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DWI HARI SUSILO, dr.

, SpB(K)Onk;(K)K/L
Division of Head and Neck Surgery, Department of Surgery
Dr. Soetomo General Hospital / Airlangga University
anterior : vermilion
posterior : anterior pharyngeal arch
superior : hard palate
Inferior : floor of mouth and tongue
lateral : bucal
Lymphatic drainage
ORAL CAVITY TUMOR

Neoplasma
Benign
malignant
Solid organ : carsinoma
sarcoma
Non Solid organ :
lymphoma, multiple myeloma

Non neoplasm : granulatic tissue, infection ect


CARSINOMA :
Malignant epithelial tumor

Origin :
Oral cavity mucosa
Glandular tissue : minor salivary gland

SARCOMA :
Malignant mesenchimal tumor( soft tissue,
bone, nerve)
INTRODUCTION

• Oral cancer is the sixth most common cancer


worldwide, 85 % of Head & Neck cancer.
• 500,000 new cases annually
• 320,000 deaths annually
• 2/3 cases in developing country
• Tend to increase and younger patien
• Often, oral cancer’s patients present with advanced
stage disease after a period of denial or neglected.

Seiwert TY, Cohen EEW. State of The Art Management of Locally


Advanced Head and Neck Cancer. Britist Journal of Cancer. 2005 ; 92
Who is at risk ?

• People over the age of 40


• Men vs. Women (6:1  2:1)
• Ethnicity
• Socioeconomic Status (SES)
• Being a heavy smoker and drinker
• People with HPV-16 and HPV-18 are at slightly 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
PRE CANCER LESION
A. Leukoplakia of the tongue
B. erythroplakia
C. Oral submucous fibrosis
ORAL CANCER :
tongue cancer
ulcerative
exophytic
LIPS CANCER
MAXILLARY CANCER
Squamous cell carsinoma
Adeno carsinoma of minor salivary gland
Adenoid cystic carcinoma, metastase to the cervical lnn
( from minor salivary gland at palatum)
OTHERS ORAL CAVITY LESION :

AMELOBLASTOMA

ginggival cancer Sublingual salivary gland cancer


ADDITIONAL STUDY

PRINCIPAL : non-invasive first


TNM

- plain foto
- CT-scan / MRI, PET-scan
- USG for detection lnn metastase
- Thorax foto (lung metastase)
- Sitology : scrapping, FNAB
- Insisional Biopsy (for dificult case or innoperable)
Bucal cancer
Squamous cell carcinoma, intermediate grade
Infiltration to the mandibular bone
CT SCAN / MRI
For some cases
Evaluate extension-infiltration to
adjacent tissue
Evaluate operability
Thorax foto : lung metastase
STAGING
T N M
Tis : insitu N0 : meta kgb(-) M0 : meta (-)
T0 : tumor (-) N1 : single,ipsilateral <3cm • Std I :T1 N0 M0
T1 : <2 cm N2a : single,ipsilateral M1 : meta (+) • Std II : T2 N0 M0
T2 : 2-4 cm >3cm-<6cm • Std III: T3 N0 M0
N2b : multiple,ipsilateral : T1,2,3 N1 M0
<6cm
• Std IVa: T4 N0,1 M0
N2c : bilateral/kontralateral
IVb : (T) N2,3 M0
<6cm
IVc : (T) (N) M1
N3 : >6cm
T3 : >4 cm
T4 : infiltrasi (+)
TREATMENT
Curative treatment modalities :

Surgery
Radiation
w/w.o chemotherapy or targetted therapy
(as radiosensitizer or reduce distant metastasis)

The goals of treatment :


maximizing tumor control
maintaining function and quality of life
Local control : TONGUE CANCER : WIDE EXCISSION
Regional control : Radical neck dissection, classic or modified
RECONSTRUCTIF SURGERY
LATISIMUS DORSI MYOCUTANEOUS FLAP
ADJUVANT TREATMENT OF ORAL CANCER :

1. Radiotherapy
2. Chemotherapy
3. Targetted therapy
ADJUVANT TREATMENT OF ORAL CANCER :
1. Radiotherapy

Locoregional control ---- reduce recurency


For locally advanced, Close margin, residif, hight grade Ca

Altered fractionation radiation schedule for better


locoregional control and reduce side effect

Problem : lack of radiotherapy fascility in indonesia (25 ?)


 waiting list
ADJUVANT TREATMENT OF ORAL CANCER :

2. Chemotherapy (almost never alone)


Concurrent chemoradiotherapy improves local control and
overall survival in locally advanced head and neck cancer with
adverse feature.
– positif margin
– T3 or T4
– N2 or N3
– level 4 or 5 cervical lnn
– perinodal invasion
– vascular embolism

3. Targetted tx w/o chemotherapy + Radiotherapy (radiosensitizer)


Anti EGFR
Anti VEGF
NEOADJUVANT CHEMOTHERAPY
(CHEMORADIATION)

• Locally advanced (considerable) resectable disease

• To improve locoregional control and overall survival

• Eradicate micrometastase
• Downsizing  surgery
• Some times as primary treatment for complete response
disease
PALLIATIVE TREATMENT
For better quality of live
Live with cancer

Analgetic, antidepressant
Palliative radiotherapy
Palliative chemotherapy
Palliatif surgery
CANCER PREVENTION
PRIMARY PREVENTION
Risk factor modification

SECONDARY PREVENTION
Early detection

TERTIARY PREVENTION
Follow up post treatment
Detection of other malignancy