Oral Diagnosis I Third Year

1. By
Dr Wael M Swelam
April 14, 2014 ,Monday

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.

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• Recurrence: original primary comes back
• Second Primary: a new cancer
• Sometimes it’s hard to tell the difference:
– Location
– Histology
– Timing
– Genetic changes

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• 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”

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!
• 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. 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. 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. 4/14/14 8

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• 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

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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. 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. 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

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Leukoplakia:
– Usually due to hyperkeratosis
– 2 to 4% are carcinoma
– 6% are precancerous
Erythroplakia:
– 80% of red lesions in high risk
areas are carcinoma

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• Patient procrastination in seeking medical
attention
• Physician delay in diagnosis
• Patient remains asymptomatic for a
prolonged period

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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.

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• Floor of mouth
• Ventrolateral tongue
• Soft palate complex
– Soft palate
– Anterior tonsilar pillar
– Lingual side of the retromolar trigone

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• 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

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• 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

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20. 4/14/14 20Forastiere, A. et al. N Engl J Med 2001;345:1890-1900

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. 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. !‫ك‬ِ‫وبحمد‬ ‫م‬ُ‫ه‬‫الل‬ ‫بحانك‬ ُ‫س‬
َ‫ك‬ُ‫ر‬ِ‫نستغف‬ ‫أنت‬ ‫إال‬ ‫إله‬ ‫ال‬ ‫أن‬ ُ‫د‬‫نشه‬
!‫إليك‬ ُ‫ونتوب‬