DEFENITION

Cancer is the uncontrolled growth and spread of cells. It can affect almost any part
of the body. The growths often invade surrounding tissue and can metastasize to
distant sites.
https://www.who.int/topics/cancer/en/

Oral cancer is a type of head and neck cancer and is any cancerous tissue growth
located in the oral cavity
https://www.fdiworlddental.org/sites/default/files/media/resources/fdi-oral_cancer-prevention_and_patient_management.pdf
 Oral cancer is the sixth deadliest cancer in the world. While most cancer survival rates
have increased over the past 40 years., the five year survival rate of oral cancer has
remained below 50%

Paru,payudara, usus besar,

prostat,lambung, World Cancer Resesarch
Fund International (WCRF) pada tahun
2012
Main risk factor

Tobacco contains many carcinogenic molecules,

especially polycyclic hydrocarbons and nitrosamines
Tobacco And Alcohol:
Deadly Combination

 It is estimated that
tobacco smoking and
alcohol drinking
combined account for
approximately ¾ of all
oral and pharyngeal
cancers in the U.S.
(ACS, 2004)
 Electronic cigarette (E-cigarette)
The electronic cigarette (E-cigarette) is a handheld electronic device that
vaporizes a nicotine-containing fluid for inhalation. Invented in 2003 by Chinese
pharmacist Hon Lik, the E-cigarette was developed as a substitute for tobacco
cigarettes. The use of E-cigarettes continues to grow in popularity in most parts of
the world, and many consider their use and the use of other electronic nicotine
delivery systems (ENDS) to be healthier than smoking tobacco cigarettes.
 Our in vitro experiments employing 2 brands of e-cigs show that at biologically
relevant doses, vaporized e-cig liquids induce increased DNA strand breaks and
cell death, and decreased clonogenic survival in both normal epithelial and
HNSCC cell lines independently of nicotine content.
 (Yu et al in Oral Oncol 2016 January ; 52: 58–65. doi:10.1016/j.oraloncology.2015.10.018)

 Tobacco cigarette smoking is a known risk for cancers, including oral cancer.
Patients and clinicians (physicians, dentist and nurses) need to be aware that
the use of electronic-cigarettes (E-cigarettes) or other electronic nicotine
delivery systems (ENDS) may also be associated with an increased risk of oral
cancer. Here we describe two patients, with positive history for chronic E-
cigarette use, that developed oral cancer without any identifiable risk factors
other than E-cigarette use. Further investigation is warranted.
(Nguyen H, Kitzmiller JP, Nguyen KT, Nguyen CD, Bui TC (2017) in Oral Carcinoma Associated with Chronic Use of Electronic
Cigarettes. Otolaryngol (Sunnyvale) 7: 304. doi:10.4172/2161-119X.1000304)

In conclusion, our study strongly suggests that electronic

cigarettes are not as safe as their marketing makes them
appear to the public
“
Other risk factors

”
Fanconi syndrome is a rare disorder of kidney tubule function that results in excess amounts of glucose, bicarbonate, phosphates (phosphorus salts), uric acid,
potassium, and certain amino acids being excreted in the urine.

(kelainan pada fungsi tubuli ginjal yang tidak mampu menyaring dan menyerap protein dan mineral ke dalam sel sel tubuh sehingga terbuang di urin)

Benign oral lesions caused by HPV include squamous papilloma, verucca vulgaris, condy loma
acuminatum and focal epithelial hyperplasia. These lesions may look similar, but they are
caused by different subtypes of HPV.2
VERUCO 1, CONDI >>,
 Dentists play an important role in the early detection of oral cancer.
 Only 30% of oral and pharyngeal cancers are identified at an early stage,
while 50% are diagnosed at an advanced stage of metastasis (stage III or
IV).
 Oral cancer screening must therefore be an essential component of the
routine head and neck examination conducted in the primary dental care
setting
 Early diagnosis is critically important to decrease oral cancer mortality
 In early stages, the lesion may be flat or elevated and may be minimally
palpable or indurated.
 Diagnosis is based on clinical examination and biopsy, which is the gold
standard procedure.
 Squamous cell carcinomas (SCC) constitute more than 90% of all oral
cancer. Other malignant tumors can arise from the epithelium, connective
tissue, minor salivary glands, lymphoid tissue, and melanocytes or
metastasis from a distant tumor.

Cari contoh kanker diatas

 The more common premalignant lesions including leukoplakia,
erythroplakia, oral lichen planus, and oral submucous fibrosis have varying
potential for malignant transformation.
 The WHO (2005) classifies premalignant lesions according to degree of
dysplasia into mild, moderate, severe, and carcinoma in situ.
SAMURI

htpp://oralcancerscreening-150727132336-lva1-app6891.pdf
Dentist intra oral examination
Extra Oral examination
Lymphadenopathy is an early indicator of some disease ,therefore physical examination
of lymph nodes of head and neck is of great importance

Source: Lenton P, Majerus G,Bakdash B, The Intra oral and Extra oral Exam, 2019
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce337
Extra Oral examination
The major lymph nodes of the head and neck area should be palpated with the patient in an upright
position. Findings which should be noted in the patient record include enlarged palpable nodes, fixed
nodes, tender nodes and whether the palpable nodes are single or present in groups. Single or multiple
non-tender, and fixed nodes are very suspicious for malignancy

Source: Lenton P, Majerus G,Bakdash B, The Intra oral and Extra oral Exam, 2019
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce337
Signs and symptoms or oral cancer

 A sore in the mouth / Persistent mouth pain.

 Numbness of the tongue or elsewhere in the mouth.
 A lump / Jaw swelling that makes denture hurt or fit pooryly.
 A white or red patch
 A sore throst or feeling that something is caught in the throat that doesn’t go away.
 Persistent Halitosis
 Difficulty in swallowing or chewing.
 Difficulty in moving the jaw or tongue/ trismus
 Loosening of the teeth.
 Voice change.
 Significant weight loss.
Leukoplakia
Leukoplakia is a clinical term defined as a “white
patch or plaque that cannot be characterized
clinically or pathologically as any other disease”

Saman W. Clinical features and presentation of oral potentially

malignant disorders. ORAL AND MAXILLOFACIAL PATHOLOGY, Vol. 125 No. 6 June 2018
Leukoplakia

 GAMBAR

Nihat Akbulut and Ahmet Altan (November 5th 2018). Early Detection and Multidisciplinary Approach to Oral Cancer
Patients [Online First], p.10, IntechOpen, DOI: 10.5772/intechopen.81126. Available from:
https://www.intechopen.com/online-first/early-detection-and-multidisciplinary-approach-to-oral-cancer-patients
Leukoplakia vs Erythroplakia

Saman W. Clinical features and presentation of oral potentially

malignant disorders. ORAL AND MAXILLOFACIAL PATHOLOGY, Vol. 125 No. 6 June 2018
ERYTHROPLAKIA

Erythroplakia is a “bright red velvety

patch that cannot be characterized
clinically or pathologically as being
caused by any other condition”
Surgical excision is recommended as
these lesions have higher malignant
potential than leukoplakia and are
commonly associated with dysplasia
and carcinoma in situ.
ERYTHROPLAKIA

Messadi D. International Journal of Oral Science (2013) 5,59–65ß 2013 WCSS. All rights reserved 1674-
2818/13
 Oral Lichen Planus (0LP)

Oral lichen planus (OLP) is an autoimmune, inflammatory, chronic disease affecting oral
mucous membranes. Malignant transformation most often involves erosive, atrophic and
plaque-like lesions, but is also possible in the remaining types.
Saman W. Clinical features and presentation of oral potentially
malignant disorders. ORAL AND MAXILLOFACIAL PATHOLOGY, Vol. 125 No. 6 June 2018
Erosive OLP
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce541/oral-lichen-planus-olp
ORAL SUBMUCOUS FIBROSIS
https://www.juniordentist.com/oral-submucous-fibrosis.html
HOW TO DX LESION
BIOPSY
https://www.slideshare.net/indiandentalacademy/diagnostic-aids-for-oral-cancer-dental-
crown-bridge-courses
EXFOLIATIVE CYTOLOGY
 SCC

https://ipj.quintessenz.de/index.php?doc=html&abstractID=20892
 oral exfoliative cytology is a useful method for detecting premalignant and
malignant oral lesions. Oral exfoliative cytology is a simple, rapid, minimally
invasive, and relatively painless method that is well accepted by patients
and therefore suitable for population screening programs
 Surgical biopsy and histopathological examination remain the gold
standard for the definitive diagnosis of oral pathology; however, oral biopsy
is invasive and involves both psychological implications for the patient and
technical difficulties for sample collection.
Conclusions

 Dentists play an important role in the early detection of oral cancer

 Knowledge of clinical signs and oral manifestations of precancerous lesions
in general dentistry is of paramount importance
 Dentists should realize that a visit to the dentist is no longer only about filling
cavities, crowns, or a postponable cleaning of teeth but actually a matter
of health and quality-of-life.
Reference

 Pablo H. Montero, MD* and Snehal G. Patel, MD, Surg Oncol Clin N Am.
2015 Jul; 24(3): 491–508. Published online 2015 Apr 15.
doi: 10.1016/j.soc.2015.03.006
lymphoma vs lymphangioma

 Lymphangiomas and certain other types of masses related to the

lymphatic system are known as lymphatic malformations. These swellings or
masses are benign and not associated with cancer.
 Surgical excision is regarded as the most definitive treatment, giving the
highest chance of cure with a recurrence rate of 17% to 23%
 If the lymphangioma is not causing specific problems, either medically or
regarding appearance, then often no treatment is needed.
 Surgery: Surgical removal can be a difficult procedure if the lymphatic
malformation has traveled into the nerves and muscles.
 Sclerotherapy: A solution is injected into the swelling to cause it to shrink or
collapse.
 Radiofrequency ablation: A high frequency current delivered via a needle
destroys abnormal tissue.
 Dermabrasion: A skin resurfacing technique can be used to treat facial scarring.
 Percutaneous drainage: An incision is made in the lymphatic malformation, and
the fluid is drained.
 Drug treatment: Commonly associated with treating cancer, the drug sirolimus
has been shown to shrink lymphatic malformations. Clinical trials are still
determining its effectiveness, however.
 Unfortunately, in many cases of lymphangiomas, they can recur after removal.
 Non-squamous cell carcinomas of the oral cavity are uncommon. Minor
salivary gland carcinomas represent less than 5% of the oral cavity cancers.
They frequently arise on the hard palate (60%), lips (25%) and buccal
mucosa (15%)35. Mucoepidermoid carcinoma is the most common type
(54%), followed by low-grade adenocarcinoma (17%), and adenoid cystic
carcinoma (15%)49,50.
 Mucosal melanomas are rare but usually present as locally aggressive
tumors, mainly of the hard palate and gingiva. Bony tumors including
osteosarcoma of the mandible or maxilla and odontogenic tumors such as
ameloblastoma can present within the oral cavity and may be mistaken for
a mucosal lesion if there is surface ulceration.