Oral Cancer (2)

8/2/2019 Oral Cancer (2)

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INTRODUCTION TO ORAL

CANCER

• WHAT IS ORAL CANCER????

• known medically as a malignant neoplasm,is a large group of different diseases , allinvolving unregulated cell growth &uncoordinated with that of the normaltissue.



.Such unregulated growth of cells(MALIGNANCY) which takes place in oraltissues is known as oral cancer

• Usually squamous cell (epithethial)

• Abnormal neoplasm of the mouth

• Found in most cases by a dentist orthe person themselves.



• HOW CANCER CELLS ACT

DIFFERENTLY FROM THEIR NORMALCOUNTERPART?

• CLONALITY• AUTONOMY• ANAPLASIA

• METASTASIS



Statistics

• 56,000 people a year diagnosed• 10,000 deaths• Higher than:

• Cervical cancer• Hodgkin’s disease • Brain cancer• Liver cancer• Testicular cancer• Kidney cancer• And malignant skin cancer



Who is at risk?

• People over the age of 40• Men vs. Women

• Ethnicity• Socioeconomic Status (SES)

• Being a heavy smoker and drinker

• People with HPV-16 and HPV-18 are atslightly higher risk



Signs and symptoms

• Sores or lesions that won’t heal • Lump or thickening in the cheek

• White or red patches on the gums, tonsils,or mouth• Chronic sore throat• Difficulty swallowing• Difficulty moving mouth or tongue• Numbness in any area of the mouth• Swelling of the jaw



Oral cancer images





Treatments most commonly

used• Radiation

• Destruction of cells making it impossible for

them to grow• Chemotherapy

• Use of chemicals to destroy cancer cells

• Surgery• Oldest form for treating cancer



EPIDEMIOLOGY

PREVALANCE & INCIDENCE• Developed countries – 3- 5 % of all cancers• Developing countries – upt 40% of all

cancers• 2.5 lakh new cases in INDIA



• Seen in older age group people (5 th – 6th decade of life.

• IN INDIA MAJOR ETIOLOGICFACTOR IS BETEL TOBACCO

CHEWING --- Cancer of BUCCALMUCOSA is found to be more

• BUCCAL MUCOSA – 65%

• LOWER ALVEOLUS- 30%• GINGIVOBUCCAL COMPLEX- 5%





Etiological factors

Genetic predispositionAtmospheric pollution

ImmunosuppressionVirusesFungal infection

DietDental sepsis

TobaccoAlcohol



Tobacco

Carcinogens of tobaccoBenzopyrenetobacco specific nitrosamines

Act locally on keratinocyte stem cellsAffecting DNA replicationCausing mutation





Tobacco forms• Smoked tobacco• Bidi,Chillum,Chutta

• Cigarettes• Dhumti• Hookah• Gudakhu• hookli



• Smokeless tobacco• Khaini• Mainpuri tobacco

• Mawa• Mishri• Paan

• Snuff• Zarda



Alcohol

Pure ethanol is not carcinogenicNitrosamines and other impuritiesRising incidence of oral cancerlinked to rising alcohol consumption



AlcoholEthanol increases mucous membranepermeabilityEthanol metabolised to acetaldehyde locally bybacterial alcohol dehydrogenases and candamage cells – poor oral hygieneAlcoholic liver disease reduces detoxification

of carcinogensHigh calorie value suppresses nutrition andleads to nutritional deficiencies



Risk factors

Genetic predisposition ?- impaired capacity to metabolise

carcinogens- DNA damage repair impaired

Atmospheric pollution

- polycyclic aromatichydrocarbons/nitrosamines/benzenes



Risk factorsImmunosuppression- organ transplant patients – lip cancer- no increased risk with AIDS of oral SCCViruses-HPV 16 and 18

viral oncogenedeactivates p53inhibit apoptosis



Risk factors

Other viruses

Herpes simplexEpstein-Barr virusHepatitis virus

no clear evidence of involvement in oralcancer



Cancer causes followingpsycological problems

• Family problems – low financial status due

to increase expenditure on treatment• No treatment• Loss of interest of patient towards life

• Depression



•Dysphagia resulting from head and neck cancer haspsychosocial implications.

•The inability to participate in mealtimes anddining out as they are accustomed to can beisolating.

•Increased mealtimes, limited food choices, special foodpreparation methods, and untidy consumption contributeto avoidance of social food consumption

PYSCOLOGICAL EFFECTS



•Use of tube feeding, diet modifications, adaptiveequipment, or rehabilitative strategies for safe andadequate intake can call attention to themselves and thusbecome a source of anxiety.

PYSCOLOGICAL EFFECTS

•Family relationships can be altered when

substantial lifestyle modifications are encountered.



Socioeconomic effects of oral cancer

•Financial burden was observed in 36% of cases and 43% of controls

•This burden was mainly due todiscontinuation or loss of job andexpenditure on treatment, medicine,transport and accommodation away fromhome.

•Disruption of routine activities was mainly because of the need of some one looking after the patient'sactivities



Early Detection Saves Lives

• 5-year survival for localized disease is 76%

• 5-year survival for metastatic disease is19%



Early detectionIf cancer can be detected early, treatment may be curative.

One means to that end is educating people regarding earlysigns of the disease: lumps, sores that do not heal promptly,abnormal bleeding, and persistent indigestion or hoarseness.

Medical attention should be sought when these occur. Early

diagnosis of cancers that are curable if detected early (cervix,breast, mouth) can be promoted in India using publiceducation and training of primary health care workers.



A second approach to early cancer detection isthroughpopulation screening; namely, the identification of peoplewith asymptomatic disease by applying simpletests. Cancerscreening should be applied only when its

effectiveness hasbeen demonstrated; programmes should beintroduced onlywhen there is adequate manpower to perform the

tests

Early Detection is Often Possible



Warning Signs

• Leukoplakia

• Erythroplakia



Other Possible Warning Signs

• Lump or thickening of oral soft tissue

• Soreness or “lump” in throat

• Difficulty chewing or swallowing

• Ear pain

• Difficulty moving jaw or tongue

• Hoarseness

• Numbness of tongue or mouth

• Swelling of the jaw





Prevention

At least 30% of the future cancer burden is potentially preventable by tobacco control. Spread of tobaccoaddiction,

promoted by commercial interests in the world, isresponsible

for the lung cancer epidemic that is already takinghundredsof thousands of lives annually; unless checked,cigaretteswill in the next decade cause more than 1 crore deaths

from cancer.



Action is also possible on dietary modification. Evidencethat excessive fat in the diet may induce some cancersand that whole grains, vegetables and fruits are protective

hasaccumulated in recent years. The same diet that lowerstherisk of cardiovascular disease may inhibit the

development of diet-associated cancers.

Prevention

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Oral Cancer (2)