Professional Documents
Culture Documents
Bachelor:
Becerra, Grecia I.D. 17.503.793
I Part: Present Perfect
• 3 Affirmative Sentences
1. I have been in Venezuela all my life.
2. You have smoked at the school.
3. She has talked to the doctor.
• 3 Negative Sentences
1. He hasn't cleaned the bathroom.
2. They haven't liked your food.
3. It hasn't worked well.
• 3 Interrogative forms
1. Have you smoked at the school?
2. Has she talked to the doctor?
3. Has he written the letter?
• 3 Affirmative Sentences
1. I could play at the park.
2. You could go to the beach.
3. We could buy the ice for those beers.
• 3 Negative Sentences
1. He couldn't find the tresor.
2. She couldn't cut that table.
3. They couldn't pay attention to what the teacher says.
• 3 Interrogative forms
1. Could I play at the park?
2. Could you go to the beach?
3. Could he go with you?
Case Study: A 58-year-old male presented to a dental office for a routine checkup.
Examination revealed a nonhealing ulceration of the lower lip.
History
When questioned about the area, the patient claimed the ulcer had been present for
at least six months, maybe longer. No pain or discomfort was noted by the patient.
When questioned about excessive sun exposure, the patient stated that he spends
many hours outdoors and does not use sunblock. The patient denied a history of
smoking and alcohol use. No history of trauma to the area was noted.
The patient had a previous history of regular and routine dental care. At the time of
the dental appointment, the patient was not taking medications of any kind. No
significant problems were noted during the health history.
Examinations
Physical examination of the head and neck region revealed no abnormal findings.
The patient`s vital signs were all found to be within normal limits. No palpable lymph
nodes were detected. No other abnormal extraoral findings were noted. Oral
examination revealed an ulcerative lesion of the vermilion of the lower lip, measuring
one centimeter in diameter (see photo). When palpated, the periphery of the lesion
felt indurated.
Clinical diagnosis
Based on the clinical information presented, which one of the following is the most
likely diagnosis?
Diagnosis
Discussion
Squamous cell carcinoma (SCC) is derived from the squamous epithelial cells, which
are the flat and scaly cells found on the surface of the oral mucosa. When these
squamous cells become cancerous, the cancer is referred to as a carcinoma, which
is defined as a malignancy of epithelial origin. SCC is found both on the lips and
inside the oral cavity. An estimated 90-95 percent of all oral cancers are squamous
cell carcinoma. SCC behaves differently depending upon its location; therefore, a
separate discussion of SCC of the lip and intraoral SCC is warranted.
The major causative factor for SCC of the lip is prolonged sun exposure. In addition,
certain forms of tobacco use play a contributing role - pipe and cigar smoking are
often linked to SCC of the lip.
Clinical features
Although SCC of the lip may occur at any age, this lesion most often occurs in adults
between the ages of 50 and 70; men are twice as likely to be affected as women.
The lower lip is affected by SCC far more frequently than the upper lip.
SCC of the lip has a variety of clinical appearances. The usual presentation is that
of a nonhealing ulceration and crust. Raised and indurated borders may be present.
The size is variable; a larger lesion may appear as a crater-like defect. SCC of the
lip is typically not painful and very slow to metastasize (spread) to the regional lymph
nodes or other organs.
Diagnosis
If a lip lesion is suspected to represent SCC, the patient must be promptly referred
to an oral surgeon for biopsy. A biopsy and histologic examination is necessary to
establish a definitive diagnosis of SCC.
Staging
Staging is the process of determining if and how far a cancer has spread. Both
treatment and prognosis are dependent upon the stage of a cancer. Staging
information is obtained from the physical exam, endoscopy, and imaging studies (CT
scan, MRI, chest X-ray, or nuclear medicine scans).
The most common system used to stage oral SCC is termed the TNM System. This
system describes three pieces of information: T refers to the size of the primary
tumor, N describes the extent of spread to regional lymph nodes, and M indicates
whether the cancer has metastasized (spread) to other organs.
Treatment
Once a diagnosis and staging has been determined, treatment can be rendered.
Treatment options for SCC of the lip include surgical excision and radiation therapy.
Smaller lesions may be surgically removed or irradiated, while larger lesions may
require a combination of both surgery and radiation.
Moh`s micrographic surgery may be used to remove some lip lesions. This method
removes the tumor in thin slices. Each slice is then immediately examined under the
microscope to look for cancer cells. The surgeon continues to remove slices until the
cancer is completely removed. This method minimizes the amount of normal tissue
that is removed along with the tumor.
Prognosis
Treatment success is based on the size of the lesion and metastasis. SCC of the lip
is slow to metastasize to regional lymph nodes and other organs. Consequently, the
overall prognosis for SCC of the lip without such metastasis is favorable, with an 85
percent five-year survival rate.
Follow-up
Upon completion of treatment, a patient with SCC of the lip should receive frequent
follow-up physical and oral examinations; approximately 80-90 percent of recurrent
lesions appear within the first two post-treatment years. Patients are usually
examined every other month during the first year, four times during the second
year, and then once a year thereafter.
TRADUCCION
Historia
Cuando se le preguntó sobre el área, el paciente afirmó que la úlcera había estado
presente durante al menos seis meses, tal vez más. El paciente no notó dolor ni
molestias. Cuando se le preguntó sobre la exposición excesiva al sol, el paciente
declaró que pasa muchas horas al aire libre y no usa bloqueador solar. El paciente
negó antecedentes de tabaquismo y consumo de alcohol. No se observaron
antecedentes de traumatismos en la zona.
El paciente tenía antecedentes de atención dental regular y de rutina. En el
momento de la cita dental, el paciente no estaba tomando medicamentos de ningún
tipo. No se observaron problemas significativos durante la historia clínica.
Exámenes
Diagnóstico clínico
Diagnóstico
Discusión
El principal factor causal para el SCC del labio es la exposición prolongada al sol.
Además, ciertas formas de consumo de tabaco juegan un papel contribuyente:
fumar en pipa y cigarros a menudo está relacionado con el SCC del labio
Características clínicas
Aunque el SCC del labio puede ocurrir a cualquier edad, esta lesión ocurre con
mayor frecuencia en adultos entre las edades de 50 y 70 años; los hombres tienen
el doble de probabilidades de verse afectados que las mujeres. El labio inferior se
ve afectado por el SCC con mucha más frecuencia que el labio superior.
SCC del labio tiene una variedad de apariencias clínicas. La presentación habitual
es la de una ulceración y costra no cicatrizantes. Las fronteras elevadas e induradas
pueden estar presentes. El tamaño es variable; una lesión más grande puede
aparecer como un defecto similar a un cráter. El SCC del labio generalmente no es
doloroso y muy lento para hacer metástasis (diseminación) a los ganglios linfáticos
regionales u otros órganos.
Diagnóstico
Si se sospecha que una lesión labial representa SCC, el paciente debe ser
referido de inmediato a un cirujano oral para una biopsia. Es necesaria una biopsia
y un examen histológico para establecer un diagnóstico definitivo de CCE.
Estadificación
El sistema más común utilizado para estadificar el SCC oral se denomina Sistema
TNM. Este sistema describe tres piezas de información: T se refiere al tamaño del
tumor primario, N describe la extensión de la diseminación a los ganglios linfáticos
regionales y M indica si el cáncer ha hecho metástasis (diseminación) a otros
órganos.
Tratamiento
Pronóstico
Seguimiento
Al finalizar el tratamiento, un paciente con SCC del labio debe recibir exámenes
físicos y orales de seguimiento frecuentes; aproximadamente el 80-90 por ciento de
las lesiones recurrentes aparecen dentro de los dos primeros años posteriores al
tratamiento. Los pacientes generalmente se examinan cada dos meses durante el
primer año, cuatro veces durante el segundo año y luego una vez al año a partir de
entonces.