Oral Cavity Neoplasma

7/30/2019 Oral Cavity Neoplasma

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NEOPLASMS OF THE

ORAL CAVITY

Divisi Onkologi


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ANATOMY

Lips to the junctional of hard and soft pallate

Mucosa buccal

Upper and lower alveolar bridges

Retromollar trigone 2/3 oral tongue

Floor mouth

Hard palate


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EPIDEMIOLOGI

Risk factor alcohol, tobacco

95% Ca sel skuamosa

Pria : Wanita = 1:2

95% > 40 tahun; umur rata-rata 60 tahun the human papillomavirus (HPV) may play a role in

the etiology of oral cavity


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Lesi mukosa putih ataupun merah membutuhkan biopsi

Lesi leukoplakia benigna dan tidak menghilang setelah

menghentikan tobako, pengobatan masih tidak jelas.

Surgical excision, laser excision, and similar techniques have all

been used with some degree of success. Nonsurgical

approaches, such as topical vitamin A therapy, also have been

tried, with complete response rates in the 10% to 27% range

and partial response rates in 54% to 90% of patients.

The side effects were minimal, but leukoplakia recurred in 50%

of patients after discontinuation of the medication


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RADIATION THERAPY

Radiation therapy and surgery have equal success in controlling T1

lesions of the oral cavity.

Treatment options must be determined by numerous factors, including

the location, the patient's physical condition and social and economic

situation, and the experience of those delivering the care.

Radiation therapy tends to provide a better functional result with superior

speech and swallowing, but significant disadvantages of radiation

therapy are diminution of taste, xerostomia, and the protracted nature ofthe treatment course.

Unlike surgery, a curative dosage of radiation therapy requires at least 6

weeks of treatment, and this can affect the treatment choice.

When considering oral cavity cancers, the highest rate of complicationsrelated to external beam radiation occurs in patients with floor-of-mouth

cancer; historically, in one fourth or more of these patients,

osteoradionecrosis of the mandible developed.

Newer techniques brachytherapy and intensity-modulated radiation

therapy (IMRT) more focused targeting and reduced complications


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CHEMOTHERAPY

Although the combination of radiation therapy and

surgery provides a better chance for cure for stage

III and IV disease than does either modality alone,

substantial evidence suggests that the addition of

concomitant chemotherapy to postoperative

radiation therapy improves locoregional control andsurvival in these patients


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BUCCAL CARCINOMA

uncommon cancer

Buccal carcinomas occur most commonly in 70-year-oldmen and are found in a region of cheek leukoplakia.

The exophytic lesions may have a relatively benign

appearance and may not penetrate into the soft tissues

of the cheek until they are relatively large. The ulcerative lesions, however, penetrate early and

make cure more difficult because of their involvement of

adjacent muscle, bone, and skin

Because no natural barriers to tumor penetration exist inthe cheek, cure rates are not as good as one might

expect in a region so easily inspected.


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As with most oral cavity neoplasms, T1 lesions can be treated either

with surgery or radiation therapy, although resection and coverage of

the area with a split-thickness skin graft may be more convenient and

expedient.

Because T1 lesions are rare, large series comparing treatmentmodalities cannot be found. Three-year survival rates for T1 and T2

lesions are approximately 80% and 60%, respectively, and

depending on the extent of the lesions, marginal or rim

mandibulectomy or partial maxillectomy or both may be necessary

for adequate margins Surgery plus radiation therapy is the treatment of choice for stage III

and IV disease. The extent of resection of these larger lesions is

variable, but may include resection of the maxilla or mandible,

parotidectomy, neck dissection, or a combination of these.

Reconstruction is with free (radial forearm) or regional myocutaneous(temporalis, pectoralis major) flaps or with an osteomyocutaneous

free flap if bone is needed.


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HARD PALATUM CARCINOMA

Primary malignancies of the hard palate are uncommon

with a relatively equal incidence of squamous cell

carcinoma and salivary gland malignancies.

Because nodal metastases are retropharyngeal, it is

unnecessary to be concerned with prophylactic necktherapy.

Only those patients with T4 lesions begin to approach

an incidence of nodal metastases (25%) for which

prophylactic neck irradiation would be considered.

Although distant metastases are rare with squamous

cell carcinoma of the hard palate, an incidence of 12%

has been found in patients with salivary gland tumors


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Radiation therapy has been reported to be as effective as

surgery in treating T1 and T2 lesions, for those of both

salivary gland and squamous etiology.

It is probably true, however, that T1 lesions are most

easily treated by excision.

For the larger T3 and T4 lesions (the 5-year survival rate

decreases from 85% for a T1 lesion to 30% for a T4

lesion), the treatment of choice is a combination of

surgery and radiation therapy

Partial or total maxillectomy is often required, and the

traditional reconstruction has been with a prosthetic

obturator, requiring preoperative evaluation by aprosthodontist


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ORAL TONGUE

In deciding on treatment modalities for oral tongue

cancer, the same factors are applicable as for most otherhead and neck sites.

T1-2 lesions can be treated by surgery or radiationtherapy, and T3-4 lesions do best with combinationtherapy.

Radiation treatment alone achieves control rates of 86%for T1 and 75% for T2 lesions.

Because of the high complication rate associated withcurative doses suggested a policy of initial surgery, with

postoperative radiation therapy being reserved forpatients with a suspected high rate of local or neckfailure.


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1. The incisive foramina house the

A. Greater palatine vessels and nerves

B. Sphenopalatine nerve

C. Palatine nerves and nasopalatine arteries

D. Anterior and posterior superior alveolar nerves

E. Lesser palatine nerve


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C


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2. A benign oral cavity lession sometimes mistaken

pathologically for squamous cell carcinoma is

a. Squamous papilloma

b. Granular cell myoblastomac. leukoplakia

d. fibrous histiocytoma

e. erythroplakia


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B


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3. Of oral cavity cancers treated primarily with

radiotherapy for cure, the site treated with the

highest complication rate is the

a. Floor of mouth

b. Tongue

c. buccal mucosa

d. Anterior tonsillar pillar

e. Retromolar trigone


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A


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4. Due to lack of natural barriers in the cheek, buccal

carcinomas, with the following thickness have a

batter prognosis

a. Less than 10 mm

b. Less than 6 mm

c. between 10 and 12 mm

d. Greater than 6 mm

e. Less than or equal to 15 mm


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B


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5. Primary malignancies of which oral cavity site are

equally distributed between salivary gland and

squamous cell carcinoma

a. Floor of mouth

b. Anterior tonsillar pillar

c. hard palate

d. Tongue

e. Buccal mucosa


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C


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6. Alveolus carcinomas are most commonly located

in the

a. Anterior maxillary segment

b. Posterior third of the mandible

c. anterior mandibular arch

d. Body of mandible

e. Posterior alveolus


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B


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C


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9. The most common surgical reconstructive

technique for the resurfacing of oral cavity defects

after oncologic resection is

a. Full-thickness skin graft

b. Split-thickness skin graft

c. radial forearm free flap

d. Tongue flap

e. Myocutaneous flap


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B


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D

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