Benign tumor These lesions may be unsightly or may be traumatised repeatedly, for example during shaving. Odontogenic cysts & non-odontogenic tumor Soft tissue tumor and hard tissue tumor
Malignant tumor Themajority of these lesions spread slowly over years but some may spread more rapidly to involve lymph glands in the local area or more distant areas. All will cause great damage if neglected.
Clinical behavior: Benign: slowlygrowing and expanding causing pressure atrophy but remain within the capsule. Very few mitosis could be seen. Malignant: Invade surrounding tissues and locally invasive. Progressive growth and metastasize to distant organs, embolic spread due to lack of cell adhesion Mitosis. Intermediate: Locally invasive, no metastasis. Basal cell carcinoma and Ameloblastoma
Early diagnosis is very essential for management Clinical diagnosis from the signs and symptoms Referral for essential investigation
CLINICAL DIAGNOSIS OF ORAL CANCER Symptoms vary according to the site of the lesion painless in the early stages painfuland tender when secondarily infected or involves a sensory nerve painless lump or ulcer on the lip Posteriorly no symptom until it reach a size of 2 ‑3 cm swelling, pain and difficulty in deglutition absence of symptoms until the tumor metastasize to regional lymph nodes hard lump on the neck
late symptoms: pain due to secondary infection or nerve involvement excessive salivation difficulty in deglutition, speech haemorrhageWithin bone: painless swelling involving the buccal and lingual or palatal sulci teeth become loose and painful ‑ acute alveolar abscess edentulous pt. the denture does not fit denture hyperplasia anaesthesia of the upper or lower lip and the cheek.
Carcinoma of lip: age 50‑70 years. Male lower class. Predisposition factor: dirty, jagged and stained teeth irritation. tobacco smoker leukoplakia. intense solar radiation ‑ blistering cheilitis due to sunshine.
Carcinoma of tongue Anterior 2/3, affect males Posterior 1/3 equal in both sexes. Age over 60 years. Predisposing factors: Female with cancer tongue suffer from Paterson ‑Kelly syndrome. Bad oral hygiene Heavy alcoholic with element of Vit.B deficiency. Producing precancerous mucosal atrophy Syphilitic and leukoplakia. 25% and 5%. Superficial glossitis, papilloma, fissures and non‑specific ulcers.
Clinically: Painless swelling Painful infected ulcer, referred pain to the ear. Excessive salivation, marked factor oris, haemorrhage loss of mobility due to fixation to the floor of the mouth.
Malignant first on one side, when occur at Tumors Fixation tongue is protruded it deviate toward the affected side indurations, fungation or ulceration which spread to the floor of the mouth and alveolar process and from post. 1/3 to the fauces, valleculae and epiglottis bilaterally. Spread to regional lymph nodes. Death: Inhalation bronchopneumonia, haemorrhage, cachexia and starvation and asphyxia.
Carcinoma of the mouth: Floor of the mouth. Typicalmalignant ulcer extend to alveolar process & tongue. The cheek: warty and proliferative. The alveolar process: warty, nodules or proliferative.
Palate: spread extensively before involving bone papillary or ulcerative. Soft palate and fauces: Poor prognosis. bilateral Lymph node involvement Proliferative, fungating lesion spread to base of tongue. Pain, dysphagia and death due to erosion of carotid artery