Introduction: Oral cancer is one of the most prevalent diseases worldwide, accounting for 30-40% of the head and neck cancer. It is fairly common and very curable if found and treated at an early stage. Definition: Oral cancer is also known as mouth cancer, is cancer of the lining of the lips, mouth or upper throat. It belongs to a large group of cancers called head and neck cancers. Classification: The TNM classification stages different types of cancer based on certain standard criteria: T describes the size of the primary tumor N describe the lymph nodes M describes whether the cancer has metastasized.

1. ORAL CANCER
DENDEN DIANA

2. INTRODUCTION
• Oral cancer is one of the most prevalent
diseases worldwide, accounting for 30-40% of
the head and neck cancer. It is fairly common
and very curable if found and treated at an
early stage. Most develop in the squamous
cells found in the mouth, tongue and lips.

3. SQUAMOUS CELL

4. DEFINITION
• Oral Cancer: It also known as mouth cancer,
is cancer of the lining of the lips, mouth or
upper throat. It belongs to a larger group of
cancers called head and neck cancers.

5. EPIDEMIOLOGY
• According to World Health Organization, oral
cavity cancer is amongst the most prevalent cancers
worldwide and incidence rates are higher in men than
women.
• In India, incidence of oral cancer for males and
females was highest. For males, it was 64.8% and for
females it was 37.2% at 70 yrs of age.
• The highest magnitude was observed in west and
northeast regions (58.45%) at 60 years of age.

6. ETIOLOGY AND RISK FACTORS
1) GENERAL
• Gender: Oral cancer is twice as common in men as in women.
• Age: The average age at diagnosis for oral cancer is 62, and two-
thirds of individuals with this disease are over age 55, although it
may occur in younger people, as well.
• Ultraviolet light: Cancers of the lip are more common among
people who work outdoors and visit tanning beds, and among those
with prolonged exposure to sunlight.

7. CONTD…
• Poor nutrition: Studies have found a link between diets low in
fruits and vegetables and an increased oral cancer risk.
2) GENETICS
• Genetic syndromes: Some inherited genetic mutations, which cause
different syndromes in the body, carry a high risk of oral cancer.
These include:
 Fanconi anemia is a blood condition caused by inherited
abnormalities in several genes. Patients may experience symptoms
at an early age and may develop anemia or aplastic anemia.

8. CONTD…
• Dyskeratosis congenita is a genetically linked syndrome
that may also cause aplastic anemia, and carries a high risk
of oral cancer, beginning at an early age.
3) LIFESTYLE
• Tobacco use: About 80 percent of patients with oral cancers
use tobacco in the form of cigarettes, chewing tobacco or
snuff. The risk of developing oral cancer depends on the
duration and frequency of tobacco use.

9. CONTD…
• Alcohol: About 70 percent of people diagnosed with
oral cancer are heavy drinkers. This risk is higher for
people who use both alcohol and tobacco.
• Betel quid: Many people in Southeast Asia and other
parts of the world chew betel quid. Chewing gutka, a
combination of betel quid and tobacco, is also
common. Both of these substances are associated with
an increased oral cancer risk.

10. OTHER CONDITIONS:
• Human papillomavirus (HPV) infection
• Immune system suppression
• Lichen planus
• Graft-versus-host disease (GVHD): This
condition may develop after a stem-cell
transplant, in which bone marrow is replaced
following cancer occurrence or treatment.

11. CLASSIFICATION OF ORAL
CANCER
• The TNM classification system stages different types of
cancer based on certain standard criteria:
• T describes the size of the original (primary)
tumor. N indicates whether or not the cancer has reached
nearby lymph nodes. M measures whether the cancer has
spread (metastasized) to other areas of the body.

12. CONTD…
T — Primary tumour
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
Tis Carcinoma in situ
T1 Tumour 2 cm or less in greatest dimension
T2 Tumour more than 2 cm but not more than 4 cm in greatest
dimension
T3 Tumour more than 4 cm in greatest dimension
T4a (lip) Tumour invades through cortical bone, inferior alveolar nerve, floor of
mouth, or skin (chin or nose)

13. T4a (oral cavity) Tumour invades through cortical bone, into deep/extrinsic muscle of tongue
(genioglossus, hyoglossus, palatoglossus, and styloglossus), maxillary
sinus, or skin of face
T4b (lip and oral
cavity)
Tumour invades masticator space, pterygoid plates, or skull base; or
encases internal carotid artery
N - Regional Lymph Nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in
greatest dimension
N2 Metastasis as specified in N2a, 2b, 2c below
N2a Metastasis in a single ipsilateral lymph node, more than 3 cm but
not more than 6 cm in greatest dimension

14. N2b Metastasis in multiple ipsilateral lymph nodes, none more
than 6 cm in greatest dimension
N2c Metastasis in bilateral or contralateral lymph nodes, none
more than 6 cm in greatest dimension
N3 Metastasis in a lymph node more than 6 cm in greatest
dimension
M - Distant metastasis
M0 No distant metastasis
M1 Distant metastasis

15. PATHOPHYSIOLOGY
Due to the etiological factors
Mutation inactivates tumor suppressor gene
Cells proliferate
Mutation inactivates DNA repair gene
Mutation of proto-oncogene creates an oncogene
Mutation inactivates several more tumor suppressor genes
Cancer

16. CLINICAL MANIFESTATIONS:
• A sore on the lip or in the mouth that doesn't heal
• Pain in the mouth that doesn’t go away
• A lump or thickening in the lips, mouth, or cheek
• A white or red patch on the gums, tongue, tonsil, or
lining of the mouth
• A sore throat
• Trouble chewing or swallowing
• Trouble moving the jaw or tongue
• Persistent halitosis

17. CLINICAL MANIFESTATIONS:
• Numbness of the tongue, lip, or other area of the
mouth
• Swelling or pain in the jaw
• Dentures that start to fit poorly or become
uncomfortable
• Loosening of the teeth or pain around the teeth
• Voice changes
• A lump or mass in the neck or back of the throat
• Weight loss
• Pain in the ear

18. DIAGNOSTIC EVALUATIONS:
• A complete medical history, asking about the
patient’s signs and symptoms of oral cancer
and risk factors.
• Feel for any lumps on the neck, lips, gums,
and cheeks.
• Examine the area behind the nose, the larynx
(voice box), and the lymph nodes of the neck.

19. DIAGNOSTIC EVALUATIONS:
• E n d o s c o p y : A n
endoscopy allows to see
inside the mouth and
throat. Typically,
is inserted
through the nose to
examine the head and
n e c k a r e a s .

20. BIOPSY:
• During a fine needle
aspiration biopsy, cells
are removed using a thin
needle inserted directly
into the suspicious area.

21. ORAL BRUSH BIOPSY:
During routine dental
examinations, some
dentists are using a
newer, simple technique
to detect oral cancer in
which the dentist uses a
small brush to gather cell
samples of a suspicious
a r e a .

22. X-RAY:
• An x-ray is a way to create
a picture of the structures
inside of the body, using a
small amount of radiation
to look for abnormal
findings in the mouth or
n e c k .

23. Barium swallow/modified barium
swallow. :
 The first is
. During an x-ray exam, the
patient is asked to swallow liquid
barium to look for any changes in the
structure of the oral cavity and throat
and see whether the liquid passes
e a s i l y t o t h e s t o m a c h .
 or
videofluoroscopy, may be used to
evaluate difficulties with swallowing.

24. Computed tomography (CT or CAT)
scan:
• A special dye called a
contrast medium is given
before the scan to provide
better detail on the image.
This dye can be injected into
a patient’s vein or given as a
pill or liquid to swallow.

25. MRI :
 An MRI uses magnetic fields, not x-
rays, to produce detailed images of the
body, especially images of soft tissue,
such as the tonsils and the base of the
tongue. MRI can be used to measure
the tumor’s size. A special dye called a
contrast medium is given before the
scan to create a clearer picture.