oral cancer: premalignant lesions, diagnosis staging and treatment.pptx
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Oral cancer is very common in Nepal and India. Screening is very useful tool in reducing the incidence rate. The timely diagnosis of the pre malignant lesion and early lesion is one of the most most know topic for the medicos.
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oral cancer: premalignant lesions, diagnosis staging and treatment.pptx
- 1. ORAL CANCERS Presented by: Dr. Rahul Shah 6/8/2022
- 3. 6/8/2022
- 4. 6/8/2022
- 5. 6/8/2022
- 6. 6/8/2022
- 7. MOST COMMONS •Most common Site: LIP (Nepal: Buccal Mucosa/gingivobuccal sulcus) •MC Mutated gene: P53 •MC Pathological type: SCC 6/8/2022
- 8. RISK FACTORS • Smoking • Alcohol • Tobacco • Sharp-Ill fitting dentures • HPV, EBV • Oral Infections 6/8/2022
- 9. 6/8/2022
- 10. Pre malignant conditions 6/8/2022 HIGH RISK LESIONS 1. Erythroplakia 2. Proliferative Veruccis Leucoplakia 3. Chronic Hyperplastic Cadiidiasis MEDUIM RISK LESIONS 1. OSMF 2. Syphilitic Glossitis LOW RISK 1.OLP 2.Discoid lupus erythematosus 3.Discoid Keratosis Congenita
- 13. ERYTHROPLAKIA • Red patch • 6-9x malignancy risk • Most aggressive form: Speckled erythroplakia • Management: excision 6/8/2022
- 14. Oral Submucous Fibrosis • Fibrous deposition • Inadequate mouth opening • Poor Oral Hygiene • Mngmt: Stop smoking/tobacco Triamcinolone IL Exercises 6/8/2022
- 15. PLUMMER VINSION SYNDROME Increases chance of SCC of esophageal And hypophrangeal cancer. 6/8/2022
- 16. FIELD CANCERIZATION • All risks are acting on entire mucosa leading to multiple tumor. • Also Seen in: oral cavity, bladder and colorectal region 6/8/2022
- 18. TNM STAGING 6/8/2022 MO: NO DISTANT METS M1: DISTANT METS
- 20. MANAGEMENT OF ORAL CANCER 3 MODALITIES SURGERY CHEMOTHERAPY RADIATION THERAPY 6/8/2022
- 21. 6/8/2022
- 22. SURGERY • WLE of the primary lesion (margin 0.5cm) • LN involvement: Neck dissection • MANDIBLE involvement: Mandubulectomy 6/8/2022 SEGMENTAL HEMI MARGINAL
- 23. COMMANDO PROCEDULE • WLE+NECK DISSECTION+MANDIBULECTOMY 6/8/2022
- 24. RECONSTRUCTION USING FLAP • DELTOPECTORAL FLAP • PMMC FLAP • ABBE ESTLANDER FLAP/LIP SWITCH FLAP • CIRCUMORAL ADVANCEMENT FLAP 6/8/2022
- 25. FREE FLAPS • RADIAL ARTERY FOREARM FLAP • FREE FIBULAR FLAP: PERONEAL VESSEL • ILIAC CREST FLAP: BASED ON DEEP CIRCUMFLEX ILIAC ARTERY 6/8/2022
- 26. LIP CANCER 6/8/2022 <1/3RD AREA 1/3RD TO 2/3RD AREA >2/3RD AREA RESECTION & PRIMARY CLOSURE JOHANSOON/STEPLADDER APPROACT FLAP (ABBE ESTLANDER)
- 27. BUCCAL MUCOSAL TUMOR • WLE followed by flap reconstruction • Approaches: 6/8/2022 INTRAORAL APPROACH LIP SPLIT APPROACH VISOR APPROACH WEBER FERGUSON APPROACH
- 28. HARD PALATE TUMOR WLE High risk of Oroantral fistula 6/8/2022
- 30. RADIATION THERAPY • Decrease LRR • EXTERNAL BEAM RADIOTHERAPY: • BRACHYTHERAPY 6/8/2022 COMBINED CHEMOORADIATION THERAPY • BETTER RESPONSE RATE • CHEMO ACTS AS RADIOSENSITIZER NEOADJUVANT CHEMORADIATION • For advanced tumors
- 31. 6/8/2022
- 33. COMPLICATION • Hemorrhage • Nerve injury • Seroma • Flap necrosis • Carotid artery blow out 6/8/2022 Marginal Mandibular N/ Ramus Mandibularis Spinal accessory N. Lingual N Hypoglossal N
- 34. METS FROM UNKNOWN PRIMARY LESION • METS TO CERVICAL L.N. • FNAC 6/8/2022 SCC ADENOCARCINOMA SCC DO TRIPLE ENDOSCOPY ADENOCARCINOMA DO PANENDOSCOPY
- 35. BLIND AREA • OROPHARYNGEAK AND NASOPHARYNGEAL REGION • FLOOR MOUTH • RMT • TONSILAR FASCIA • PYRIFORM SINUS • FOSSA OF ROSENMULLER 6/8/2022 PET CT: 18 FDG IS USED INCIDENCE OF THE UNKNOWN PRIMARY TUMOR IS REDUCED
- 37. REFRENCES • BAILEY AND LOVE’s SHORT PRACTICE OF SURGERY • GLOBOCAN • INDIAN JOURNAL OF CANCER • CHEMOTHERAPY ADVISER 6/8/2022
- 38. 6/8/2022
Editor's Notes
- Scc: typical keratin pearls more differentiated morepearrls
- Old peridominantly ulcerative OLP
- LEUKOPLAKIA: WHITE PATCH, CANT BE RUBBED OFF 3-5X INCREASE IN RISK, MNGMT: ANTIOXIDANTS, STOP CIGRETTE/TOBACCO, IF PERSISTS CP2 LASER EXCISION/ CAUTERY and send for histopath CANDIDIASIS: WHITISH SURROUNDED BY ERYTHEMATOUS BORDER, CAN BE RUBBED OFF
- Proliferative verrucus : patient don’t exhibit typical RF for oral CA Usually multifocal, increase chance conversion to malignancy (50%) Don’t wait , Managed with excision you can wait and see progression but it is always safer to excise Speckeled: Leukoplakia over an erythemstous border, highest risk of malligant conversion, managed with excision Send always for histopath
- Cannot be rubbed off Leukoplakia was 3 to 5 x Excise and send for histopath Spekled erythroplakia has highest risk foe malignancy conversion
- It is hypersensitive rxn against prosucts of betel nuts Fibrous deposition at angle: inadq mouth opening If fiber deposition at angle of mouth inadequate mouth opening We may think that we can cut fibrous tissue and restore moyth opening but if we do that to heal it there will be more and more fiber deposition and worsen the condition IL TRAIMCINOLONE ALSO USED IN KELOIDS GANGLION AND COSTOCONDRITIS
- DESERVES SPECIAL MENTION AKA PATTERSON KELLY BROWN SYNDROME AKA SIDEROPENIC DYSPHAGIA SEEN TYPICALLY IN PERIMENOPAUSAL WOMEN Cf: , IDA, GLOSSITIS, ANGULAR CHELITIS, POST CRICOID WEB GIVES DYSPHAGIA MNGMT: CORRECT ANEMIA, CORRECT WEB (DILATATION/LASER ABLATION) THIS INCREASES THE RISK OF HYPOPHRANGYEAL AND ESOPHAGEAL CA
- Oral cavity: Synchronous cancer: develop with in 6 months off initial; tumor Metachronous: more than 6 months of initial tumor 15% risk is there IN ORAL ca 4 percent in colorectal Internship 28 yr female who did threading in parlour Put ine end of thread in mouth and use finger to remove hair Constant trauma: developed ca did partial glossectomy since she was a sole earner in her family she kept working in parlor Again more trauma exposure and then she came after 8 months the hemiglossectomy with flap reconstruction was done
- Incisional from edge of the ulcer (edge, wedge biopsy) never from center because center is necrotic In an inconclusive biopsy give antibiotic for 7 days and repeat
- AJCC AMERICAN JOINT COMISSION ON CANCER Tx cant be assessed Tis in situ T4A INV OF ADJACENT STRUCTURE WHIICH CAN BE RESECTED T4B CANNONT BE RESECTED DEPTH OF INVASION: INDEPENDENT PROGNOSTIC FACTOR ECTRA NODAL EXTENSION ALSO INDEPENDENT PROG FACTOR /// IF ENE POSITIVE CLINICALLY OR RADIOLOGICALLY : N3B MC DISTANT METS LUNGS\ TUMOR WHICH HAVE PROPENSITY FOR BLATATERAL LN INVOLVEMENT: ANGLE O F MOUTH, TIP OF TONGUE, LIP CA CROSSIING MIDLINE, SOFT PALATE CA NEW CT: P53 AND HPV POSIITVE TUMORS
- Old margin 2cm SMALL SEGMENT REMOVED IN SEGMENTAL HALF OF THE MANDIBLE IS REMOVED ‘IF CANCER INVOLVES INNER TABLE SHAVE OUT THE INNER TABLE ONLY
- 7 TO 8 HOURS MORBID PROCEDURE
- 1: BASED ON PERFORATER ARTERY OF INTERNAL MAMMARY ARTERY 2: PMMC PERCUTANEOUS MAJOR MYOCUTANEIOUS FLAP: MC BY HEAD AND NECK SURGEON, BASED ON PECTORAL BRANCH OF THORACOACROMIAL VESSEL. 3: ABBE: MIDLINE DEFECT // ESTLANDER: THE ANGLE OF MOUTH RECONATRUCTION 4. AKA KARPANDAZIC FLAP FOR LIP RECONSTRUCTION
- 2. MC USED FLAP FOR MANDIBULAR RECONSTRUCTION (EDENTOLOUS MANDIBLE) IN DENTATE MANDIBLE 3 IS USED
- IN 1 NO MICROSTOMIA
- INTRAORAL APPROACH: ANTERIOR TUMORS CLOSE TO ANGLE OF MOUTH LIP SPLIT FOR POSTERIORLY PLACED TUMOR (SPLIT THE LIP) VISOR WILL GIVE GOOD ASSESSMENT OF THE MANDIBLE AND FLOOR OF MOUTH (LIFT ALL STRUCTURE UP LIKE VISOR) WEBER FOR MAXILLECTOMY
- HOW DO YOU KNOW: WHATEVER YOU EATING WILL COME OUT FROM NOSE SO DO flap closure
- LRR: locoregional RECURRENCY BRACHY ELECTRODE IMPLANTED AT SITE CHEMO MAKES THE TUMOR MORE RESPONSIVE TO RADIOTHERAPY ADVANCED TUMOR NACT
- RND: DEACRIB BY CRILE LEVEL 1 TO 5 LN REMOVED + 3 EXTRA LYMPHATIC STRUCTURE REMOVED (IJV, SPINAL ASS N., SCM) MRND: 1 TO 5 REMOVED BUT AT LEAST ONE ECTRA LYMPHATIC STRUCTURE SAVED MRND1: SPINAL ASS N. SAVED MRND II: BITH AI==SPINAL ASS. N AND SCM SAVED MRND III: ALL SAVED ( FUNCTIONAL NECK DISSECTION) The submandibular gland and tail of parotid are removed in both 1 and 2 SND: CENTRAL ND: LVL VI LN IS REMOVED, USED IN THYROID CA SOND (SUPRAOMOHYOID ND): LVL I, II, III REMOVED EXTENDED AOND: LEVEL I TO IV ARE REMOVED
- MARGINAL MANDIBULAR: BRANCH OF FACIAL NERVE SUPPLYING ANGLE OF MOUTH : DROOPING OF ANGLE OF MOUTH PREVENTION’: INCISION SHOULD BE DONE AT LEAST 2 FONGER BREEADTH BELOW THE ANGLE OF MANDIBLE SAN: SHOULDER DYSFUNSTION
- TRIPLE ENDOSCOPY: NASOPHARUNGOSCOPY, BRONCHOSCOPY, ESOPHAGOSCOPY PAN: UGI, COLONOSCOPY, BRONCHOSCOPY
- TUMORS CAN BE MISSED