CONTENT
ORAL CANCER
EPIDEMIOLOGY
RISK FACTORS
ADDITIONAL RISK FACTORS
ORAL SQUAMOUS CELL CARCINOMA
ETIOLOGY
CLINICAL FEATURES
RATIOGRAPHIC FEATURE
HISTOPATHOLOGY
LAB INVESTIGATION
TREATMENT
COMPLICATION
PREVENTION
ORAL CANCER
Cancer that occurs on the inside of the mouth is called oral cancer or oral cavity
cancer
Oral cancer can occur on the:
Lip
Gingiva
Inside lining of cheeks (buccal mucosa)
Floor of the mouth
Anterior 2/3 of the mouth
Hard palate
EPIDERMIOLOGY
Oral cancer is of the ten most common malignancies in the world
In developing countries it counstitudes the 3rd commonest malignancy
Over 80% of the malignant neoplasm of the orofacial region are squamous
cell carcinoma of oral mucosa, tongue and lip
Males are often affected more than females
RISK FACTOR
Tobacco
Alcohol
Diet and nutrition
Ultraviolet light
Fungal and viral infection
Habits
Chronic infection
immunodeficiency/ supression
Occupational risk
ADDITIONAL RISK FACTORS LINKED TO ORAL CANCER
HPV-20-30% association
HSV
Nutritional deficiencies (vit.A)
Oral lichen planus
Immuno supression
Syphilis
Marijuana use
Chronic irritation (ill filled dentures, broken tooth)
Chronic candidiasis
ORAL SQUAMOUS CELL CARCINOMA
DEFINITION
It is a malignant neoplam of stratified squamous epithelium in the oral
cavity
Capability of local destruction growth and metastasis
INCIDENCE
Possible sites
Lower lip
Tongue
Floor of the mouth
Soft palate
Gingival / alveolar ridge
Buccal mucosa
ETIOLOGY
The etiology is uncommon. But a number of etiological factor have been
implicated
Strong association:
Tobacco smoking and chewing chronic alcohol consumption
Human papilloma virus infection
TOBACCO
Major source of intra-oral carcinogen
All forms of tobacco consumption have been linked
South east asia: bethel quid-north africa and middle east: a mixture of
tobacco and lime water or oil called naswar or nash
Smokers in crude or factory made cigrattes
Carcinogen in tobacco: nitrosamine (nicotine), the polycyclic aromatic
hydrocarbon(3,4-benzopyrene)
ALCOHOL
2nd major risk factor
Associated with cancer of the floor of the mouth and tongue
Excess consumption of every type of alcohol (including hard liquor, wine,
& beer)
Potentiates the effect of tobacco
Dehydration effects of alcohol on the mucosa
Increasing mucosal permiability
Irritation of mucosa
ETIOLOGY
Weak association
Chronic irritation from ill-fitting denture
Sub mucosal fibrosis
Poor orodental hygiene
Nutritional deficiencies
Exposure to sunlight(lip cancer)
Plummer vinson syndrome
PATHOGENESIS
NEOPLASIA: the process of transformation from a normal cell to a
cancerous one.
An abnormality of cell growth and multiplication characterized by:
At cellular level
excessive cellular proliferation
uncordinated growth
tissue infiltration
At moleculal level
disorder of growth respiratory genes
HALLMARKS OF ORAL CANCER
Autonomy in growth signaling
Insensitivity to inhibitory growth signals
Evasion of apoptosis
Limitless replication
Angiogenesis
Invasion and metastasis
MALIGNANT CELL
Continuous reproduction
Formation of abnormal protein
ANAPLASIA:
loss of normal cell function (abnormal DNA transcription)
Proliferation
Movement of cells
invasion of nearby tissue
metastasis
CLINICAL FEATURES
A sore in the mouth that does not heal (most common symptoms)
Pain in the mouth
A persistent lump or thickining in the cheek
A persistent white or red patch on the gums, tongue, tonsils, or lining of the
mouth
A sore throat or a feeling that something is caught in the throat
Increased salivation
Difficulty chewing or swallowing
Difficulty moving the jaw or tongue
Swelling of the jaw that cause denture to fit poorly or become uncomfortable
Loosening of the teeth or pain around the teeth or jaw
Voice changes
A lump or mass in the neck
Weight loss
Persistent bad breath
OTHER CANCER IN DIFFERENT INTRAORAL LOCATION
CARCINOMA OF LIP
CARCINOMA OF THE FLOOR
CARCINOMA OF TONGUE
CARCINOMA OF SOFT PALATE
OF THE MOUTH
CARCINOMA OF BUCCAL MUCOSA
CARCINOMA OF GINGIVA
DIFFERENTIAL DIAGNOSIS OF SQUAMOUS CEL CARCINOMA
Keratoacanthoma
Lymphoma
Ewings tumor
Neuroblatoma
Granular cell myoblastoma
Pseudoepithiliomatous hyperplasia
RADIOLOGICAL FEATURES OF SQUAMOUS CELL
CARCINOMA
Variable degrees of bone destruction may occur when malignant cell of the
squamous cell carcinoma invade into the jaw bone
This type of bony involvement can be seen more frequently if the primary
tumor occurs in gingiva or alveolar ridge or floor of the mouth
Radiographically the involved bone often exhibit large, regular, irregular,
and ill-defined radiolucent are with a typical mouth-eaten appearance
Destruction of the interdental or inter-radicular bone occurs quiet frequently
and this causes displacement or efoliation of the regional teeth
In advanced cases, the bone destruction could be extensive and this may lead
to pathological fracture in the affective bone
HISTOPATHOLOGY
Dysplastic changes in the malignant tumor cell with varying grades of
defferentiation
Invasion of the tumor cell into the underlying connectve tissue
Inherent potential or tendency of the malignant cells to spread to the distant
sites or organ in the body
SCC are divided into three histologic types Well-differentiated SCC
Moderately-differentiated SCC
Poorly-differentiated SCC
WELL-
MODRATELY-
POORLY-
DIFFERENTIATION
DIFFERENTIATION
DIFFERENTIATION
SCC
SCC
SCC
WELL-
MODERATELY-
POORLY-
DIFFERENTIATION
DIFFERENTIATION
DIFFERENTIATION
WITH KERATIN
WITH FEW
WITH NO KERATIN
PEARLS FORMATION
KERATIN PEARLS
PEARLS
FORMATION
FORMATION
BREAK IN BASEMENT
BREAK IN
BREAK IN
MEMBRANE
BASEMENT
BASEMENT
MEMBRANE
MEMBRANE
Fair PROGNOSIS
VERY POOR
Good PROGNOSIS
PROGNOSIS
LAB INVESTIGATION
Incisional biopsy
Fine needle aspiration biopsy
Mucosal staining
o Toludine blue test
o Acridine binding method
Chemiluminescent light
Routine blood investigation
RADIOLOGICAL INVESTIGATION
MRI
CT face + neck + CT chest
Positrion emission tomography
endoscopy
orthopantomogram
TREATMENT
SURGERY
Removal of part or all the jaw
Removal of the tumor on a larger area to remove the tumor and surrounding
healthy tissue
Maxillectomy
Removal of lymph nodes and other tissue in the neck
Plastic surgery, including skin grafting, tissue flaps or dental implant to
restore tissue removed from the mouth and neck
Tracheostomy
Dental surgery to remove teeth or assist with reconstruction
RADIATION THERAPY
Used alone to treat small or late-stage tumors.
PROTON THERAPY
Delivers high radiation doses directly into the tumor, sparing nearby healthy
tissue and vital organs.
CHEMOTHERAPY
Used to shrink the cancer before surgery
TUMOR GROWTH FACTOR INHIBITOR
Target EGF receptors and may stop cancer cell from growing
COMPLICATION
MUCOSITIS, an inflammation of the mucous membrane in the mouth.
Infection, pain, and bleeding.
Dehydration & malnutrition due to dysplasia.
Xerostomia due to injury to the gland that produce saliva.
Trismus due to drainage to the muscles & joints of the jaw & the neck
Hypovascularization (reduction in BV &BS)
Affect other form of dental disease ( caries or soft tissue complication)
Cause bone death (osteonecrosis)
Rehabilitation of patient after surgery could be either surgical reconstruction,
prosthetic reconstruction or both
All pt. must be placed on life-long review of about 6 monthly intervals
during which risk factor should be continually assessed.
PREVENTION
Prevention involve intervention aimed at elimination, eradicating or
minimizing the impact of the disease
PIMARY: reduce the incidence of cancer and precancer. it is aimed reducing
the number of new cases.
Discourage smoking and alcohol consumption
Encourage good oral hygiene
Encourage balanced diet
Health education
SECONDARY: aimed at detection of cancer at an early stage
Early detection, especially at the precancerous stage, offers a better
prognosis with a better chance of cure
Public education on early signs and self examination
Screening
TERTIARY: treat late stage of disease and complication.
