Oral squamous cell carcinoma

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Oral squamous cell carcinoma

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Oral squamous cell carcinoma

  1. 1. Preethi Agnes.R B.D.S 2012 Batch
  2. 2.  It is a Malignant neoplasm of stratified squamous epithelium in the oral cavity  capable of local destructive growth and distant metastasis
  3. 3.  Possible       sites lower lip tongue floor of the mouth soft palate gingival / alveolar ridge buccal mucosa
  4. 4. Incidence lower lip tonguefloor of mouth soft palate gingiva buccal mucosa
  5. 5. The etiology is unknown. But a number of etiological factors have been implicated. Strong Association: • Tobacco smoking and chewing • Chronic alcohol consumption • Human papilloma virus infection
  6. 6.  Major source of intra-oral carcinogen.  All forms of tobacco consumption have been linked.  South east Asia: bethel quid– North Africa and Middle East: a mixture of Tobacco and lime water or oil called naswar or nash  It could be held in the mouth  Smoked in crude cigars or factory made cigarettes  Carcinogens in tobacco: Nitrosamine (nicotine), the polycyclic aromatic hydrocarbons (3,4-benzopyrene)
  7. 7. 2nd major risk factor  Associated with cancer of the floor of the mouth and tongue.  Excess consumption of EVERY TYPE of alcohol(including “hard” liquor, wine, and Beer) raises the risk status of oral cancer  Potentiates the effects of tobacco  Mechanism(s)  Dehydrating effects of alcohol on the mucosa  increasing mucosal permeability,  Irritation of mucosa  and it also acts as a solvent for carcinogens(especially those in tobacco) 
  8. 8. Weak association:  Chronic irritation from ill-fitting denture  Sub mucosal fibrosis  Poor orodental hygiene  Nutritional deficiencies  Exposure to sunlight(lip cancer)  Plummer –Vinson syndrome
  9. 9.  NEOPLASIA:The process of transformation from a normal cell to a cancerous one.  An abnormality of cell growth and multiplication characterised by:  At cellular level     Excessive cellular proliferation Uncoordinated growth Tissue infiltration At molecular level  Disorder of growth regulatory genes
  10. 10. NEOPLASTIC (malignant) CELLS Increase in growth factors Increase in growth factor receptors Increase in signal transduction - Disturbed processes of mitosis and protein synthesis Increase in activation of transcription
  11. 11.  Continuous reproduction  Formation of abnormal proteins  ANAPLASIA:      loss of normal cell function (abnormal DNA transcription) proliferation movement of cells Caused by altered DNA and altered invasion of nearby tissue cellular programs which make new metastasis signals
  12. 12.  two  Monoclonal   general types initial neoplastic change affects a single cell Field origin  carcinogen acts on large number of cells producing field of potentially neoplastic cells
  13. 13. growth factors  receptors  signal-relay or transduction factors ras - colon cancer myc - lymphoma bcr-abl - chronic myelogenous leukemia (Philladelphia chromosome) 
  14. 14. - code for factors that down- regulate the cell cycle, promote differentiation and supress oncogenes from causing cancer Rb-1 – retinoblastoma gene p53
  15. 15. NEOPLASIA  proto-oncogene is activated or tumor suppressor gene is inactivated normal growth  oncogenesis Activation of proto-oncogene: point mutation translocation gene amplification Also - Failure of Immune Surveillance theory : immune system responds to neoantigens as to foreign antigens, but neoplastic cells escape recognition and destruction --> become clinical cancers
  16. 16.    Transmission of some forms of cancer from parents to offspring through defects in the DNA of the egg or sperm cells E.g.  Retinoblastoma – tumor of the retina of the eye Polyposis coli syndrome – polyps that grow in the colon and rectum Other colon, breast and kidney cancers Cause: loss of a segment of DNA or a change in the coding sequence of DNA   Detection – DNA sequencing, DNA probes In many cases – abnormalities in tumor suppressor genes
  17. 17. A sore in the mouth that does not heal (most common symptom)  Pain in the mouth  A persistent lump or thickening in the cheek  A persistent white or red patch on the gums, tongue, tonsil, or lining of the mouth  A sore throat or a feeling that something is caught in the throat  Increased salivation 
  18. 18. Difficulty chewing or swallowing  Difficulty moving the jaw or tongue  Swelling of the jaw that causes dentures to fit poorly or become uncomfortable  Loosening of the teeth or pain around the teeth or jaw  Voice changes  A lump or mass in the neck  Weight loss  Persistent bad breath 
  19. 19. Grossly, squamous cell carcinoma of oral cavity may have the following types:  Ulcerative type  Papillary or verrucous type  Nodular type  Scirrhous type All these types appear on a background of leukoplakia or erythroplasia of the oral mucosa. Enlarged cervical lymph nodes may be present.
  20. 20.  Increased mitotic activity  Well differentiated  Keratin pearls (abnormal keratinization)  Hyperchromatic nuclei  Pleomorphism  Epithelium islands  Connective tissue stroma with chronic inflammation (histiocytes, lymphocytes, etc.)
  21. 21. Keratinized cells Mitotic figures Inflamed connective tissue stroma
  22. 22.  Primary:          Photographs Incisional biopsy Fine needle aspiration biopsy Orthopantogram Mucosal staining CXR chemiluminescent light Routine blood investigations For staging      MRI CT face + neck ± CT chest USG of neck or primary ± USG guided FNAC of suspicious lymphadenopathy PET Endoscopy
  23. 23.  Surgery  Removal  Removal of part or all of the jaw of the tumor on a larger area to remove the tumor and surrounding healthy tissue  Maxillectomy  Removal of lymph nodes and other tissue in the neck  Plastic surgery, including skin grafts, tissue flaps or dental implants to restore tissues removed from the mouth or neck  Tracheotomy, or placing a hole in the windpipe, to assist in breathing for patients with large tumors or after surgical removal of the tumor  Dental surgery to remove teeth or assist with reconstruction
  24. 24. Radiation Therapy -used alone to treat small or early-stage tumors.  Proton Therapy -delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs.  Chemotherapy -used to shrink the cancer before surgery or radiation  Tumor Growth Factor Inhibitors -target EGF receptors and may stop cancer cells from growing. 
  25. 25. Mucositis ,an inflammation of the mucous membranes in the mouth.  Infection, pain, and bleeding  Dehydration and malnutrition due to dysphagia  Xerostomia due to injury to the glands that produce saliva.  Trismus due to damage to the muscles and joints of the jaw and neck.  Hypovascularization (reduction in blood vessels and blood supply.  Affect other forms of dental disease (caries, or soft tissue complications),  Cause bone death (osteonecrosis). 
  26. 26.  Rehabilitation of patient after surgery could be either surgical reconstruction, prosthetic reconstruction or both  This is aimed at restoring esthetics, function and speech.  All patients must be placed on life-long review of about 6monthly intervals during which risk factors should be continually assessed.
  27. 27. Prevention involves interventions aimed at eliminating, eradicating or minimizing the impact of the disease.  PRIMARY: Reduce the incidence of cancer and precancer. It is aimed reducing the number of new cases.   Discourage smoking and alcohol consumption Encourage good oral hygiene  Encourage balanced diet  Use of hat in sunlight for farmers  Wearing of facemasks for factory workers involved with chemicals and metals  Health education
  28. 28.  SECONDARY: aimed at detection of cancer atan early stage.  Early detection, especially at the precancerous stage, offers a better prognosis with a better chance of cure.  Public education on early signs and selfexamination  Screening  TERTIARY: Treat late stage of disease and complications

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