Oral cancer

1. Associated with cell dysregulation More common to see below 50 Certain chromosomal alterations

2. Awareness level Access to health care system Late diagnosis

3. even after treatment Quality of life Pain Death

4. Hallmarks of Carcinoma

5. Autonomy in growth signaling Normal cells require external stimuli for growth. Cancer cells usurp this growth and proliferative pathways. Resulting in aberrant tumour cell multiplication

6. Insensitivity to inhibitory growth signals Balance between growth and maintenance is achieved by various stimuli. Tumerogenic conditions this balance is lost

7. Evasion of apoptosis Apoptosis is important for organogenesis, embryogenesis, cellular homeostasis Antiapoptotic and proapoptotic balance is lost in malignancy

8. Limitless replication Transformed cells acquire the ability to undergo unlimited cycles of mitosis immortalization

9. Angiogenesis Tumor cells acquire the ability to sustain continued new vessel growth

10. Invasion and metastasis Ability to invade, spread to regional lymphatics, metastasis to distant organs Loss of intercellular adhesion Degradation of basement membrane Epithelial-mesechymal transition

11. Oral Cancer

12. Introduction 400,000 new cases every year 5th most common cancer in men 7th most common cancer in female 10th common cause for death Carcinomas 96% Sarcomas 4% Most common squamous cell carcinoma

13. Etiology Multifactorial Predisposing factors: Tobacco-chewing or smoking Chewing Betel quid Alcohol Chronic irritation

14. Other contributing factors Natural carcinogenic agents Industrial pollutants Actinic radiation Malnutrition Familial/genetic

15. Contd Immune suppression Plummer Vinson syndrome Syphylitic glossitis Avitaminosis Viral infections Candida albicans

16. Symptoms of oral cancer Lump or a swelling Pain/burning sensation Bleeding Loose teeth Restriction of tongue movement /mouth opening Ill-fitting dentures

17. Contd Anesthesia/Parasthesia Paralysis Diplopia Dysphagia Voice change Halitosis

18. Clinical appearance Exophytic (mass forming) Endophytic,Indurated (ulcerating,Non-ulcerating) White patch Red patch

19. Investigation Toludine blue staining: uptake in dysplasia & malignant tissues DNA synthesis in malignant cells Greater diffusion through haphazardly arranged tumor cells

20. Before staining

21. After staining

22. Biopsy Incisional biopsy Excisional biopsy Needle biopsy (FNAC) Exfoliative cytology

23. Imaging Routine radiographs CT MRI Nuclear scintigraphy Ultrasound

24. TNM staging T4 Tumor invades adjacent structures

25. Stage TNM Classification Survival Rate Stage I T1 N0 M0 85% Stage II T2 N0 M0 66% Stage III T3 N0 M0 T1,T2,T3,N1, M0 41% Stage IV Any T4 lesion, or Any N2 or N3 or Any M1 9%

26. Treatment Surgery Radiotherapy Chemotherapy Combination of these

27. Surgical modality Blade Laser Electrosurgery Cryosurgery

28. Surgery Indication If tumor not radiosensitive Recurrence in already irradiated area Situation in which side effect of radiation are more severe than surgical defects Neoplasms involving bone, lymph node, salivary gland In palliative cases reduce the bulk

29. Contd Surgical management of clinically positive cervical nodes is the treatment of choice. Surgery is needed when bone is involved, and radiotherapy alone cannot be considered adequate to produce a cure.

30. Radiation therapy Radiation may be administered to a localized lesion by using implant techniques (brachytherapy) or to a region of the head and neck by using external-beam radiation (Teletherapy)

31. Radiation therapy Choice of treatment should be done according to Relative cure that can be obtained with radiation as compared with surgery or any other modality Relative morbidity associated with radiation therapy Cosmetic & functional result of radiation versus surgery or a combination

32. Radiation kills cells by interaction with water molecules in the cells, producing charged molecules that interact with biochemical processes in the cells. DNA is disrupted, and chromosomal damage occurs. The affected cells may die or remain incapable of division. Contd

33. 60 -65 Gy in 30 fractions , 1.8 to 2 Gy / fraction spread over 5 weeks. The biologic effect of radiation depends on the dose per fraction, the number of fractions per day, the total treatment time, and the total dose of radiation. Contd

34. Cell survival is influenced by the repair of sublethal damage, oxygenation of the cells, total dose, fraction size, and the type of radiation used. Contd

35. Radiation therapy has the advantage of treating the disease in situ and avoiding the need for the removal of tissue, and it may be the treatment of choice for many T1 and T2 tumors. Contd

36. BRACHYTHERAPY Interstitial and intracavitary implants are used to treat primary cancers in the head and neck. Primary treatment modality for localized tumors in the anterior two thirds of the oral cavity

37. For treatment of superficial tumors, radiation with a low penetration may be used. Deep-seated tumors may be treated with heavy particle irradiation, such as neutron beam radiation. Treatment Contd

38. Treatment planning for radiation The radiation treatment plan is determined by tumor site, tumor size, the total volume to be radiated, the number of treatment fractions, the total number of days of treatment, teeth in the line of radiation, and the tolerance of the patient.

39. Chemotherapy Chemotherapy has been considered for treatment of individuals with advanced tumors or recurrent disease in whom surgery or radiation is unlikely to achieve result

40. The toxic effects of chemotherapy : mucositis, nausea, vomiting, and bone marrow suppression. Methotrexate Bleomycin Cisplatin and Platinum derivatives 5-fluorouracil Combinations of these

Oral cancer

Health & Medicine

cancer cells

common cancer

angiogenesis tumor cells

normal cells

t1 n0 m0

t2 n0 m0

common cause

t3 n0 m0 t1