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DIAGNOSIS AND MANAGEMENT OF ORAL CANCER

DIAGNOSIS AND MANAGEMENT OF ORAL CANCER. Arun Mathai Mani 2002 Batch. Epidemiology. Globally, 6 th most common malignancy Most common malignancy in Asia and India Incidence Men > Women. Etiology.

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DIAGNOSIS AND MANAGEMENT OF ORAL CANCER

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  1. DIAGNOSIS AND MANAGEMENT OF ORAL CANCER Arun Mathai Mani 2002 Batch

  2. Epidemiology • Globally, 6th most common malignancy • Most common malignancy in Asia and India • Incidence Men > Women

  3. Etiology • TOBACCO use (smoking or using smokeless tobacco or snuff) • Excessive consumption of ALCOHOL • PAN: betel vine leaf + areca nut + lime + catechy + tobacco

  4. Etiology • Reverse smoking - Ca Hard palate • Ultraviolet light exposure - Ca Lip • Premalignant lesions

  5. Etiology • Viral infections with oncogenic viruses - HPV, HSV, HIV, EBV • Pipe smoking • Plummer-Vinson syndrome

  6. Etiology • Chronic infection with syphilis • Immunocompromised status • Dietary factors - low intake of fruits and vegetables

  7. Histopathology • Squamous cell carcinomas - 95% well-differentiated moderately differentiated poorly differentiated undifferentiated

  8. Histopathology • Others :– • Lymphomas • Kaposi sarcoma • Melanoma

  9. DIAGNOSIS SYMPTOMS & SIGNS

  10. Cardinal Symptoms of Oral Cancer • Pain    Secondary to ulceration      Secondary to trauma due to functional interference • Slurring of speech - tongue involvement • Difficulty in mastication

  11. Cardinal Symptoms of Oral Cancer • Paraesthesias • Drooling

  12. Cardinal Signs of Oral Cancer • Nonhealing ulcer – elevated and indurated margins • Presence of a red or white patch • Bleeding - resulting from ulcerations

  13. Cardinal Signs of Oral Cancer • Rigidity • Induration • Cervical lymphadenopathy

  14. MANAGEMENT OF ORAL CANCER

  15. MANAGEMENT • INVESTIGATIONS • STAGING • TREATMENT

  16. INVESTIGATIONS

  17. Surgical Biopsy • Incisional Biopsy - recommended in all cases • Should include the most suspicious area of the lesion and some normal adjacent mucosa

  18. Fine Needle Aspiration Biopsy • Lumps in the neck • Especially suspicious lymph nodes in a patient with a known primary carcinoma

  19. Cervical lymph node aspirate showing typical malignant squamous cells

  20. Rotational Pantomography or Panorex • Rotating or panoramic x-ray of the upper and lower jaws • Assessing alveolar and antral involvement

  21. Panorex

  22. Radiography • Plain Radiography - limited value • Chest radiography - rule out synchronous lung lesions

  23. CT • Best at evaluating bony destruction • Evaluation of antral tumors • Assessment of pterygoid regions • Assess metastatic disease in cervical lymph nodes, lung, liver and skeleton

  24. MRI • Investigation of choice • Very good at imaging soft tissue infiltrations • Very useful in assessing cancers arising in tongue and floor of mouth

  25. Ultrasound • Assess cervical lymph node involvement • Abdominal USG – most appropriate technique for assessing liver metastasis

  26. Radionuclide studies • Technetium pertechnate bone scans of facial skeleton

  27. STAGING OF ORAL CANCER

  28. TNM Staging for Oral Cancer : T • TX Unable to assess primary tumor  • T0 No evidence of primary tumor 

  29. TNM Staging for Oral Cancer : T • Tis Carcinoma in situ

  30. TisCarcinoma in situ

  31. TNM Staging for Oral Cancer : T • T1 Tumor is ≤ 2 cm in greatest dimension   • T2 Tumor > 2 cm and < 4 cm in greatest dimension   • T3 Tumor ≥ 4 cm in greatest dimension  

  32. T1 Tumor is ≤ 2 cm in greatest dimension  

  33. T2 Tumor >2 cm and <4 cm in greatest dimension

  34. T3 Tumor ≥4 cm in greatest dimension

  35. TNM Staging for Oral Cancer : T • T4 (lip) Primary tumor invading cortical bone inferior alveolar nerve floor of mouth skin of face (e.g., nose or chin) 

  36. TNM Staging for Oral Cancer : T • T4a (oral) Tumor invades adjacent structures (e.g., cortical bone, into deep tongue musculature, maxillary sinus) skin of face

  37. T4a Tumor invades adjacent structures, skin of face

  38. TNM Staging for Oral Cancer : T • T4b (oral) Tumor invades masticator space pterygoid plates skull base encases the internal carotid artery

  39. TNM Staging for Oral Cancer : N • NX Unable to assess regional lymph nodes   • N0No evidence of regional metastasis 

  40. TNM Staging for Oral Cancer : N • N1Single ipsilateral lymph node, ≤3 cm in greatest dimension

  41. N1Single ipsilateral lymph node, ≤ 3 cm in greatest dimension

  42. TNM Staging for Oral Cancer : N • N2 • N2a Single ipsilateral lymph node >3 cm and ≤6 cm • N2b Multiple ipsilateral lymph nodes, all nodes ≤6 cm   • N2cBilateral or contralateral lymph nodes, all nodes ≤ 6 cm  

  43. N2a Single ipsilateral lymph node >3 cm and ≤ 6 cm

  44. N2b Multiple ipsilateral lymph nodes, all nodes ≤ 6 cm

  45. N2cBilateral or contralateral lymph nodes, all nodes ≤ 6 cm

  46. TNM Staging for Oral Cancer : N • N3Any lymph node(s) > 6 cm in greatest dimension

  47. N3Any lymph node(s) > 6 cm in greatest dimension

  48. TNM Staging for Oral Cancer : M • MX Unable to assess for distant metastases • M0No distant metastases  • M1 Distant metastases present

  49. M1 Distant metastases present

  50. Stage 0 • Indicates • Carcinoma in situ (Tis) • No spread to lymph nodes (N0) • No distant metastasis (M0)

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