ORAL TUMOR / CANCER

Wirsma Arif Harahap

Head Neck and Breast Oncology Consultant
Andalas Medical School
Padang
 Category of the Disease
• Congenital
• Trauma
• Inflamation
• Metabolic Endocrine
• Degenerative
• Neoplasia
Term for “Oral”
 TUMOR
• Tumor  neoplasma
• Tumor
– Origin
• Epithelial
• Mesenchimal
• Mixed, etc
– Type
• Benign
• Malignant
 What is oral cancer?

• Malignant neoplasm of the mouth

• Usually squamous cell carcinoma (99%)

• Found in most cases by a dentist or the

person themselves.
 Statistics on Oral Cancer

• Accounts for 2% of all cancers

• 60 years of age and older are at a higher risk

• Men > women ( Smoker, Alcoholism …)

• Overall 5 year survival rate of 65%.

• This varies from 84% if diagnosed when

localized  66% if it has spread to the nodes
in the neck  39% in distance metastatic.
• Survival rates also are dependent on the
location of the disease in the mouth.
Type of cancer
 Precancer Lesion
vs
Precancer Condittion in Oral
Cancer
 Precancer Condition
• Persistent gum disease can lead to oral cancer
and other potential life threatening conditions
like:
– Heart Disease
– Stroke
– Diabetes
– Chronic Kidney Disease (CDK)
– Transplant patients
– Human Papilloma Virus (HPV)
leukoplakia
Precancer : eritroplakia
Etiology / Risk Factor
of Oral Cancer
Risk Factors of Oral Cancer
Pathogenesis of the Risk Factor
Symptoms & Signs
 Symptoms & Signs
• In the mouth  starts as a painless white patch,
that thickens, develops red patches, an ulcer,
and continues to grow.
• Lips  a persistent crusting ulcer that does not
heal, and slowly grows.
• Other symptoms  difficult or painful
swallowing, new lumps or bumps in the neck, a
swelling in the mouth, or a feeling of numbness
in the mouth or lips, hot potato sound
Physical

Exm
Cervical Nodes Exm
Tongue cancer
 Problem …

• Patient
– Late case

• Primary Care Doctor

– Ignorance
– Negleted
 Diagnosis
• Clinical presentation
– History + Physical Exam ( gnrl, oral and neck exm)
• Imaging
• Pathology examination
– Brush biopsy
– Incisional biopsy (inoperable case)
– Frozen section
– Parafin Block
– FNAB : cervical lymph node
 Diferensial Diagnosis

• Ulcer
– stomatitis apthosa
– Traumatic ulcer ( sharp teeth,
inappropriate dental prothesis)
• Precancer lesion.
 Staging

• AJCC / UICC
• TNM
• Early Stage, Locally Advanced, Advanced
 Treatment

Multimodality and Multidicipline

•Surgery
•Radiotherapy
•Chemotherapy
•Targeted Therapy
•Rehabilitation
Surgery …….
Surgery + Neck Dissection + Post Operative XRT
Hemiglosectomy + Neck dissection + Brachytherapy
Neoadjuvant Chemotherapy +
Hemiglosectomy +
Upper neck dissection +
Free flap
Prognosis
Survival Rate by Stage of Diagnosis
 Side Effects of Treatment
• Swelling
• Sore mouth
• Difficulty chewing, swallowing, or talking
• Changes to appearance
• Weight loss
• Inability to wear dentures for a period of time
Prevention and Screening
Prevention
 Screening

• American Cancer Society recommends that

adults over 20 years who have periodic health
examinations should have the oral cavity
examined for cancer.
 Summary
• Mortality rate of oral cancer is high
• Indonesian  late case
• Early detection program is needed
• Multidicipline team and multimodality
• Local failure still mainstay problem after
treatment
• Prevention and screening is the best tools
Thank You