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Oral squamous cell carcinoma is a major health problem in India amongst all the malignancies its incidence ranks number one in males and three in females Many oral cancers are detected only when they are well advanced as a result of illiteracy or socioeconomic status of patient and being painless in the early stages resulting in higher morbidity and mortality In developing countries such as India, where there is a high prevalence of disease, the focus is on downstaging oral cancer at diagnosis from advanced to earlier disease
ORAL CANCER A GLOBAL BURDEN Oral cancer is emerging as a global burden due to increased no. of deaths world wide .
g.INTRODUCTION Early detection of oral premalignant lesions and conditions improves the prognosis and helps in better screening which save millions of life. Progression from premalignant lesions to cancer usually occurs over years . a premalignant condition or lesion These lesions often present as a white patch or. Early detection has the potential to significantly reduce oral cancer deaths and morbidity Early detection aims to screen the cancer at very early stage e. less frequently. a red patch.
. with particular reference to quantity. which should include review of: General health history including a list of current medications and medication allergies Oral habits and lifestyle. frequency and duration of tobacco use and alcohol consumption Symptoms of oral pain or discomfort.FIRST STEP The first step in screening for oral cancer is the completion of a patient history.
78.65.VARIOUS TECHNIQUES For early detection of oral cancer the various techiniques employed are: Vital staining by toluidine blue Chemilumniscence Autofluoroscence Cytologic (Papanicolaou) smear Fine needle aspiration cytology Brush biopsy Cytogenetic analysis Polymerase Chain reaction DNA sequencing methods Tumour markers.91 .
the loss of cell cohesion.TOLUIDINE BLUE Toluidine blue is a acidophilic metachromatic dye belonging to the thiazine group that selectively stains the acidic tissue components Dye is taken up by the nuclear debris on the surface of tumour cells. increased mitoses and loss of heterozygosity . Toluidine Blue in dysplastic lesions and carcinomas shows increase uptake due to the high density of nuclear material. In addition. malignant epithelium may contain intracellular canals that are wider than normal epithelium. this is a factor that would enhance penetration of the dye upto depth of 50µm.
CHEMILUMINESCENCE The term ¶Chemiluminescence· refers to the emission of light from a chemical reaction. The blue white light is absorbed by the cells of the normal mucosa and is reflected by cells with abnormal nuclei including dysplastic and neoplastic cells. .
sharper and more distinct margins17 . whereas abnormal mucosal areas reflect the light (due to higher nuclear/cytoplasmic ratio of epithelial cells) and appear more aceto white with brighter.CHEMILUMINESCENCE The acetic acid rinse putatively removes debris and disrupts the glycoprotein barrier on the surface of the epithelium allowing penetration.3 The normal mucosa appears blue.
.VELSCOPE The autoflorescence signal is finally visualized directly by a human observer. normal oral mucosa emits a pale green autofluorescence when viewed through the instrument handpiece whilst abnormal tissue exhibits decreased autofluorescence and appears darker with respect to the surrounding healthy tissue. With regards to the oral cavity.
hyperchromatin and increased cellular/nuclear pleomorphism) and metabolism (e.. a process defined autoflorescence. . These epithelial and stromal changes can alter the distribution of tissue fluorophores and as a consequence the way they emit fluorescence after stimulation with intense blue excitation (400 to 460 nm) light. composition of collagen matrix and elastin).g.VELSCOPE The concept behind tissue autoflorescence is that changes in the structure (e. concentration of flavin adenine dinucleotide [FAD] and nicotinamide adenine dinucleotide [NADH]) of the epithelium.g. hyperkeratosis. alter their interaction with light.g. as well as changes of the subepithelial stroma (e.
fixed and stained. spread on a slide. The usefulness of cytology is augemented in 90% of oral cancers because most of them are epithelial in origin and thereby surface lesions. . Thus. direct sampling allows for accurate diagnosis.CYTOLOGICAL SMEAR Exfoliative cytology is a technique used for observing the microscopic morphology of individual cells after they have been obtained from a tissue.
FINE NEEDLE ASPIRATION CYTOLOGY Fine neddle asiration cytology is a highly acceptable and recommended technique for differentiating benign from malignant lesions involving the lymph nodes. cystic and neoplastic lesions. Use of this minimally invasive technique accelerates the diagnosis. . The armamenterium involves the use of 22 Gauze needle. reactive. quick reliable procedure that can immediately differentiate inflammatory . treatment and overall management It is a safe.
also known as OralCDx Brush Test system. .BRUSH BIOPSY The oral brush biopsy. intermediate and parabasal/basal layers of the epithelium This test was specifically designed to investigate mucosal abnormalities that would otherwise not be subjected to biopsy because of low-risk clinical features. consists of a method of collecting a trans-epithelial sample of cells from a mucosal lesion with representation of the superficial.
stained with a modified Papanicolaou test and analyzed microscopically via a computer-based imaging system.BRUSH BIOPSY A specially designed brush is the non-lacerational device used for epithelial cell collection and samples are eventually fixed onto a glass slide. Results are reported as "positive" or "atypical" when cellular morphology is highly suspicious for epithelial dysplasia or carcinoma or when abnormal epithelial changes are of uncertain diagnostic significance respectively Results are defined as negative when no abnormalities can be found .
SCALAPEL BIOPSY The gold standard for the diagnostic test still remians the tissue biopsy and histopathological confirmation .
Molecular changes in the progression to SCC include common changes at chromosome sites that lead to changes in RNA and subsequent protein production. can be assessed in exfoliated cells . Changes occur at the molecular level before they are seen under the microscope and before clinical changes occur. LOH and other molecular changes. including changes at p16. p53 and cyclin D.CYTOGENETIC ANALYSIS Tumour Exfoliated cells can be subjected to additional analysis.
CYTOGENETIC ANALYSIS It is of three types Chromosome Karyotyping FISH (Fluorescence In Situ Hybridization) CGH (Comparative Genomic Hybridization) .
The underlying principle is allellic imbalance analysis All the tumour supressor genes tobecome inactive requires the loss of one copy on one chromosome and mutation of the other copy on other chromosome. .POLYMERASE CHAIN REACTION It is considered as an important tool for the detection of chromosome gain or lossin many human cancers It involves isolation of DNA from a fresh tissue specimen or from a tissue in paraffin block.
POLYMERASE CHAIN REACTION .
DNA SEQUENCING METHODS These methods are employed for the detection of smaller genetic alterations which are common in oral squamous cell carcinoma These methods are used to characterize the mutational events like mutation in p53 gene in oral precancer and cancer The method is employed by fluoroscent labeleld nucleotides The fastest method that is available now a days is Capillary electrophoresis .
Biomarkers arise as a result of the changes in the malignant tissue changes from one type to another type of malignancy that distinguish it from another or changes within a tumour type that distinguish one behaviour from other Tumour markers are substances. biochemicals (hormones) or enzymes.TUMOUR MARKERS A tumour marker is a molecule or tissue based process requiring a special assay that marks the various biochemical markers in the malignant tissue. . such as proteins. produced by tumour cells or by the body in response to tumour cells.
radio-immunoassay. spectrophotometry.TUMOUR MARKERS Tumour markers can be detected by various methods including antigen-antibody based techniques (enzyme linked immunosorbent assay. . chromatographic techniques and molecular genetic methods. immunoscintigraphy). flowcytometry. precipitin tests. immunohistochemistry.
TUMOUR MARKERS FOR ORAL CANCER The recent tumour markers which help in early detection of oral cancer are:32 A) Sialic Acid levels B) Serum protein profiles C) Serum hyaluronan levels 24 .
Analysis of oral lesion biopsies identified and evaluated by visual examination. 3 April 2010 Epstein JB etal .BIBLIOGRAPHY Lauren L Patton Adjunctive techniques for oral cancer examination and lesion diagnosis JADA 2008. Bouquot.139(7):896-905. Stefano Fedele Diagnostic aids in the screening of oral cancer J Head & Neck Oncology 2009: 1758-3284 Jerry E.538-544 . No. Oral Precancer and Early Cancer Detection in the Dental Office ² Review of New Technologies The Journal of Implant & Advanced Clinical Dentistry Vol. chemiluminescence and Toluidine blue J Oral Oncology 2008.44. 2.
2408-2410 .521-27 Mashberg A Tolonium rinse ² A Screening method for recognition of squamous carcinoma : Continuing study of oral cancer J AMA 19184.108.40.206.820-24 S Ram and C H Siar Chemiluminescence as a diagnostic aid in detection of oral cancer and potentially malignant epithelial lesions Int J Oral & Maxillofacial surgery 2005.BIBLIOGRAPHY Farah S Camile etal A pilot case control study on efficacy of acetic acid wash and chemilumniscent illumination in the visualization of oral mucosal white lesions J Oral Oncology2007.
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