening in the cheek • White or red patches on the gums, tonsils, or mouth • Chronic sore throat • Difficulty swallowing • Difficulty moving mouth or tongue • Numbness in any area of the mouth • Swelling of the jaw
  19. 19. 4/14/14 19
  20. 20. 4/14/14 20Forastiere, A. et al. N Engl J Med 2001;345:1890-1900
  21. 21. 4/14/14 21 Clinical 9p 3p, 17p 8q, 13p, 18q Molecular 4q, 11q, 13q, 14,q, 17q, 6p, 8p Hyperplasia Mild Dysplasia Severe Cancer Histopathologic Slide from: Scott M. Lippman, M.D.
  22. 22. 4/14/14 22 • Radiation •Destruction of cells making it impossible for them to grow • Chemotherapy •Use of chemicals to destroy cancer cells • Surgery •Oldest form for treating cancer
  23. 23. !‫ك‬ِ‫وبحمد‬ ‫م‬ُ‫ه‬‫الل‬ ‫بحانك‬ ُ‫س‬ َ‫ك‬ُ‫ر‬ِ‫نستغف‬ ‫أنت‬ ‫إال‬ ‫إله‬ ‫ال‬ ‫أن‬ ُ‫د‬‫نشه‬ !‫إليك‬ ُ‫ونتوب‬

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