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This document discusses oral cancer, including its incidence, classification, etiology, clinical features, diagnostic aids, and patient workup. Some key points: - Oral cancer is the 6th most common cancer worldwide and accounts for 40% of cancers in India. Squamous cell carcinoma makes up 90% of cases. - Risk factors include tobacco, alcohol, HPV infection, and poor nutrition. Potentially precancerous conditions include lichen planus and leukoplakia. - Diagnostic aids include tissue staining, brush biopsy, imaging modalities like CT and MRI, and salivary biomarkers. - A thorough patient workup includes medical history, clinical exam of oral cavity and lymph
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- 2. Work Up • INTRODUCTION • ORAL CANCER • INCIDENCE • CLASSIFICATION • ETIOPATHOGENESIS • CLINICAL FEATURES • TNM STAGING • INVESTIGATIONS
- 4. • A TUMOR is a commonly used, but non-specific, term for a neoplasm. The word tumor simply refers to a mass. • This is a general term that can refer to benign or malignant growths.
- 5. NEOPLASIA NEO “new” PLASMA “formation” R. A WILLIS "A neoplasm is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues, and persists in the same excessive manner after cessation of the stimulus which evoked the change."
- 6. • Cancer is a general term for malignant neoplasm CARCINOS • CARCINOMA SARCOMA LYMPHOMA LEUKEMIA
- 8. CELL CYCLE
- 10. CHARACTERISTICS OF CANCER CELLS • Unrestricted cellular proliferation • Transformation ability to invade • Metastasis • Suppression of apoptosis • Angiogenesis
- 12. ORAL CAVITY AND OROPHARYNX
- 13. Incidence • 6th most common malignancy • India –upto 40% of all malignancies • M>F -2:1 • AGE : 60 yrs • 5 year survival rate • 90% is SCC • Most common site – lateral border of tongue
- 14. CLASSIFICATION • Malignant epithelial tumours Squamous cell carcinoma Verrucous carcinoma Basaloid squamous cell carcinoma Papillary squamous cell carcinoma Spindle cell carcinoma Acantholytic squamous cell carcinoma Adenosquamous carcinoma Carcinoma cuniculatum Lymphoepithelial carcinoma
- 15. • Salivary gland tumours • Salivary gland carcinomas • Acinic cell carcinoma • Mucoepidermoid carcinoma • Adenoid cystic carcinoma • Polymorphous low-grade adenocarcinoma • Basal cell adenocarcinoma • Epithelial-myoepithelial carcinoma • Clear cell carcinoma, not otherwise specified Cystadenocarcinoma • Mucinous adenocarcinoma • Oncocytic carcinoma • Salivary duct carcinoma • Myoepithelial carcinoma • Carcinoma ex pleomorphic adenoma
- 16. • Soft tissue tumours • Kaposi sarcoma • Lymphangioma • Ectomesenchymal chondromyxoid tumour
- 17. • Haematolymphoid tumours • Diffuse large B-cell lymphoma (DLBCL) • Mantle cell lymphoma • Follicular lymphoma • Extranodal marginal zone B-cell lymphoma of MALT type • Burkitt lymphoma • T-cell lymphoma (including anaplastic large cell lymphoma) • Extramedullary plasmacytoma • Langerhans cell histiocytosis • Extramedullary myeloid sarcoma • Follicular dendritic cell sarcoma / tumour • Mucosal malignant melanoma • Secondary tumours
- 18. ETIOLOGY • Tobacco with or without Betel Nut: About 90% of people with oral cavity and oropharyngeal cancer use tobacco • Alcohol: Drinking alcohol strongly increases a smoker's risk of developing oral cavity and oropharyngeal cancer. • Ultraviolet light: More than 30% of patients with cancers of the lip have outdoor occupations associated with prolonged exposure to sunlight. • Irritation: Long-term irritation to the lining of the mouth caused by poorly fitting dentures
- 19. • Poor nutrition: A diet low in fruits and vegetables is associated with an increased risk • Mouthwash: Some studies have suggested that mouthwash with a high alcohol content • Human papillomavirus (HPV) infection: • Immune system suppression: • Age: The likelihood of developing oral and oropharyngeal cancer increases with age, especially after age 35. • Gender: Oral and oropharyngeal cancer is twice as common in men as in women
- 20. WHO has listed several conditions having potential to transform into OC • Lichen planus • Erythroplakia • Actinic chelitis • OSMF • Leukoplakia ( verrucous) • SYPHILIS • DLE • Sideropenic Dysphagia
- 25. Inherited Risk Factors A review of inherited cancer syndromes and their relevance to oral squamous cell carcinoma (Prime SS, Thakker NS, et.al. Oral oncology 2001 Jan;37(1):1-16: examined genetic defects associated with inherited cancer syndromes and their relevance to oral cancer. Defective DNA repair mechanism: xeroderma pigmentosa, bloom syndrome, fanconi anemia, cowden syndrome,dyskeratosis congenita
- 26. • Tumor suppressor gene(p53) defect: Li Fraumeni syndrome. • Relationship between ABO blood groups and oral cancer (Jaleel BF, et. al. Indian J Dental Research 2012 Jan;23(1):7-10: found that people with blood group A had 1.46 times higher risk of developing oral cancer as compared with other blood group.
- 28. Molecular Basis of Cancer • Tumor suppressor genes : p16,p21,p53,RB gene. • Proto-oncogene : bcl1 , cyclin D1,bcl2 erb-b, ras. • Telomeres, telomerase, cell senescence • Tumor invasion and metastasis:: loss of 9p21 chromosome region
- 31. Early Detection is Critical !!! • Tongue : 35% • Floor of mouth: 30% • Lower alveolus: 15% • Buccal mucosa: 10% • Upper alveolus/hard palate: 8% • RMT: 2% followed by • Lips: lower-93%, upper-5%, commissure- 2%
- 33. Clinical Examination : 8 step examination
- 34. Examination of Lymph Nodes
- 36. DIAGNOSTIC AIDS IN DETECTION OF CANCER
- 38. Brush BIOPSY
- 39. BIOPSY
- 42. NARROW EMISSION TISSUE FLUORESCENCE • VELscope
- 45. COLPOSCOPY
- 46. • SALIVARY BIOMARKERS • ELASTOGRAPHY • BIO NANOCHIP( LAB ON A CHIP)
- 47. IMAGING MODALITIES • Conventional modalities – 2D imaging • Ultrasonography with FNAC • CBCT • CT- Multi Detector Row CT • MRI • PET .. PET CT
- 48. MUST Do’s… Patient work up • Investigations : Primary: Photographs Incisional biopsy FNAC Orthopantogram CXR ECG Routine blood investigations
- 49. Investigations: for staging - CT head + neck ± CT chest - MRI - USG of neck or primary ± USG guided FNAC of suspicious lymphadenopathy - PET
- 51. SOME COMMON ORAL CANCER THAT WE ENCOUNTER are
- 53. Basal cell CA
- 59. OSTEOSARCOMA
- 61. REFERENCE Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment C Scully Burket's Oral Medicine 12th edition M Glick Oral Pathology: Clinical Pathologic Correlations Regezi ,Sciubba, Jordan The Washington Manual of Oncology R Govindan
- 62. JOURNALS • Basis of Carcinogenesis P Uma Devi Health administrator • Oral field cancerization : update on current concepts M Mohan Oncology Reviews • Diagnostic aids in detection of Oral Cancer : An update G Sharma WJS