Oral Cancer

2.  Associated with cell dysregulation
 More common to see below 50
 Certain chromosomal alterations

3.  Awareness level
 Access to health care system
 Late diagnosis

4.  even after treatment
 Quality of life
 Pain
 Death

5. Hallmarks of Carcinoma

6. Autonomy in growth signaling
 Normal cells require external stimuli for growth.
 Cancer cells usurp this growth and proliferative
pathways.
 Resulting in aberrant tumour cell multiplication

7. Insensitivity to inhibitory
growth signals
 Balance between growth and maintenance is achieved
by various stimuli.
 Tumerogenic conditions this balance is lost

8. Evasion of apoptosis
 Apoptosis is important for organogenesis,
embryogenesis, cellular homeostasis
 Antiapoptotic and proapoptotic balance is lost in
malignancy

9. Limitless replication
 Transformed cells acquire the ability to undergo
unlimited cycles of mitosis
 immortalization

10. Angiogenesis
 Tumor cells acquire the ability to sustain continued
new vessel growth

11. Invasion and metastasis
 Ability to invade, spread to regional lymphatics,
metastasis to distant organs
 Loss of intercellular adhesion
 Degradation of basement membrane
 Epithelial-mesechymal transition

12. Oral Cancer

13. Introduction
 400,000 new cases every year
 5th most common cancer in men
 7th most common cancer in female
 10th common cause for death
 Carcinomas 96%
 Sarcomas 4%
Most common squamous cell carcinoma

14. Etiology
Multifactorial
Predisposing factors:
 Tobacco-chewing or smoking
 Chewing Betel quid
 Alcohol
 Chronic irritation

15. Other contributing factors
 Natural carcinogenic agents
 Industrial pollutants
 Actinic radiation
 Malnutrition
 Familial/genetic

16. Contd…
 Immune suppression
 Plummer Vinson syndrome
 Syphylitic glossitis
 Avitaminosis
 Viral infections
 Candida albicans

17. Symptoms of oral cancer
 Lump or a swelling
 Pain/burning sensation
 Bleeding
 Loose teeth
 Restriction of
tongue movement /mouth opening
 Ill-fitting dentures

18. Contd…
 Anesthesia/Parasthesia
 Paralysis
 Diplopia
 Dysphagia
 Voice change
 Halitosis

19. Clinical appearance
 Exophytic (mass forming)
 Endophytic,Indurated
(ulcerating,Non-ulcerating)
 White patch
 Red patch

20. Investigation
 Toludine blue staining:
uptake in dysplasia & malignant tissues
 DNA synthesis in malignant cells
 Greater diffusion through haphazardly arranged
tumor cells

21. Before staining

22. After staining

23. Biopsy
 Incisional biopsy
 Excisional biopsy
 Needle biopsy (FNAC)
 Exfoliative cytology

24. Imaging
 Routine radiographs
 CT
 MRI
 Nuclear scintigraphy
 Ultrasound

25. TNM staging
T4 Tumor invades adjacent structures

29. Stage TNM Classification Survival Rate
Stage I T1 N0 M0 85%
Stage II T2 N0 M0 66%
Stage III T3 N0 M0
T1,T2,T3,N1, M0
41%
Stage IV Any T4 lesion, or
Any N2 or N3 or
Any M1
9%

33. Treatment
 Surgery
 Radiotherapy
 Chemotherapy
 Combination of these

34. Surgical modality
 Blade
 Laser
 Electrosurgery
 Cryosurgery

35. Surgery
Indication
 If tumor not radiosensitive
 Recurrence in already irradiated area
 Situation in which side effect of radiation are more
severe than surgical defects
 Neoplasms involving bone, lymph node, salivary gland
 In palliative cases reduce the bulk

36. Contd…
 Surgical management of clinically positive cervical
nodes is the treatment of choice.
 Surgery is needed when bone is involved, and
radiotherapy alone cannot be considered adequate to
produce a cure.

37. Radiation therapy
 Radiation may be administered to a localized lesion by
using implant techniques (brachytherapy) or to a
region of the head and neck by using external-beam
radiation (Teletherapy)

38. Radiation therapy
Choice of treatment should be done according to
 Relative cure that can be obtained with radiation as
compared with surgery or any other modality
 Relative morbidity associated with radiation therapy
 Cosmetic & functional result of radiation versus surgery
or a combination

39.  Radiation kills cells by interaction with water molecules
in the cells, producing charged molecules that interact
with biochemical processes in the cells. DNA is
disrupted, and chromosomal damage occurs.
 The affected cells may die or remain incapable of
division.
Contd…

40.  60 -65 Gy in 30 fractions , 1.8 to 2 Gy / fraction spread
over 5 weeks.
 The biologic effect of radiation depends on the dose
per fraction, the number of fractions per day, the total
treatment time, and the total dose of radiation.
Contd…

41.  Cell survival is influenced by the repair of
sublethal damage, oxygenation of the cells, total
dose, fraction size, and the type of radiation used.
Contd…

42.  Radiation therapy has the advantage of treating the
disease in situ and avoiding the need for the
removal of tissue, and it may be the treatment of
choice for many T1 and T2 tumors.
Contd…

43. BRACHYTHERAPY
 Interstitial and intracavitary implants are used to
treat primary cancers in the head and neck.
 Primary treatment modality for localized tumors in
the anterior two thirds of the oral cavity

44.  For treatment of superficial tumors, radiation with a
low penetration may be used.
 Deep-seated tumors may be treated with heavy
particle irradiation, such as neutron beam radiation.
Treatment Contd…

45. Treatment planning for radiation
 The radiation treatment plan is determined by tumor
site, tumor size, the total volume to be radiated, the
number of treatment fractions, the total number of days
of treatment, teeth in the line of radiation, and the
tolerance of the patient.

46. Chemotherapy
 Chemotherapy has been considered for treatment of
individuals with advanced tumors or recurrent disease
in whom surgery or radiation is unlikely to achieve result

47.  The toxic effects of chemotherapy : mucositis,
nausea, vomiting, and bone marrow suppression.
 Methotrexate
 Bleomycin
 Cisplatin and Platinum derivatives
 5-fluorouracil
 Combinations of these