ORAL CANCERS

Recent Advances in
Investigations & Management

Dr. Bilal Yousaf

FCPS-II Resident
OMFS-LMDC
 Objective

• Generate Discussion about recent advances in

investigations and management of oral
cancers.
 Investigations
• Imaging
– OPG
– Chest x-ray
– Endoscopy
– Ultrasound
– Scintigraphy
– CT-scan
– MRI
– F-fluorodeoxyglucose (FDG) Positron Emission Tomography
(PET)
– PET combined with CT
 Investigations (Contd..)
• Biopsy
• FNAC
• Ultrasound guided FNAC
• Bio-markers
 Bio-Markers
• A biomarker, or biological marker, is in general
a substance used as an indicator of a biological
state. It is a characteristic that is objectively
measured and evaluated as an indicator of
normal biologic processes, pathogenic
processes or pharmacologic responses to a
therapeutic intervention.
 Bio-Markers
Genotype : Genetic changes in OSCC.
Methods to identify changes:
 Microarray Analysis
 Allelic imbalance in tumor suppressor gene
 Ploidy Analysis
 Bio-Markers
• Phenotype : Expressed Markers Of Prognosis
in OSCC.
Marker Type Marker linked to
OSCC
Tumor Suppressor loss P53,pRB,CDK inhib,S100
Tumor Growth Promoters EGF&EGF-R, Cyclins,PCNA
Angiogenesis related markers VEGF&VEGF-R
Tumor Invasion & Metastasis MMPs,cathepsins,integrins
 Serum Markers
• Total Sialic Acid.
• β2-microglobulin.
• Lipid Soluble Sialic
Acid
 Table 1: Levels of β2-microglobulin, total sialic acid (TSA) and lipid-bound
sialic acid (LBSA) in
healthy controls and various stages of oral cancer patients.
Clinical No. of Patients β2- TSA LBSA
Condition microglobulin mg/dl mg/dl
mg/L

Healthy 40 2.06 ± 0.36 66.92 ± 7.11 9.73 ± 2.73

Controls

Stage I 11 2.77 ± 0.09 77.45 ± 8.94* 12.96 ± 1.69*

Stage II 8 3.02 ± 0.04* 98.87 ± 5.27* 16.25 ± 0.98*

Stage III 10 3.48 ± 0.30* 110.0 ± 3.09* 21.58 ± 1.52*

Stage IV 11 3.48 ± 0.30* 127.90 ± 8.88* 24.81 ± 2.35*

Tumor Characteristics assessment by:

• Optical Spectroscopy

• Orthogonal Polarization Spectral(OPS)Imaging

 Management Of Oral Cancers
• Gene Therapy
• Photodynamic Therapy
• Immune/Biological Therapy
• Alternative Treatments
 Gene Therapy
• Gene therapy is the insertion, alteration, or
removal of genes within an individual's cells
and biological tissues to treat disease. It is a
technique for correcting defective genes that
are responsible for disease development.
 Types of Gene Therapy

1. Germ line Gene Therapy

2. Somatic Gene Therapy

3. Suicide Gene Therapy

 Approaches
1. Mutation Compensation
 Inhibition of expression of dominant oncogenes and
augmentation of deficient tumor suppressor gene.
2. Molecular Chemotherapy
 Administration of toxin gene to eliminate tumor cells.
 Drug resistance gene to protect bone marrow.
 Gene that enhance the conventional treatment.
3. Genetic Immunopotentiation
 Both tumor cells and immune system have been genetically
modified.
 Vectors in Gene Therapy
– Viruses

- Non-viral methods
• Injection of Naked DNA
• Physical Methods to Enhance Delivery
– Electroporation
– Gene Gun
– Sonoporation
– Magnetofection

– Hybrid methods
 Photodynamic therapy: Process
• Two individually non-toxic components
brought together to cause harmful effects on
cells and tissues
– Photosensitizing
agent
– Light of specific
wavelength
 Reaction Mechanisms
• Type 1:
– Direct reaction with substrate (cell membrane or
molecule)
– Transfer of H atom to form radicals
– Radicals react with O2 to form oxygenated
products
• Type 2:
– Transfer of energy to O2 to form 1O2
Type 1 and 2 Reactions
 Treatment of cancer

• PDT best suited for:

– Early stage tumors
– Inoperable for various reasons

• Limited success due to lack of specificity and

potency of photosensitizing agents

• Three mechanisms of tumor damage

 Mechanism 1

• Direct Photodamage to Tumors by Oxygen

Ions & Peroxides.
 Mechanism 2

• Vascular Damage
– Blood vessels supply nutrients to tumor cells.
 Mechanism 3

• Immune Response
– Movement of lymphocytes, leukocytes,
macrophages into treated tissue
– Up regulation of interleukin
– Neutrophil – slows tumor growth
 Immunotherapy
• Immunotherapy is defined as "treatment of
disease by inducing, enhancing, or
suppressing an immune response
 Contents
1 Examples of activation immunotherapies
– Cancer
• Dendrite cell based immunotherapy
• T cell based adoptive immunotherapy
– Vaccination
2 Examples of suppression immunotherapies
– Immune tolerance
– Allergies
 Alternate treatments
• Dimethyl Sulfoxide (DMSO).
 changes the structure of water
 Increases permeability
 Improves immunity
 Prohibit cancer
 Helps substances to kill cancer cells.
• Cesium Chloride
 Raise the PH.
 Stage IV cancer
 Amazon Factor
 Stop ATP production
• The Budwig Diet
 Flaxseed oil + cottage cheese = Makes oil water soluble
• Brandt Grape Cure
THANK YOU!