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    MUCLecture 2024 12858278

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    ikpi90833
    Oral cancer is a malignant tumor that develops in the oral cavity. Some key points: - It is among the 10 most common cancers worldwide, with around 300,000 new cases annually. - Risk factors include tobacco smoking, smokeless tobacco, alcohol consumption, and HPV infection. - It most commonly occurs on the tongue, floor of mouth, lower gingiva and buccal mucosa. - Treatment involves surgery to remove the tumor, neck dissection of lymph nodes, and radiotherapy or chemotherapy. The treatment approach depends on the size, location and spread of the cancer.

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    MUCLecture 2024 12858278

    Uploaded by

    ikpi90833
    9 views36 pages
    Oral cancer is a malignant tumor that develops in the oral cavity. Some key points: - It is among the 10 most common cancers worldwide, with around 300,000 new cases annually. - Risk factors include tobacco smoking, smokeless tobacco, alcohol consumption, and HPV infection. - It most commonly occurs on the tongue, floor of mouth, lower gingiva and buccal mucosa. - Treatment involves surgery to remove the tumor, neck dissection of lymph nodes, and radiotherapy or chemotherapy. The treatment approach depends on the size, location and spread of the cancer.

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    MUCLecture_2024_12858278

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    Oral cancer is a malignant tumor that develops in the oral cavity. Some key points: - It is among the 10 most common cancers worldwide, with around 300,000 new cases annually. - Risk factors include tobacco smoking, smokeless tobacco, alcohol consumption, and HPV infection. - It most commonly occurs on the tongue, floor of mouth, lower gingiva and buccal mucosa. - Treatment involves surgery to remove the tumor, neck dissection of lymph nodes, and radiotherapy or chemotherapy. The treatment approach depends on the size, location and spread of the cancer.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    9 views36 pages

    MUCLecture 2024 12858278

    Uploaded by

    ikpi90833
    Oral cancer is a malignant tumor that develops in the oral cavity. Some key points: - It is among the 10 most common cancers worldwide, with around 300,000 new cases annually. - Risk factors include tobacco smoking, smokeless tobacco, alcohol consumption, and HPV infection. - It most commonly occurs on the tongue, floor of mouth, lower gingiva and buccal mucosa. - Treatment involves surgery to remove the tumor, neck dissection of lymph nodes, and radiotherapy or chemotherapy. The treatment approach depends on the size, location and spread of the cancer.

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    of 36

    Oral Cancer

    Dr.Mohammed Alaraji
    Definition:it is abnormal mass or tissue ,its growth with
    extension & its uncoordinated with that of normal tissue. The
    growth is excessive ,progressive
    ▪INCIDENCE

    OSCC is among the 10 most common cancers worldwide:


    around 300 000 new cases worldwide annually, amounting to
    around 3% of total cancers.
    Genetic bases of cancer

    ▪The regulation of cell cycle is under control of over


    40 genes in which proto-oncogen & tumor
    suppressor genes, normally the coordinated
    expression of these gene leads to equilibrium
    between growth promoting gene & growth
    restraining gene , the imbalance between these
    gene which is caused by proto-oncogen activation
    & TSG inactivation will lead to tumor initiation.
    Etiology
    ▪Tobacco smoking & Smokeless tobacco use
    ▪. Betel quid
    ▪Alcohol
    ▪Chronic irritation
    ▪Phenolic agents
    ▪Radiation
    ▪Iron deficiency
    ▪Vitamin A deficiency
    ▪. Syphilis (tertiary stage):
    ▪. Candidal infection
    ▪Oncogenic viruses
    Site distribution
    ▪1-Tongue - 35% (31% lateral border, 2% tip and 2%
    dorsum).
    ▪2- Floor of mouth 30% (25% anterior and 5%
    posterior).
    ▪3- Lower alveolus → 15%.
    ▪4- Buccal mucosa 10%.
    ▪5- Upper alveolus +5%.
    ▪6-Hard palate + 3%.
    ▪7- Retromolar region 2%.
    Clinical presentation
    ▪1-Exophytic
    mass forming lesion which typically has a surface
    that is irregular, fungating, papillary, or verruciform,
    and its color may vary from normal to red to white,
    ▪2-Endophytic
    depressed, irregularly shaped, ulcerated, central
    area with a surrounding rolled border of normal, red
    or white mucosa
    ▪Leukoplakic, Erythroplakic
    Symptoms
    ▪Lesions in the floor of mouth or tongue may be painful
    indurated, Rolled ulcer margins.
    ▪complain of difficulty in swallowing or speaking

    ▪pain while chewing, intermittent bleeding, loose teeth


    or ill-fitting dentures in gingival or alveolar ridge
    lesions.
    ▪altered sensation or anesthesia of the lower lip may
    signify locally advanced disease
    ▪Palpable lymph node in neck

    ▪Non-healing tooth socket


    Clinical examination
    ▪During examination the following points should b considered:
    ▪# Tumor's location,
    ▪# Fixation to the mandible.
    ▪# Proximity to the midline
    ▪#Trismus or decreased tongue mobility.
    ▪#Cranial nerve deficits.
    ▪#The status of the dentition.
    ▪# Biopsy of the primary tumor is required for histologic
    diagnosis and treatment planning.
    ▪# Lymph nodes in the neck
    Clinical staging
    ▪TNM system
    ▪T= Tumor size.
    ▪N=Nodal status in the cervical region.
    ▪M=Metastatic disease beyond the cervical lymph nodes.
    ▪Definition of Primary Tumor (T)
    ▪T1 Tumor size between 1-2 cm
    ▪T2 Tumor size between 2 & less than 4 cm
    ▪T3 Tumor>4 cm
    ▪T4 advanced local disease
    ▪Definition of Regional Lymph Node (N)
    ▪NO No regional lymph node metastasis
    ▪N1 Metastasis in a single ipsilateral lymph node,
    ▪N2a Metastasis in a multiple ipsilateral nodes
    ▪N2b , Metastasis in bilateral or contralateral lymph nodes
    ▪N3 when the tumor involved the LN & its fixed to underlying
    structure
    ▪Definition of distant metastasis (M)

    ▪MO no Distant metastasis


    ▪M1 distant metastasis
    ▪Classification according to the stages:

    ▪Stage I T1 NO M0
    ▪Stage II T2 N0 M0
    ▪Stage III T3 N1 M0

    ▪Stage IV any T any N M1


    Grading
    ▪Histopathologic grading of SCC is based upon the
    degree of differentiation and resemblance to normal
    squamous epithelium and the amount of keratin
    production
    ▪Grade 1 (well differentiated) is a low-grade tumor

    ▪Grade 2 (moderately differentiated)

    ▪Grade 3 (poorly differentiated) high grade tumor


    Imaging assessment

    Pretreatment imaging is important to evaluate:


    ▪#The tumor size and extent.

    ▪#Involvement of adjacent anatomic structures.

    ▪# Staging the cervical lymph nodes.

    ▪#Tumor invasion for the bone especially the


    mandible.
    The modalities used include:

    ▪Conventional Radiographs

    ▪Computed Tomography

    ▪Magnetic Resonance Imaging

    ▪Ultrasound

    ▪Positron Emission Tomography (PET)


    Treatment
    ▪The main modalities of treatment are surgery,
    radiotherapy& CHEMOTHERAPY
    other( like ,Immnotherpy)
    Mid face degloving
    mandiblotomy Lip spliting
    Management of the Neck

    ▪The status of the cervical lymph nodes is the most


    important prognostic factor in SCC of the head and
    neck. The overall survival rate decreases by
    approximately 50% in patients with metastases to
    the cervical lymph nodes.
    Anatomy and biology of lymphatic metastasis
    ▪Level I, submental and submandibular group; Level II, upper
    jugular group; Level III, middle jugular group; Level IV, lower
    jugular group; Level V, posterior triangle group Level VI,
    anterior compartment.
    Classification of Neck Dissection
    ▪ Radical Neck Dissection (RND
    en bloc removal of all ipsilateral lymph nodes from levels I through V,
    along with the Ipsilateral spinal accessory nerve (SAN), internal jugular
    vein (IJV), and sternocleidomastoid muscle (SCM).
    ▪ Modified Radical Neck Dissection (MRND) When one or more
    nonlymphatic structures are preserved during the dissection.
    ▪ Selective Neck Dissection (SND
    one or more lymph node groups are preserved during cervical
    lymphadenectomy that are routinely removed with RND.
    ▪ Extended Neck Dissection
    one or more lymph node groups or non-lymphatic structures, or both,
    that are not usually involved in RND are removed.
    Neck access
    Apron flap incision
    Radiotherapy
    ▪It uses ionizing radiation; it is locoregional treatment and
    should be considered as complementary to surgery rather
    than competitive.
    ▪Types of radiotherapy
    ▪1. External beam radiotherapy (Teletherapy).
    a beam of radiation is directed toward the tumor bearing part of
    the patient who is a distance away. It uses photons (like X-rays
    or Gamma rays)
    ▪2. Brachytherapy.
    radioactive sources are brought close to the tumor mass (or
    even implanted within it) to deliver a highly localized radiation
    dose, it uses radioactive isotopes e.g., Radium, Iridium or
    Radon
    ▪3. Unsealed radionuclide radiotherapy.
    Chemotherapy
    ▪chemotherapy is used in combination with radiotherapy
    and/or surgery in radical treatment or alone in palliative
    treatment.

    ▪Classes of chemotherapeutic agents


    ▪1-Antimetabolites; this group predominantly interferes with
    synthesis and metabolism of DNA like methotrexate, 5-
    fluorouracil (5-FU)

    ▪DNA damaging agents


    A-Alkylating agents like cyclophosphamide
    B-Antibiotics like bleomycin

    ▪Mitosis inhibitors like vincristine


    ▪Cancer cell enzyme inactivator,
    Scheduling of Chemotherapy
    ▪•Before radiotherapy (Neoadjuvant or Induction).

    ▪• During radiotherapy (Synchronous or


    Concomitant).
    ▪• After radiotherapy (Adjuvant or Subsequent

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