Tumors of the head and neck region encompass a broad spectrum of diseases, including malignancies of the upper aerodigestive tract, skin, salivary glands, thyroid and parathyroid glands, and soft tissue and bone tumors. Head and neck cancers account for 3% of all new cancers and 2% of cancer deaths in the US annually. Risk factors include smoking, alcohol consumption, HPV infection, and nutritional deficiencies. Diagnosis involves clinical examination, imaging studies, and biopsy. Treatment depends on tumor stage and location, and may involve surgery, radiation therapy, chemotherapy, or a combination.
This document discusses oral squamous cell carcinoma:
- It is one of the most common oral cancers, arising from dysplastic epithelial cells and characterized by invasive islands of malignant squamous cells.
- Risk factors include tobacco, alcohol, HPV infection and poor nutrition. Clinically, it presents as ulcers or masses that are often painless.
- If left untreated, it can spread to lymph nodes and distant sites like lungs. Staging evaluates tumor size and spread. Treatment involves surgery, radiation and chemotherapy. Prognosis depends on stage at diagnosis.
Cancer arises from uncontrolled cell growth and spread. It was named for swollen veins around tumors resembling a crab. Indian medicine previously called it "arbuda". Cancer is characterized by loss of control over cellular growth and proliferation beyond physiological needs. The main types are carcinomas of epithelial cells, sarcomas of connective tissues, leukemias of blood stem cells, and lymphomas of lymph nodes. Predisposing factors include age, heredity, lifestyle, diet, occupation and some pre-cancerous diseases. Cancer cells show diminished growth control, invasion of tissues, and metastasis to other parts.
More than 90% of malignant tumors in the oral region are squamous cell carcinomas arising from the mucosal epithelium.
However, it is now apparent that these mucosal carcinomas comprise a number of different diseases that must be considered separately, due to differences in site, etiology, prognosis and management.
More than 90% of malignant tumors in the oral region are squamous cell carcinomas arising from the mucosal epithelium.
However, it is now apparent that these mucosal carcinomas comprise a number of different diseases that must be considered separately, due to differences in site, etiology, prognosis and management.
Carcinoma GI tract- Buccal, Esophagial, Gastric & intestinal.pptxsanjula .
This document discusses squamous cell carcinoma of the oral mucosa. It notes that squamous cell carcinoma comprises 90% of all oral malignant tumors. Strong risk factors include tobacco smoking, chewing, and drinking alcohol. Histologically, it can range from well-differentiated to undifferentiated. Prognosis is generally poor due to late detection and early lymph node metastasis, especially for tongue and soft palate cancers. The document also briefly mentions other less common oral cancers.
This document discusses tumors of the ear, including benign and malignant tumors of the auricle, external auditory canal, and middle ear. It describes common tumor types such as sebaceous cysts, dermoid cysts, keloids, and various carcinomas. Diagnostic procedures include imaging, biopsy, and treatment involves surgical excision, radiation, or chemotherapy. Nursing care focuses on supporting the patient, educating them about their condition and treatment, and preventing infection.
Tumors of the head and neck region encompass a broad spectrum of diseases, including malignancies of the upper aerodigestive tract, skin, salivary glands, thyroid and parathyroid glands, and soft tissue and bone tumors. Head and neck cancers account for 3% of all new cancers and 2% of cancer deaths in the US annually. Risk factors include smoking, alcohol consumption, HPV infection, and nutritional deficiencies. Diagnosis involves clinical examination, imaging studies, and biopsy. Treatment depends on tumor stage and location, and may involve surgery, radiation therapy, chemotherapy, or a combination.
This document discusses oral squamous cell carcinoma:
- It is one of the most common oral cancers, arising from dysplastic epithelial cells and characterized by invasive islands of malignant squamous cells.
- Risk factors include tobacco, alcohol, HPV infection and poor nutrition. Clinically, it presents as ulcers or masses that are often painless.
- If left untreated, it can spread to lymph nodes and distant sites like lungs. Staging evaluates tumor size and spread. Treatment involves surgery, radiation and chemotherapy. Prognosis depends on stage at diagnosis.
Cancer arises from uncontrolled cell growth and spread. It was named for swollen veins around tumors resembling a crab. Indian medicine previously called it "arbuda". Cancer is characterized by loss of control over cellular growth and proliferation beyond physiological needs. The main types are carcinomas of epithelial cells, sarcomas of connective tissues, leukemias of blood stem cells, and lymphomas of lymph nodes. Predisposing factors include age, heredity, lifestyle, diet, occupation and some pre-cancerous diseases. Cancer cells show diminished growth control, invasion of tissues, and metastasis to other parts.
More than 90% of malignant tumors in the oral region are squamous cell carcinomas arising from the mucosal epithelium.
However, it is now apparent that these mucosal carcinomas comprise a number of different diseases that must be considered separately, due to differences in site, etiology, prognosis and management.
More than 90% of malignant tumors in the oral region are squamous cell carcinomas arising from the mucosal epithelium.
However, it is now apparent that these mucosal carcinomas comprise a number of different diseases that must be considered separately, due to differences in site, etiology, prognosis and management.
Carcinoma GI tract- Buccal, Esophagial, Gastric & intestinal.pptxsanjula .
This document discusses squamous cell carcinoma of the oral mucosa. It notes that squamous cell carcinoma comprises 90% of all oral malignant tumors. Strong risk factors include tobacco smoking, chewing, and drinking alcohol. Histologically, it can range from well-differentiated to undifferentiated. Prognosis is generally poor due to late detection and early lymph node metastasis, especially for tongue and soft palate cancers. The document also briefly mentions other less common oral cancers.
This document discusses tumors of the ear, including benign and malignant tumors of the auricle, external auditory canal, and middle ear. It describes common tumor types such as sebaceous cysts, dermoid cysts, keloids, and various carcinomas. Diagnostic procedures include imaging, biopsy, and treatment involves surgical excision, radiation, or chemotherapy. Nursing care focuses on supporting the patient, educating them about their condition and treatment, and preventing infection.
The document discusses testicular tumors, providing details on:
1) Germ cell tumors (seminomas and nonseminomas) account for 95% of testicular tumors and can spread rapidly.
2) Sex cord-stromal tumors include Leydig cell and Sertoli cell tumors.
3) Risk factors for germ cell tumors include cryptorchidism, pesticide exposure, and genetic factors. Tumor markers like HCG, AFP, and LDH help diagnose and monitor these cancers.
This document discusses oral cancer, including its incidence rates, risk factors, clinical features, diagnosis, staging, treatment, and prognosis. Some key points:
- Oral cancer is the 8th most common cancer in males and 15th in females worldwide, with 30,000 new cases and 8,000 deaths annually in the US.
- Risk factors include tobacco, alcohol, and HPV infection. Early detection through screening for lesions can improve outcomes, with 76% 5-year survival for localized disease vs 19% for metastatic disease.
- Clinical features may include lumps, sores, difficulty chewing or swallowing. Diagnosis is based on biopsy and pathology results, while staging uses the TNM system to
This document provides an overview of salivary gland tumors. It discusses that salivary gland tumors are heterogeneous and most are benign. The majority originate in the parotid glands. Pleomorphic adenoma is the most common benign tumor and occurs most often in the parotid glands. The document describes the histopathology and classification of various salivary gland tumors including pleomorphic adenoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. It also discusses the genetics and hypothesized cells of origin for different salivary gland neoplasms.
Gastric cancer is the second most common fatal cancer worldwide. It most commonly presents in the 5th and 6th decades of life and affects males twice as often as females. The vast majority are adenocarcinomas that arise from chronic gastritis and intestinal metaplasia. Gastric cancers are broadly classified into polyps and carcinomas, with adenocarcinoma making up about 90% of carcinomas. Early gastric cancer is confined to the mucosa and submucosa, while advanced gastric cancer has invaded deeper into the stomach wall.
Head and Neck Cancer
The concept of head and neck cancer is included in the syllabus of the master's of clinical pharmacy.This presentation includes epidemiology, Types, Pathology, Etiology and risk factors, signs and symptoms, treatment according to stages, Classification, Mechanism of action, and the latest research.
This document provides information about testicular pathology, including epididymitis, orchitis, and testicular tumors. It discusses the normal histology of the testis and epididymis. It describes the causes and pathology of epididymitis and orchitis, including non-specific, granulomatous, gonorrhea and tuberculosis types. It then covers the classification and features of testicular tumors, separating them into germ cell tumors and sex cord stromal tumors. Within germ cell tumors it discusses seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma and mixed germ cell tumors.
Premalignant lesion (Doctor Faris Alabeedi MSc, MMedSc, PgDip, BDS.)Doctor Faris Alabeedi
1. Premalignant oral lesions involve the mouth lining and may become oral cancer, though it's difficult to predict which will transform. Risk increases with age and factors like tobacco/alcohol use.
2. Abnormal patches of various colors on high-risk sites like the tongue or throat could indicate premalignant lesions. Biopsies determine if lesions are benign, premalignant (dysplastic), or cancerous.
3. Patients with high-grade dysplasia have a higher risk of malignant transformation and require close follow-up, though elimination of risks and healthy behaviors can help.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Tumors & tumor like conditions of nasal cavityDr Durga Gahlot
This document provides information on the classification, histology, and clinical features of various tumors of the nasal cavity and paranasal sinuses. It begins by describing the normal anatomy and histology of the nasal cavity. It then classifies benign and malignant tumors of the nasal cavity and paranasal sinuses into epithelial, neuroectodermal, and mesenchymal categories. Specific tumor types are further described in terms of their epidemiology, clinical presentation, gross and microscopic appearance, immunoprofile, and prognosis. These include schneiderian papilloma, squamous cell carcinoma, adenocarcinoma, undifferentiated carcinoma, hemangiomas, angiofibroma, and olfactory neuroblastoma
The document discusses several oral cavity pathologies including lichen planus, leukoplakia, erythroplakia, oral hairy leukoplakia, and oral squamous cell carcinoma. Lichen planus presents as white lesions that predominantly affect the buccal mucosa, tongue, and gingivae. Leukoplakia presents as a white patch or plaque potentially associated with tobacco or alcohol use, between 5-25% being premalignant. Erythroplakia presents as red velvety lesions with a high risk (75-90%) of being carcinoma. Oral hairy leukoplakia occurs in HIV patients and is associated with Epstein-Barr virus
Benign Retroperitoneal Teratoma in young adult--A case report and literature ...iosrjce
This document describes a case report of a rare benign retroperitoneal teratoma in an 18-year-old male patient who presented with left parietal wall abscess. Exploratory laparotomy revealed a large retroperitoneal cystic mass containing tissues from all three germ layers. The mass was successfully resected and histopathological examination confirmed the diagnosis of a benign cystic teratoma. The patient recovered well post-operatively with no recurrence at one month follow up.
Benign odontogenic and non odontogenic tumoursAbhishek Roy
This document provides information on various benign odontogenic tumors of the jaws. It begins by classifying these tumors into three categories based on their histological composition. It then discusses specific tumor types in more detail, including their clinical features, radiographic appearance, histology, treatment and prognosis. The tumors covered include ameloblastoma (solid/multicystic, unicystic and peripheral subtypes), calcifying epithelial odontogenic tumor, and adenomatoid odontogenic tumor. For each tumor, the summary highlights their defining characteristics and typical presentation.
A malignant neoplasm that contains elements of carcinoma (cancer of epithelial tissue, which is skin and tissue that lines or covers the internal organs) and sarcoma (cancer of connective tissue, such as bone, cartilage, and fat) so extensively intermixed as to indicate neoplasia of epithelial and mesenchymal tissue.
Cancer is the general name for over 100 medical conditions involving uncontrolled and dangerous cell growth. Some cancers are caused by genetic factors while others are caused by environmental exposures, such as chemicals. Two patients may have cancer for different reasons - one may have a family history of breast cancer while the other was exposed to carcinogenic chemicals at work. Both ultimately suffer from abnormal cell growth triggered by different root causes.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
The document discusses testicular tumors, providing details on:
1) Germ cell tumors (seminomas and nonseminomas) account for 95% of testicular tumors and can spread rapidly.
2) Sex cord-stromal tumors include Leydig cell and Sertoli cell tumors.
3) Risk factors for germ cell tumors include cryptorchidism, pesticide exposure, and genetic factors. Tumor markers like HCG, AFP, and LDH help diagnose and monitor these cancers.
This document discusses oral cancer, including its incidence rates, risk factors, clinical features, diagnosis, staging, treatment, and prognosis. Some key points:
- Oral cancer is the 8th most common cancer in males and 15th in females worldwide, with 30,000 new cases and 8,000 deaths annually in the US.
- Risk factors include tobacco, alcohol, and HPV infection. Early detection through screening for lesions can improve outcomes, with 76% 5-year survival for localized disease vs 19% for metastatic disease.
- Clinical features may include lumps, sores, difficulty chewing or swallowing. Diagnosis is based on biopsy and pathology results, while staging uses the TNM system to
This document provides an overview of salivary gland tumors. It discusses that salivary gland tumors are heterogeneous and most are benign. The majority originate in the parotid glands. Pleomorphic adenoma is the most common benign tumor and occurs most often in the parotid glands. The document describes the histopathology and classification of various salivary gland tumors including pleomorphic adenoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. It also discusses the genetics and hypothesized cells of origin for different salivary gland neoplasms.
Gastric cancer is the second most common fatal cancer worldwide. It most commonly presents in the 5th and 6th decades of life and affects males twice as often as females. The vast majority are adenocarcinomas that arise from chronic gastritis and intestinal metaplasia. Gastric cancers are broadly classified into polyps and carcinomas, with adenocarcinoma making up about 90% of carcinomas. Early gastric cancer is confined to the mucosa and submucosa, while advanced gastric cancer has invaded deeper into the stomach wall.
Head and Neck Cancer
The concept of head and neck cancer is included in the syllabus of the master's of clinical pharmacy.This presentation includes epidemiology, Types, Pathology, Etiology and risk factors, signs and symptoms, treatment according to stages, Classification, Mechanism of action, and the latest research.
This document provides information about testicular pathology, including epididymitis, orchitis, and testicular tumors. It discusses the normal histology of the testis and epididymis. It describes the causes and pathology of epididymitis and orchitis, including non-specific, granulomatous, gonorrhea and tuberculosis types. It then covers the classification and features of testicular tumors, separating them into germ cell tumors and sex cord stromal tumors. Within germ cell tumors it discusses seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma and mixed germ cell tumors.
Premalignant lesion (Doctor Faris Alabeedi MSc, MMedSc, PgDip, BDS.)Doctor Faris Alabeedi
1. Premalignant oral lesions involve the mouth lining and may become oral cancer, though it's difficult to predict which will transform. Risk increases with age and factors like tobacco/alcohol use.
2. Abnormal patches of various colors on high-risk sites like the tongue or throat could indicate premalignant lesions. Biopsies determine if lesions are benign, premalignant (dysplastic), or cancerous.
3. Patients with high-grade dysplasia have a higher risk of malignant transformation and require close follow-up, though elimination of risks and healthy behaviors can help.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Tumors & tumor like conditions of nasal cavityDr Durga Gahlot
This document provides information on the classification, histology, and clinical features of various tumors of the nasal cavity and paranasal sinuses. It begins by describing the normal anatomy and histology of the nasal cavity. It then classifies benign and malignant tumors of the nasal cavity and paranasal sinuses into epithelial, neuroectodermal, and mesenchymal categories. Specific tumor types are further described in terms of their epidemiology, clinical presentation, gross and microscopic appearance, immunoprofile, and prognosis. These include schneiderian papilloma, squamous cell carcinoma, adenocarcinoma, undifferentiated carcinoma, hemangiomas, angiofibroma, and olfactory neuroblastoma
The document discusses several oral cavity pathologies including lichen planus, leukoplakia, erythroplakia, oral hairy leukoplakia, and oral squamous cell carcinoma. Lichen planus presents as white lesions that predominantly affect the buccal mucosa, tongue, and gingivae. Leukoplakia presents as a white patch or plaque potentially associated with tobacco or alcohol use, between 5-25% being premalignant. Erythroplakia presents as red velvety lesions with a high risk (75-90%) of being carcinoma. Oral hairy leukoplakia occurs in HIV patients and is associated with Epstein-Barr virus
Benign Retroperitoneal Teratoma in young adult--A case report and literature ...iosrjce
This document describes a case report of a rare benign retroperitoneal teratoma in an 18-year-old male patient who presented with left parietal wall abscess. Exploratory laparotomy revealed a large retroperitoneal cystic mass containing tissues from all three germ layers. The mass was successfully resected and histopathological examination confirmed the diagnosis of a benign cystic teratoma. The patient recovered well post-operatively with no recurrence at one month follow up.
Benign odontogenic and non odontogenic tumoursAbhishek Roy
This document provides information on various benign odontogenic tumors of the jaws. It begins by classifying these tumors into three categories based on their histological composition. It then discusses specific tumor types in more detail, including their clinical features, radiographic appearance, histology, treatment and prognosis. The tumors covered include ameloblastoma (solid/multicystic, unicystic and peripheral subtypes), calcifying epithelial odontogenic tumor, and adenomatoid odontogenic tumor. For each tumor, the summary highlights their defining characteristics and typical presentation.
A malignant neoplasm that contains elements of carcinoma (cancer of epithelial tissue, which is skin and tissue that lines or covers the internal organs) and sarcoma (cancer of connective tissue, such as bone, cartilage, and fat) so extensively intermixed as to indicate neoplasia of epithelial and mesenchymal tissue.
Cancer is the general name for over 100 medical conditions involving uncontrolled and dangerous cell growth. Some cancers are caused by genetic factors while others are caused by environmental exposures, such as chemicals. Two patients may have cancer for different reasons - one may have a family history of breast cancer while the other was exposed to carcinogenic chemicals at work. Both ultimately suffer from abnormal cell growth triggered by different root causes.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Onco in Greek means swelling or mass.
For neoplasia to occur, an irreversible change must take place in the cells, and this change must be passed on to the new cells.
Unlike hyperplasia, neoplasia is an uncontrolled abnormal process.
Cells are abnormal; proliferation of these cells is uncontrolled and unlimited.
Radiation from sunlight (ultraviolet rays), x-rays, nuclear fission, or other sources is well established as a cancer-producing agent in humans.
Tumors are divided into two categories: benign and malignant.
Cancer is synonymous with malignancy.
Refer to Table 7.1: Comparison of Benign and Malignant Tumors.
Figure 7.1: Photomicrographs of malignant tumors show pleomorphic (P) and hyperchromatic (H) nuclei and mitotic figures (MI). A, Squamous cell carcinoma. B, Osteosarcoma.
Normal and abnormal mitotic figures are seen in the nucleus of the neoplastic cells.
Table 7.2 lists names of tumors.
The prefix of the name of a tumor is determined by the cell or tissue of origin.
The suffix -oma is used to indicate tumor.
The names of some malignant tumors sound like benign tumors. Lymphoma, melanoma, and myeloma sound benign, but are always malignant.
For malignant tumors, often a combination of two or three modalities is used.
Three different types of epithelial tumors occur in the oral cavity.
These are the types of squamous epithelium tumors that are discussed in this section.
Figure 7.2, A shows the clinical appearance of a papilloma of the oral mucosa that shows a cauliflower-like appearance and rough surface resulting from fingerlike projections.
Figure 7.2, B shows the microscopic appearance of a papilloma that shows fingerlike projections surfaced by squamous epithelium and supported by thin cores of fibrous connective tissue.
Three types of premalignant lesions are discussed in this section.
Figure 7.3 shows the clinical appearance of leukoplakia. A, Floor of the mouth. B, Maxillary alveolar mucosa and palate. The cause of these lesions could not be identified.
Leukoplakia is a clinical term that does not refer to a specific microscopic appearance.
Sometimes called idiopathic leukoplakia to indicate that the specific cause of the lesion is not known.
Figure 7.4 shows the clinical appearance of a white lesion that was associated with smokeless tobacco (smokeless tobacco–associated keratosis). This lesion developed on the lower labial mucosa at the site where the tobacco was held.
Depending on the study, approximately 5% to 25% of leukoplakias examined microscopically demonstrate epithelial dysplasia.
A specific form of leukoplakia called proliferative verrucous leukoplakia is characterized by the development of persistent, slowly spreading, rough-surfaced, keratotic plaques.
In one study, 60 cases of leukoplakia were seen for every 1 case of erythroplakia.
When examined microscopically, more than 90% of cases of erythroplakia demonstrate epithelial dysplasia or squamous cell carcinoma.
Malignant transformation of oral submucous fibrosis to squamous cell carcinoma has been reported to be between 2% and 8%.
Figure 7.5 shows the microscopic appearance of epithelial dysplasia. Loss of the normal stratification of the epithelium, hyperplasia of the basal cells, and enlarged, hyperchromatic nuclei are seen.
Unlike squamous cell carcinoma, the cellular changes in epithelial dysplasia may revert to normal if the stimulus, such as tobacco smoking, is removed.
These lesions are developmental and characterized by disordered growth. They are not considered premalignant lesions.
All dysplastic lesions should be excised surgically.
Close long-term follow-up examinations are indicated because of the potential for recurrence.
It is also called epidermoid carcinoma.
Squamous cell carcinoma can infiltrate and destroy bone.
Figure 7.6: A, Clinical appearance of a squamous cell carcinoma of the posterolateral tongue shows an exophytic, ulcerated mass. B, Clinical appearance of a squamous cell carcinoma on the left side of the soft palate and facies. C, Clinical appearance of a squamous cell carcinoma on the floor of the mouth. D, Left side of a panoramic radiograph shows destruction of the mandible by a squamous cell carcinoma.
The essential microscopic feature of a squamous cell carcinoma is the invasion of tumor cells through the epithelial basement membrane into the underlying connective tissue.
Figure 7.7: A, Microscopic appearance (low power) of a squamous cell carcinoma shows infiltration of the tumor into the connective tissue. B, High-power photomicrograph shows abnormal keratinization and keratin pearls (K).
In addition to normal surface keratin, the keratin may be see in individual cells within the tumor and as structures called keratin pearls.
Figure 7.8: A and B, Clinical appearance of squamous cell carcinoma of the lower lip. Squamous cell carcinoma (arrow) is seen with actinic (solar) cheilitis in (A).
The majority of squamous cell carcinomas occur in patients over 40 years of age.
Avoidance of sun exposure and the use of a sun-blocking agent are important in preventing the damaging effects of sunlight.
The proportion of smokers is much higher among patients with oral squamous cell carcinoma than among the general population.
There is no evidence that chronic irritation is an initiating factor in the development of oral cancer.
TNM staging is shown on the next slide.
Table 7.3 shows the TNM staging system.
The higher the stage, the worse the prognosis.
It is important to clinically identify asymptomatic areas of leukoplakia and erythroplakia while they are small and to remove all potentially premalignant lesions.
Figure 7.9, A shows the clinical appearance of a verrucous carcinoma occurring on the commissure and anterior buccal mucosa.
Most cases occur in men over 55 years of age.
Figure 7.9, B shows the clinical appearance of a verrucous carcinoma occurring on the maxillary alveolar ridge.
Treated by surgical excision. Although it is a carcinoma, it usually does not metastasize; therefore prognosis is better for verrucous carcinoma than for squamous cell carcinoma.
Figure 7.10 shows the clinical appearance of a basal cell carcinoma (arrow), illustrating the characteristic “rolled” borders.
Locally invasive tumor that can become quite large and disfiguring if not removed
As a general rule, a patient should be referred to an oral and maxillofacial surgeon or dermatologist to have a biopsy performed on any nonhealing ulcer of the skin or lips that has been present for more than 2 weeks.
Tumors of minor salivary gland origin are much more common in the upper lip than in the lower lip.
Figure 7.11, A shows a benign salivary gland tumor of the palate (pleomorphic adenoma).
All salivary gland tumors are diagnosed on the basis of their microscopic appearance.
Figure 7.11: B, Malignant salivary gland tumor of the palate (adenoid cystic carcinoma). Biopsy site should be noted. C, Benign salivary gland tumor of the upper lip (pleomorphic adenoma). D, Malignant salivary gland tumor of the buccal mucosa (mucoepidermoid carcinoma). E, Malignant salivary gland tumor of the tongue (adenoid cystic carcinoma).
A biopsy and microscopic examination of the tissue are required to establish a specific diagnosis.
Tumors of minor salivary gland are much more common in the upper lip than in the lower lip.
The most common extraoral location for the pleomorphic adenoma is the parotid gland; the most common intraoral location is the palate. However, these tumors may occur wherever salivary gland tissue is present.
Figure 7.12 shows the microscopic appearance of a pleomorphic adenoma. A, Low-power photomicrograph shows a capsule (C). B, High-power photomicrograph shows a mixture of epithelium (E) and connective tissue (CT).
Most pleomorphic adenomas occur in individuals over 40 years of age, and a female predilection has been noted.
A small percentage (2% to 4%) of long-standing pleomorphic adenomas have been reported to undergo malignant transformation.
Figure 7.13 shows the microscopic appearance of a portion of a monomorphic adenoma.
Recently, more specific names rather than monomorphic adenoma have been used for this group of tumors. Canalicular and basal cell adenomas are monomorphic-type adenomas that are named for the microscopic pattern of the tumor.
Figure 7.14 shows the microscopic appearance of a portion of a papillary cystadenoma lymphomatosum (Warthin tumor), with spaces lined by epithelium and surrounded by sheets of lymphocytes.
Often develops bilaterally and occurs predominantly in adult men.
A higher incidence is noted in individuals who smoke.
Most studies shows that the mucoepidermoid carcinoma represents the most common malignant salivary gland neoplasm.
Figure 7.15: A, Microscopic appearance (low power) of a mucoepidermoid carcinoma shows cystic structures, mucous cells, and epidermoid cells. B, Radiograph of a central mucoepidermoid carcinoma shows a multilocular radiolucency.
On occasion, a mucoepidermoid carcinoma may arise centrally within bone.
May occur over a wide age range.
Usually occurs in adults after middle age; this tumor is the most common malignant salivary gland neoplasm in children.
Low-grade tumors have a 92% 5-year survival rate after initial treatment.
For high-grade tumors, only 49% of patients survive 5 years after the initial treatment.
Unencapsulated and infiltrates surrounding tissue.
The adenoid cystic carcinoma is a slow-growing malignant tumor.
Figure 7.16 shows the microscopic appearance of an adenoid cystic carcinoma, with perforated islands of uniform cells. The tumor (T) is seen infiltrating the adjacent adipose tissue.
Radiation treatment has been attempted and has been shown to be of benefit in some cases.
Metastasis occurs late in the course of the disease.
About 30% of patients experience cervical lymph node involvement.
In addition to the adenoid cystic and mucoepidermoid carcinomas, several other malignant salivary gland tumors exist.
Odontogenic tumors are derived from tooth-forming tissues.
Some odontogenic tumors are composed of epithelium only; some are composed of mesenchymal tissue only, and others are composed of a mixture of both elements.
Table 7.4 shows the classification of central odontogenic tumors.
Malignant odontogenic tumors occur but are rare.
Most odontogenic tumors are benign.
These are the types of epithelial odontogenic tumors.
Figure 7.18, B is a radiograph of an ameloblastoma showing multilocular radiolucency in the molar area of the mandible.
When it occurs in the maxilla, death can result from direct extension into the brain and adjacent vital structures.
Figure 7.17: Microscopic appearance (low power) of a follicular ameloblastoma shows dental follicle–like islands composed of epithelial cells consisting of peripheral ameloblast-like cells (A) and stellate reticulum–like areas (S).
80% of ameloblastomas arise in the mandible.
Figure 7.19 (top) shows a radiograph of an ameloblastoma that formed in association with an impacted tooth and dentigerous cyst.
Figure 7.18, A (bottom) is a radiograph of an ameloblastoma showing multilocular radiolucencies in the molar area of the mandible.
Recurrence is common.
When these occur in the gingiva and do not involve bone, they’re known as peripheral ameloblastomas.
Figure 7.20, A shows the microscopic appearance (low power) of a calcifying epithelial odontogenic tumor, with sheets of epithelial cells (E), amorphous material (A), and calcifications (C).
It is also known as a Pindberg tumor.
Figure 7.20, B is a radiograph of a calcifying epithelial odontogenic tumor showing a multilocular radiolucency.
Majority of affected patients are adults.
Recurrence is rare; lower than that for an ameloblastoma.
Figure 7.21, B is a radiograph of an adenomatoid odontogenic tumor showing a unilocular radiolucency surrounding the crown of an unerupted maxillary cuspid. (Note that the radiolucency extends beyond the cemento-enamel junction.)
Many are associated with the crown of an unerupted tooth.
Figure 7.21, B shows the microscopic appearance of a portion of an adenomatoid odontogenic tumor, with the capsule (C), epithelial cells, and ductlike structures (D).
Microscopic examination reveals a dense, fibrous connective tissue capsule surrounding ductlike structures.
Clinician should treat an AOT conservatively by enucleation.
Recurrence is rare.
Figure 7.22, B is a radiograph of a calcifying odontogenic cyst showing a unilocular radiolucency of the mandible.
No significant sex predilection is noted; lesions occur equally in maxilla and mandible.
Figure 7.22, A shows the microscopic appearance of a calcifying odontogenic cyst, with a cystic structure lined by odontogenic epithelium (E) with associated ghost cells (G).
The solid variant may exhibit more aggressive behavior and should be treated by a more extensive surgical procedure.
These are the three types of mesenchymal odontogenic tumors that are discussed in this section.
Figure 7.23, B is a radiograph of an odontogenic myxoma showing a multilocular, honeycombed radiolucency.
The tumor may be quite large and cause tooth displacement.
Figure 7.23, A is a photomicrograph of an odontogenic myxoma showing background substance containing widely dispersed cells with long cytoplasmic processes.
The extent of the surgery depends on the size of the tumor.
The recurrence rate is approximately 25%, and most recurrences take place within 2 years of treatment.
Figure 7.24, C is a radiograph of a central cementifying fibroma showing a well-circumscribed radiolucent lesion.
Figure 7.24, A is a photomicrograph of a central cementifying fibroma showing rounded, globular calcifications (GC) and cellular fibrous connective tissue (FCT). B is a radiograph of a central cementifying fibroma showing a radiolucent and radiopaque lesion.
Because these lesions are well delineated, they separate easily from the surrounding bone.
Figure 7.25 is a radiograph of a benign cementoblastoma showing a well-circumscribed radiopaque mass surrounded by a radiolucent halo and attached to the roots of a mandibular first molar.
The radiolucent halo represents the periodontal ligament.
These are three types of mixed odontogenic tumors that are discussed in this section.
Most cases occur in individuals younger than 20 years of age.
Figure 7.26, A shows the microscopic appearance of an ameloblastic fibroma, with a combination of odontogenic epithelium (E) and mesenchymal tissue (M).
Most patients are asymptomatic.
Figure 7.26, B is a radiograph of an ameloblastic fibroma showing a poorly defined unilocular radiolucency.
Radiographically, the ameloblastic fibroma appears as either a well-defined or poorly defined unilocular or multilocular radiolucency.
Some patients may experience swelling of the affected area.
This is a well-circumscribed lesion that usually separates from the surrounding bone.
Figure 7.27 is a radiograph of a compound odontoma showing a collection of numerous, small, toothlike radiopacities surrounded by a radiolucent halo.
An odontoma is an odontogenic tumor composed of mature enamel, dentin, cementum, and pulp tissue.
Figure 7.28 is a radiograph of a complex odontoma showing a radiopaque mass surrounded by a radiolucent halo.
There is no sex predilection.
These tumors generally do not recur.
Several of the odontogenic tumors have been reported to occur on the gingiva without underlying bone involvement.
Figure 7.29 shows the clinical appearance of a peripheral ameloblastoma.
The peripheral ossifying fibroma is composed of a combination of fibrous tissue and islands or strands of odontogenic epithelium.
Surgical excision is the preferred treatment for peripheral ossifying fibroma.
Tumors of soft tissue include benign and malignant tumors of adipose (fat) tissue, nerve, muscle, blood vessels, and lymphatic vessels.
Figure 7.30, A shows the clinical appearance of a lipoma.
No sex predilection is noted.
Figure 7.30, B is a photomicrograph of a lipoma showing mature fat cells.
A lipoma generally does not recur.
These are the types of tumors of nerve tissue that are discussed in this section.
Figure 7.31, A shows the clinical appearance of a neurofibroma, with a nonulcerated mass on the lateral border of the tongue.
A schwannoma is derived from Schwann cells and perineural fibroblasts.
Figure 7.31, B shows a photomicrograph of a neurofibroma.
Schwannomas have been reported to occasionally cause a complaint of pain.
Figure 7.32, A shows the clinical appearance of a granular cell tumor of the tongue with a nonulcerated mass.
This tumor most likely arises from a neural or primitive mesenchymal cell.
Figure 7.32, B is a photomicrograph of a granular cell tumor showing granular cell(s) (G) between striated muscle fiber(s) (M). C is a photomicrograph of a granular cell tumor showing overlying pseudoepitheliomatous hyperplasia.
This tumor is treated by surgical excision and does not recur.
This neoplasm most likely arises from a primitive mesenchymal cell.
Occasional examples have regressed without treatment.
Rhabdomyomas and leiomyomas are called vascular leiomyomas and occasionally occur in the oral cavity.
Despite treatment, the prognosis is poor.
These are the types of vascular tumors discussed in this section.
Figure 7.33, B shows the clinical appearance of a vascular malformation of the lower lip.
This common vascular lesion is considered by many to represent a developmental lesion rather than a tumor.
Figure 7.33, C is the clinical appearance of a vascular malformation of the buccal mucosa.
More than half of the hemangiomas that occur in the body occur in the head and neck area.
When a hemangioma occurs in an adult, it should be referred to as a vascular malformation.
Figure 7.33, D shows the microscopic appearance of a cavernous hemangioma, with large dilated blood vessels (B) filled with red blood cells (RBC).
Injection of a sclerosing solution into the lesion will cause it to shrink or resolve.
Unlike a hemangioma, a lymphangioma will not shrink after injection with a sclerosing solution.
Malignant vascular tumors arising from endothelial cells include an angiosarcoma and Kaposi sarcoma.
In the 1980s, with the advent of HIV, Kaposi sarcoma appeared in a much more aggressive form.
In HIV-positive patients, recurrence is common, and the disease may progress rapidly.
These are two types of tumors of melanin-producing cells that will be discussed in this section.
Figure 7.34 is the clinical appearance of a melanocytic nevus showing a well-defined pigmented lesion on the labial mucosa.
What is the plural form of nevus? (Nevi)
Intraoral tumors consist of tan-to-brown macules or papules that occur most often on the hard palate.
Pigmented lesions that exhibit ulceration, an increase in size, or a change in shape or color may be malignant.
What does ABCDE stand for in terms of assessing pigmented skin? (Asymmetry, Border, Color, Diameter, and Evolving)
Figure 7.35 is the clinical appearance of malignant melanoma showing a darkly pigmented lesion in the area of the facies.
All melanomas are malignant.
Melanoma usually presents as a rapidly enlarging, blue-to-black mass.
The prognosis for oral melanoma is poor.
These are the types of tumors of bone and cartilage discussed in this section.
Multiple osteomas are a component of Gardner syndrome, which is transmitted genetically and is discussed in Chapter 6.
Figure 7.36 is a radiograph of an osteoma that shows a radiopacity of the posterior mandible.
Figure 7.37, A is the clinical appearance of an osteogenic sarcoma showing swelling.
Tumors that involve the long bones occur at an average age of 27 years.
Some patients initially present with a toothache or tooth mobility.
Figure 7.37, B is a radiograph of an osteogenic sarcoma in the left molar area showing a poorly defined radiopaque lesion.
In some cases, asymmetric widening of the periodontal ligament space and a sunburst pattern may be seen radiographically.
Only about 20% of patients with an osteosarcoma of the jaws survive 5 years.
Only about 30% of patients with chondrosarcoma involving the jaws survive 5 years after the diagnosis.
Figure 7.38 is the clinical appearance of a chondrosarcoma showing an exophytic mass in the anterior mandible.
These tumors of blood-forming tissues are discussed in this section.
Figure 7.39 shows the clinical appearance of a patient with leukemic infiltration of the gingiva, resulting in diffuse enlargement.
Several types of leukemia are classified according to the kind of cells that are proliferating: myelocytes, lymphocytes, or monocytes.
Leukemias are divided into two forms—acute and chronic.
Rarely, a lymphoma may present as a primary lesion in the oral soft tissues or bone.
The prognosis depends on the type of lymphoma and the extent of involvement.
Figure 7.40, A is the microscopic appearance of multiple myeloma showing a proliferation of plasma cells.
Pathologic fracture of an involved bone is common and typically occurs in bones weakened as a result of their destruction by the proliferation of neoplastic plasma cells.
Oral complications related to this treatment are discussed in Chapter 9.
On occasion, the oral metastatic tumor is the first manifestation of a primary tumor elsewhere.
Radiographically, the appearance of metastatic tumors varies.
Systemic bisphosphonate medication is used to prevent bone destruction in patients with tumors such as breast and prostate cancer that metastasize to bone.
Figure 7.41 is a radiograph showing diffuse radiolucent and radiopaque changes resulting from metastatic carcinoma of the prostate gland.