Power Point Presentation on Oral cancer with levels of prevention regarding community medicine

1. Hammad Shahid
ROLL NO 156

2. INTRODUCTION

3. DEFINATION:
A MALIGNANT GROWTH OR TUMOUR RESULTING FROM AN UNCONTROLLED
DIVISION OF CELLS IS TERMED AS CANCER.
“CANCER OCCURING IN ANY PART OF ORAL CAVITY IS TERMED AS ORAL CANCER”
 MORE THAN 90% OF ORAL CANCERS ARE SQUAMOUS CELL CARCINOMAS.
 6TH MOST COMMON CANCER IN THE WORLD
 A HIGH PREVALENCE OF ORAL CANCER IN PAKISTAN AND OTHER SIAN COUNTRIES
IS MAINLY DUE TO INFLUENCE OF REGION SPECIFIC EPIDEMIOLOGICAL FACTORS
SUCH AS TOBACCO AND BETEL QUID CHEWING
 PROGNOSIS IS POOR SO EARLY DIAGNOSIS IS OF PARAMOUNT IMPORTANCE
 HISTOLOGICAL EXAMINATION IS THE GOLD STANDARD IN THE DIAGNOSIS OF ORAL
CANCER AND PRE-CANCEROUS LESIONS AND CONDITIONS

4. PATHOGENESIS
ORAL SQUAMOUS CARCINOGENESIS IS A MULTISTEP PROCESS IN
WHICH MULTIPLE GENETIC EVENTS OCCUR THAT ALTER THE NORMAL
FUNCTIONS OF ONCOGENES AND TUMOUR SUPPRESSOR GENES
 THIS CAN RESULT IN INCREASED PRODUCTION OF GROWTH FACTORS
OR NUMBERS OF CELL SURFACE RECEPTORS, ENHANCED
INTRACELLULAR MESSENGER SIGNALLING, AND/OR INCREASED
PRODUCTION OF TRANSCRIPTION FACTORS.
 IN COMBINATION WITH THE LOSS OF TUMOUR SUPPRESSOR ACTIVITY,
THIS LEADS TO A CELL PHENOTYPE CAPABLE OF INCREASED CELL
PROLIFERATION, WITH LOSS OF CELL COHESION, AND THE ABILITY TO
INFILTRATE LOCAL TISSUE AND SPREAD TO DISTANT SITES.

5. THE SPECTRUM OF MALIGNANT TUMORS TO AFFECT THE ORAL CAVITY
VARY WIDELY AND INCLUDES
(1)SURFACE EPITHELIUM
• SQUAMOUS CELL CARCINOMA (OVER 90%)
(2)GLANDULAR EPITHELIUM
• ADENOCARCINOMA IN FEMALES
• MUCOEPIDERMOID CARCINOMA IN MALES
(3)MESENCHYMAL TISSUES
• LYMPHOMAS
• SARCOMAS

6. RISK FACTORS

7. GLOBAL INDICATORS
PERCENTAGE OF INDIVIDUALS ADDICTED TO SMOKING
PERCENTAGE OF TEENAGERS OR ADOLESCENTS ADDICTED TO SMOKING
PREVALENCE OF HUMAN PAPILLOMA VIRUS
NUCLEAR SITES LOCATION IN A SPECIFIC PLACE
ORAL HYGIENE OF POPULATION
PERCENTAGE OF INDIVIDUALS ADDICTED TO ALCOHOL
TYPE OF MOUTH WASH USED ESPECIALLY WITH HIGH ALCOHOL
CONTENT
CANCER INCIDENCE AND PREVALENCE
LITERACY RATE
SOCIO-ECONOMIC CONDITION OF A POPULATION
TYPE OF DIET

8. INCIDENCE AND PREVALENCE IN PAKISTAN

9. INCIDENCE:
 63,451 NEW CANCER CASES WERE REPORTED IN 2017 IN PAKISTAN
 ORAL CANCER WAS THE 4TH MOST DETETCTED CANCER AMONG
PATIENTS
 MAJORITY OF ORAL CANCER CASES WERE REGULAR SMOKERS
 MAJORITY OF SMOKERS HAD POOR SOCIO-ECONOMIC STATUS
 IN FEW CASES LEISIONS BECOME ORAL CANCER DUE TO NEGLIGENCE
 ALTHOUGH IT IS COMMON IN OLD AGE PEOPLE BUT 26% OF CASES ARE
YOUNG UNIVERSITY GOING STUDENTS WHICH WAS ALARMING.

10. ANNUAL INCIDENCE 31,000 AMERICANS;REST WORLD WIDE
HIGH MORTALITY;50% OF PATIIENTS LIVE MAXIMUM OF 5
YEARS FOLLOWING DIAGNOSIS
MORE COMMON THAN CERVICAL CANCER
MORE FATAL THAN MALIGNANT MELANOMA OR HODGKIN’S
DISEASE
INCIDENCE RELATED TO SOCIO-ECNOMIC FACTORS
MULTIPLE PRIMARIES
FREQUENT LYMPH NODE METASTASIS

11. ORAL CANCER APPEARS AS A GROWTH OR SORE IN THE MOUTH THAT
DOES NOT GO AWAY.
 INCLUDES CANCERS OF THE LIPS, TONGUE, CHEEKS, FLOOR OF THE
MOUTH, HARD AND SOFT PALATE, AND PHARYNX (THROAT).
MEN FACE TWICE THE RISK OF DEVELOPING ORAL CANCER AS WOMEN,
AND MEN WHO ARE OVER AGE 50 FACE THE GREATEST RISK.
25% CASES OF ORAL CANCER OCCURS IN NON-SMOKERS

13. BELOW TABLE SHOWS ORAL CANCER CASES IN DIFFERENT PROVINCES OF PAKSTAN
ORAL CAVITY CANCER ETHNICITY
ETHNICITY MALES % FEMALES % TOTAL V
PUNJAB 7.4 9.0 8.2
KPK 5.7 2.7 4.3
BALOCHISTAN 14.8 19.8 17.2
SINDH 7.4 9.9 8.6
MOHAJIR 32.8 26.1 29.6
OTHERS 0 0.9 0.4UNKNOWN 32 31.5 31.8
TOTAL 100 100 100

14. PREVALENCE TREND IN PAKISTAN
 LIP AND ORAL CAVITY CANCER IS THE SECOND MOST PREVALENT,
FREQUENTLY DIAGNOSED AND LEADING CAUSE OF CANCER DEATH
IN PAKISTAN, WITH AN ESTIMATED 5-YEAR PREVALENCE OF
30,647 CASES, 12,761 NEWLY DIAGNOSED CASES AND
7,266 DEATHS IN 2014.

15. EPIDEMIOLGICAL STUDIES

16. ORAL CANCER WITH ICD-10 CODES RANGING C01-C06
RANKS AMONGSTTHE 3 MOST COMMON TYPES IN PAKISTAN
IT IS AN IMPORTANT PUBLIC HEALTH ISSUE
NON-COMMUNICABLE DISEASE INCLUDING IT ARE MAJOR
THREAT TO DEVELOPMENT,ECONOMIC GROWTH AND HUMAN
HEALTH
THERE IS VARIATION IN INCIDENCE AND PATTERN OF
DISEASE DUE AGEING OF POPULATION

17. EPIDEMIOLOHICAL FACTORS

19. 1.HOST FACTORS

20. SITE
TONGUE SIDES
LIPS
FLOOR OF MOUTH
SOFT PALATE
TONSILS
SALIVARY GLANDS
BACK OF THROAT
AGE AND GENDER
INDIVIDUALS OVER 45 YEARS OF AGE (<10%)
MALES ARE MORE LIKELY
MEAN AGE IS USUALLY BETWEEN 51-55 YEARS OF AGE

21. RACE
 COMMON IN PERSONS OF CHINESE ANCESTRY.
 DECREASED INCIDENCE IN AMERICAN WHITES
GENETICS
 INCREASED BY GENETIC MUTAGENS IN TOBCACO,ALCOHOL
AND BETEL QUID
 GENETIC MUTATIONS-
3p,4q,6q,8p,9p,13q(RETINOBLASTOMA TUMOR
SUPRESSOR GENE) AND 21q.

22. SOCIO-ECONOMIC STATUS
 MORE COMMON IN POOR PEOPLE AND LOWER SOCIO-ECONOMIC GROUPS OF
SOCIETY DUE TO HIGH EXPOSURE TO RISK FACTORS
EDUCATION
 MORE IN ILLITERATE PEOPLE.
OCCUPATION
PEOPLE ASSOSCIATED WITH
 TAR INDUSTRY
 COAL MINE
 URANIUM MINERS
 TEXTILE INDUSTRIES

23. BLOOD GROUP
 BLOOD GROUP O SHOWS LEAST SUSCEPTIBILITY
 BLOOD GROUP A SHOWS HIGHEST SUSCEPTIBILITY
 BLOOD GROUP B AND AB SHOWS DOUBTFUL SUSCEPTIBILITY
LIFESTYLE FACTORS
 MORE IN PEOPLE WITH VITAMIN (A,C,E) DEFICIENCIES
 INVERSE RELATION WITH BODY MASS INDEX
 HIGH IN PEOPLE WITH LOW BETA-CAROTENE LEVELS

24. 2.AGENT FACTORS

25. BIOLOGICAL
 HUMAN PAPILLOMA VIRUS
CHEMICALS
 APPLICATION OF DRY LIME AND KATHTHA
MECHANICAL
 ILL FITTING DENTAL DEVICES CAUSIMG IRRITATION TO ORAL MUCOSA

26. 3.ENVIRONMENTAL FACTORS

27. •
SIGNS AND SYMPTOMS
MOUTH SORES THAT DO NOT HEAL
PERSISTANT MOUTH PAIN
LUMP OR THICKENING IN CHEEKS
WHITE OR RED PATCH IN GUMS
SORE THROAT
DIFFICULTY IN SWALLOWING OR CHEWING
NUMBNESS OF TONGUE
DIFFICULTY MOVING JAW
LOOSENING OF TEETH
VOICE CHANGES
WEIGHT LOSS
PERSISTANT BAD BREADTH
LUMP IN NECK

28. SCREENING

29.  IT IS AN EXAMINATION PERFORMED BY THE DENTIST OR DOCTOR TO LOOK FOR THE
SIGNS OF CANCER OR PRECANCEROUS CONDITION IN MOUTH
SCREENING PREPARATION
• ROUTINE HEAD AND NECK
EXAMINATION
• REVIEW HISTORY OF ALCOHOL
AND SMOKING
• FOLLOW UP
OVERVIEW
• PROPER LIGHTENING,PROBE
MOUTH MIRROR
• GAUZE SPONGES
• DISPOSABLE GLOVES
ARMAMENTARIUM

30. EXTRA-ORAL EXAMINATION
GENERAL APPRAISAL
SKULL
SKIN
FACIAL FORM
EYES
NEUROLOGICAL DEFICIT
TMJ
MASTICATORY MUSCLES
LYMPH NODES OF HEAD AND NECK

31. INTRA ORAL EXAMINATION

33. TECHNIQUES
 ORAL CYTOLOGY
 EXFOLIATIVE CYTOLOGY
 BRUSH BIOPSY
 VITAL STAINING
 VELSCOPY
 ORASCOPTIC DK
 MICROLUX DIAGNOSIC LIGHT
 VIZILITE PLUS

34. ADVANTAGES
LESS TIME
LESS PAINFUL
THOROUGH VISUAL AND SOFT TISSUE EXAMINATION
HELPFUL IN DETERMINATION OF SURGICAL BORDER
SMALL LESIONS ALSO IDENTIFIED
DIS-ADVANTAGES
 PATIENT DISCOMFORT
 INSUFFICIENT USE OF HISTOLOGIC AND MOLECULAR MAPPING
 LACK OF METHODOLOGY SOUND CLINICAL TRAILS

35. LEVELS OF
PREVENTION

36. PRIMARY LEVEL
•PUBLIC EDUCATION
•IMPROVING PUBLIC
LIFESTYLE
•INCREASING LITERACY RATE
HEALTH
PROMOTION
•BANNING SALE OF TOBACCO
•PROPER CARE OF ORAL
LESIONS
SPECIFIC
PROTECTION

37. SECONDARY LEVEL
• SCREENING TESTS
• REGULAR FOLLOWUPSEARLY
DIAGNOSIS
• SURGICAL TRRATMENT
• MEDICAL TREATMENT
• COUNSELLING ON AVOIDING RISK
FACTORS
PROMPT
TREATMENT

38. TERTIARY LEVEL
•AVOIDING CAUSATIVE AGENTS
•ORAL HYGIENE IMPROVEMENTDISABILITY
LIMITATION
•SMOKING LEAVING THERAPY
•PSYCHOTHERAPY
•VOCATIONAL THERAPY
REHABILITATION

39. REFERENCES• PARKS TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 25TH EDITION
• GLOBAL CANCER OBSERVATORY
https://gco.iarc.fr/today/data/factsheets/populations/586-pakistan-fact-sheets.pdf
• CANCER COUNTRY PROFILE-WHO
https://www.who.int/cancer/country-profiles/pak_en.pdf
• PAKISTAN CANCER INDEX
http://www.cancerindex.org/Pakistan
• https://www.tandfonline.com/doi/full/10.1080/2331205X.2017.1288773
• SHAUKAT KHANUM RESEARCHES
https://shaukatkhanum.org.pk/health-care-professionals-researchers/cancer-
statistics/
• CANCER REGISTERY-PAK HEALTH RESEARCH COUNCIL
http://phrc.org.pk/cancer-registry.html