DENTAL HEALTH CAT 1

NAME:MAHDABA MOHAMUD IBRAHIM

REG:BSCM/2017/74727

UNIT NAME:DENTAL HEALTH

UNIT CODE:BDS4207

LECTURER:DR.KAFAYA KIBE

TASK:CAT 1

SUBMISSION DATE:11TH JAN 2021

Question:Discuss various malignancies of the oral region

Answers

Oral malignancies are cancers that arise from the mucosal lips ,tongues,floor of the mouth ,bucal
mucosa ,gingiva, hard palate and retromolar tritone.

Oral cancers incidence is greater above at 50 years of age ,affects male more than female and is more in
Hispanic race

TYPES OF ORAL CANCERS

1. Squamous cell carcinoma

This type of cancer originates in the squamous cell layer in the lining of the oral cavity due to
genetic mutation that either activates proto oncogenes or inactivate tumour supresor gene.
In the early stages ,its present only in the lining layer of cells and its termed as carcinoma in situ
but when the cancer spreads beyond the lining, its called inavsive carcinoma.
It makes 90% of all oral cancers .
Occurs in lip vermilion in smokers.
Common sites are:ventral surface of the tongue,floor of the mouth, lower lip,soft palate and
gingiva.

Morphology

 Appears raised ,firm plaques superimposed on a background of leukoplakia.

2 .vericous carcinoma /snuff_dippers cancer.

This is a low grade cancer with wart like appearance. It rarely metastisizes and eventually developed into
squamous cell carcinoma.
Comprises of 5% of all oral cancers.

It can spread deeply into the surrounding tissues requiring surgical removal with a wide margin of
surrounding tissues.

Proliferative vericose usually affects women.

MORPHOLOGY

 irregular shape cells under the microscope

 Cells have darkly staining neuclei with enlarged nucleoli
 Keratin pearls is seen

3.polymorphous adenocarcinoma

Sometimes a cancer can originate from salivary glands into other parts of oral cavity.

Causes 5%of all oral cancers.

COMMON MALIGNANCIES OF THE ORAL REGION

Oral mucosa cancer

This includes cancers of the mouth ,lips and palate.

a.LIP CANCER

Common in above age 50_70 years especially in lower class males.

Clinical PRESENTATION

 Sores,blisters,ulcers or a lamp on the lip that doesn't go away

 Red or white patch on the lip
 Pain on the lips
 Bleeding in the lips
 A swelling of the jaw
 Thickening, I induration, crusting and crusting

Cancers on the lips affects mainly the lower lip especially at the Vermillion border due to exposure to
sun rays.

It presents as persistent crusting ulcer that grows slowly and doesn't heal .

Squamous cell carcinoma is the most comon cancer that affects the lips.

Mainly affects middle age men.

b.CARCINOMA OF THE TONGUE AND FLOOR OF THE MOUTH

Mainly affects anterior 2/3 of the tongue.

Affects males more than females .

Presents late as 2cm or more ulcer .

When advanced its presents as larger,hard ,inconsistent ulcer with irregular raised edge.

When the tongue is infiltrated ,it becomes stiff and painful making swallowing and talking difficult.

CLINICAL PRESENTATION

 Painless swelling on the tongue

 Painful infected ulcer which leads to refferd pain In the ears
 Excessive salivation, hemorrhage from the ulcer and marked factor oris
 Loss of mobility of the tongue due to fixation to the floor of the mouth that leads the tongue to
deviate towards the side of the lesion when protruded..
 Induration and ulceration of the tongue leads to the cancer spreading to the floor of the mouth
and regional lymph nodes .

C.CARCINOMAOF THE ALVEOLAR RIDGE CHEEKS AND PALATE.

Carcinoma in these areas are associated with tobacco or betel quid chewing .

Carcinoma of the alveolar ridge and palate erode the bones at an early stage

Palate cancer spreads extensively before involving bone papillary or ulcerate to involve bilateral lymph
nodes .

Proliferative fungating lesions of the palate spreads to the base of the tongue .

d.SALIVARY GLANDS MALIGNANCIES

These include mucoepidermoid carcinoma ,cinic cell carcinoma, epithelial _myoepithelium carcinoma.

CLINICAL PRESENTATION

 affects mainly adults

 Involves the junction of the hard and soft palate
 Ulceration of lips
 Invades bone and may cause nerve palsies
GENERAL RISK FACTORS OF ORAL CANCERS
 Tobacco smoking
  Alcohol abuse
 Ultraviolet radiation
 Exposure to metal dusts and chemicals e.g phenoxyacetic acid
 Vit.B and mineral deficiencies e.g plummer_vinsion syndrome
 Immune deficiencies
 Constant mechanical irritation .

GENERAL CLINICAL PRESENTATION OF ORAL CANCERS.

 Numbness in the mouth

 Horse voice
 Difficulties in swallowing and chewing
 Painless /painful lumps and sores and discolouration
 Signs of precancerous lesions development e.g leukoplakia and erythroplakia
 Abnormal tissue growth or mass.

Pathogenesis of oral cancers

Oral cancers arise through 2 distant pathogenic pathways .

One group of tumours in the oral cavity occurs mainly in chronic alcohol and tobacco smokers .

Deep sequencing of these cancers has revealed frequent mutations that bear a molecular signature
consistent with exposure to carcinogens in tobacco and alcohol .these mutations frequently involve
Tp53 and genes that regulate the differentiation of squamous cells such as P63 and NOTCH1

The second group of tumours in the oral region tend to occur in the tonsilar crypts or the base of the
tongue and harbour oncogenic variants of HPV _16 ,these tumours carry far fewer mutations than those
associated with tobacco and overexpresses P16

DIAGNOSIS
Oral camcers diagnosis can be made through the following 3 ways;
 Clinical diagnosis

Symptoms vary according to size of the lesion and are lesions are usually painless in the early stages .

Lesions are painful and tender when there is secondary infection or it involves a sensory nerve

Painless , crusting lump or ulcer on the lips .

There is difficulty in swallowing and degluttation.

There is excessive salivation .

There is hemorrhage especially when the cacer is advanced.

The tongue if involved is fixated on 1 side and deviated towards the side of the lesion.

 Tissue biopsy

Tissue is taken from the lesion site for histological confirmation of the suspected cancer e.g lymph node
biopsy .

 Imaging

Several imaging techniques are used e.g X-ray ,Commuted tomography or combination imaging like
PET/CT used fro staging of the cancer .

STAGING OF ORAL CANCERS

T - primary tumour size

N - number and location of involved kymph nodes

M - metastasis

Differential diagnosis

 Traumatic ulcers of the mouth

 Tuberculosis
 Jaw cysts
 Benign tumours of the ora cavity
 Oral candidiasis

Management

Active surveillance and routine screening for any persistent Abnormalities in the oral region .

Removal of necrotic tissues in the mouth

Advice on stopage of risk factors like tobacco use.

Pain and other symptoms management with analgesics ,anaesthesia e.t.c

For confirmed malignant lesions ;

 Surgery to remove the cancerous tissue

 Chemotherapy especially after surgery or for palliative purposes incase of advanced cancer
  Radiation is done mostly for palliative reasons to alleviate symptoms or for curative purposes
after a lesion has been removed surgically

Refferences

1. Robbins basic pathology 9th edition

2. Oral pathology for dental hygienists by Olga A.C Ibsen and Joan Anderson phelan
3. Oxford handbook of clinical dentistry by Laura Mitchel
4. Textbook of pathology by Harsh Mohan
5. Special care dentistry .Handbook of oral healthcare
6. Dental management of the medically compromised patient 7th edition by James
W.Lahle,Donald A.Falace,Craig S.Millee ,Nelson .L.Robins
7. Mouth cancer symptoms and causes by Mayo clinic
8. https://www.massey vcu.edu/cancer/oral/types
9. www.healthline.oral cancers
10. Textbook of oral medicine 2nd edition by Pramod John R.Jaypee Publishers