04 Oral Cancer

U P D A T I N G N G O F T H E B A S I C O R A L C A R E N O T E B O O K 2 0 1 2F O U S P - M I N I S T R Y O F H E A L T H , B R A Z I L

UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health 1

Oral Cancer

1. Conceptual and Epidemiological Aspects

! Oral cancer includes lip and oral cavity cancer (oral mucosa, gingiva, hard palate, tongue and floor of the mouth) and is among the main causes of obits due to neoplasia ((neo= new + plasia = tissue) is used to call cellular alterations that promote an exaggerated growth of these cells, that is, abnormal cell proliferation with no control and autonomous, when they lose or reduce their differentiation ability due to alterations in the genes that regulate growth and cell differentiation. Neoplasia can be

malignant or benign. Wikipedia, May 2012).

. It represents an important cause of morbidity/mortality as more than 50% of the cases are diagnosed in advanced stage of the disease (mortality caused by disease).

It is more intense in males and 70% of the cases are diagnosed in individuals over 50 years. It is preferably located in the floor of the mouth and tongue. The most frequent histological type (90 to 95%) is squamous cell carcinoma (epidermoid carcinoma).

! According to the Estimate of Cancer Incidence in Brazil - 2008, done by Instituto

Nacional do Câncer (INCA) – National Institute of Cancer, this tumor will present 10.380 estimated cases among men (5th. more common) and 3.780 among women (7th. more common). This represents about 6% and 2%, respectively, as to all types of cancer except non melanoma skin cancer.

Oral cancer includes lip and oral cavity cancer (oral mucosa, gingiva, hard palate, tongue and floor of the mouth) and is among the main causes of obits due to neoplasia.

1. Conceptual and Epidemiological Aspects

Page 1

2. Main Risk Factors

Page 2

3. Collective Approach

Page 2

4. Individual Approacha. Diagnosisb. Treatment

Page 2

5. Rehabilitation and Clinical Cases

Page 3

6. Credits

Page 4

Chapter Updating and Illustrating

Epidermoid Carcinoma in the lip - FOUSP


Oral cancer is a disease that can be prevented in a

simple way. Emphasis should be given to health promotion, increased access to health services and early diagnosis.

2. Main Risk Factors Factors that may not allow the access to the necessary medical care, because of lack of knowledge or superstition, or even geographic circumstances:

• Cultural, social and economic factors

• Smoking (use of pipes)

• Alcoholism

• Chronic use of alcohol associated to tobacco increasing drastically the risk for mouth cancer (According to Houaiss dictionary, drug addiction character ized by the psychological dependence on tobacco consumption).

• Exposure to solar radiation (Exposure to solar radiation without photo protection is a triggering factor of cellular process that leads to neoplasia mainly in tropical countries as Brazil)

• Poor oral hygiene

• Immunodeficiency (acquired or congenital - Immunodeficiency does not allow the organism reaction to cell division alterations, as in the case of neoplasia. The individual’s general health must also be

observed by the dentist in order to detect possible anemia and nutritional failures that may alter the immunologic reaction).

• Any wound caused by a tooth or prosthesis must be evaluated by the dentist (Poorly fitted prostheses that perpetuate frequent wounds (low intensity and high frequency) may generate cell alterations that generate neoplasia).

3.Collective Approach D e v e l o p m e n t o f interventions focused in health promotion including individual and collective educational actions (campaign material), prevention and early detection of mucosa lesions and oral cancer in all age groups. These interventions should be directed to the control of risk conditions and factors, stimulating the systematic examination of the oral cavity by health professionals in order to provide early detection.! Periodical examinations in users who are more vulnerable to develop oral cancer with more than one of the following risk factors: male, more than 40 years, smoker and alcoholic, under occupational exposure to solar radiation without p r o t e c t i o n , p r e s e n t i n g immunodeficiency (congenital and/or acquired).! Be part of the Oral Health Team in the programs of smoking control, alcohol and other protection

and prevention actions against cancer.! Systematically inform the population about reference places that provide examination and early diagnosis of oral cancer.

4. Individual Approach

Early Diagnosis

! The early diagnosis of mucosa lesions and oral cancer should be an action systematically developed by the oral health teams in basic care.

! Early diagnosis is fundamental to assure preventive measures and a favorable prognosis in approaching the disease.

! One of the most important steps to diagnose oral cancer is a good case history followed by a correct and complex oral cavity examination in the first appointment and in the emergency appointments.

! The dentist should perform clinical extraoral examination (face, submandibular and submental regions and temporomandibular joint) and intraoral (lips, cheeks, tongue and palate), including visualization and palpation in order to detect anomalies. Some types of lesions should be considered oral cancer or potentially malignant: leukoplakia, actinic cheilosis and erosive or ulcerated lichen planus.

! Any soft tissue lesion in the mouth that does not recede


C L U B E D A S E Q U Ó I A


spontaneously or by the removal of possible causal factors (such as fractured

teeth, cutting edges in prosthesis, etc) in 3 weeks maximum should be referred to diagnosis.

Treatment

! The impact of oral cancer to the individuals, their families, work and their community in general is dramatic. Treatment is not reduced to surgery or radiotherapy but depends on a complex multidisciplinary work. Surgical treatment and radiotherapy should be done at the level of medium and high complexity, always followed by the Oral Health Team of primary care. Control of relapses, as well the control of risk factors for cancer and other diseases are part of the comprehensive care to be offered by the oral health service in the follow-up.

Rehabilitation

! It corresponds to all surgical and prosthetic procedures meant to replace esthetic and functional losses caused by the disease.

Clinical Cases

Epidermoid Carcinoma in the floor of the mouth






Epidermoid Carcinoma in the lip

Epidermoid Carcinoma in the lip

Epidermoid Carcinoma in the tongue



Credits

Updating of Primary Health Care in Oral Health Notebook - Ministry of Health, Brazil and images – 2012:

Celso Augusto Lemos Júnior - FOUSP

Mônica Andrade Lotufo - FOUSP

Andréa Lusvarghi Witzel - FOUSP

Norberto Nobuo Sugaya - FOUSP

Fernando Ricardo Xavier da Silveira – FOUSP

Moacyr Ely Menendez Castillero - Educodonto

Glossary:

Mary Caroline Skelton Macedo - FOUSP

C A D E R N O D E A T E N Ç Ã O B Á S I C A N ˚ 1 7S A Ú D E B U C A L - A T U A L I Z A D O E I L U S T R A D O - F O U S P , 2 0 1 2


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04 Oral Cancer