Oral
Cancer
Definition
Squamous cell carcinoma of
the skin is a common form of
skin cancer that develops in
the squamous cells that make
up the middle and outer layers
of the skin.
Is the most common type
cancer representing 90-95% of
oral malignancies.
Risk factors for oral
cancer:
1. Possible carcinogens :
a) Betel quid or Betel nut
b) Tobacco
c) Alcohol
2. Infections like:
a) Syphilis
b)Candidosis
Certain virus:
a) Human
papilloma
virus
Some
premalignant
lesion:
b) Leukoplakia
C) Lichen planus
3.Traumatic causes:
a) Cheek bite
6) Injury from tooth peck
e) Removable prosthetic
appliances
Common site of
squamous cell
carcinoma
Lateral border of tongue →
Floor of mouth ventral surface
of the tongue → soft palate→
Gingiva →Buccal mucosa →
the tongue Dorsum surface of
tongue.
Clinical diagnosis :
Early stage:
→ Painless
→ white on red patches
→Shallow ulcer
Late stage:
→ painful ulcer
→ easily bleeds on touch
Enlarged lymphnodes with
lymphadenopathies.
Floor: Sloughing
Base: Indurated
Margin: : Inverted
Edge: Rolled out
Lymphnodes:
Stony hard
Investigations: CBC
Specific Investigation:
Biopsy
FNAC
BIOPSY
If a suspicious area is
found, your doctor or
dentist may remove a
small piece of tissue for
laboratory testing
(biopsy).
FINE NEEDLE
ASPIRATION BIOPSY
The doctor might use a
scalpel to cut away a
sample of tissue
(Excisional Biopsy) or
use a needle to remove
a sample (FNAC).
In the laboratory, the
cells are analyzed for
cancer or precancerous
changes that indicate a
risk of
Cancer.
EXFOLIATIVE
CYTOLOGY Only
Surface Crits
Captured
A biopsy may be
carried out, where a
small sample of tissue
is taken to check for
cancerous cells.
Sometimes a “brush
biopsy” is used
initially; this where
cells are painlessly
collected by brushing
them to one side.
TNM staging:
TX: Primary lesion can’t be
assessed
To : No evidence of lesion
Tis
: Carcinoma in situ
71 : Lesion 22cm in
greatest
Diameter : Lesion >2cm but <4
cm in diameter.
T3 : Lesion >4cm in greatest
diameter
T4: Lesion invades through
vital structures & facial spaces.
N staging:
Nx: Regional lymphnodes can’t
be assessed No: No regional
lymphnode metastasis
Ni: Metastasis <3 cm in
diameter to a single ipsilateral
LN
N₂A: Metastasis >3 cm but not
26 cm in diameter
To a
Single ipsilateral LN
N2B: Metastasis > 6em in
multiple ipsilateral LN N₂C:
Bilateral metastasis (6cm in
diameter
N3: Metastasis in LN > 6am in
greatest diameter
M staging: Mx: Distant
metastasis canti
Assessed
Mo: No distant metastasis M,:
Distant metastasis
Histopathology:
Excessive proliferation due
to abnormal mitosis
Increased nuclear cytoplasm
ratio Hyperchromatism
Individual cell keratinization
Connective tissue infiltrated
by chronic inflammatory
cells
Principes of
Management of Early
stage cancer:
Chemotherapy
Radiotherapy
Surgical treatment
Combination therapy
Surgical technique for
resection of early
Oral Cancers –
Margins : All lesions should
be excised with a margin
of
at least 1cm in all
dimensions
Hemi mandibulectomy with
reconstruction
Segmental mandibulectomy
with reconstruction
1. Posterior
Segmental
mandibulectomy
2. Middle
third
mandibulectomy
Neck dissection
Neck dissection
is surgery to
examine and
remove the lymph
nodes in the
neck.
Description
Neck dissection
is a major
surgery done to
remove lymph
nodes that
contain cancer.
It is done in
the hospital.
Before surgery,
you will receive
general
anesthesia. This
will make you
sleep and unable
to feel pain.
The amount of
tissue and the
number of lymph
nodes that are
removed depend
on how far the
cancer has
spread. There
are 3 main types
of neck
dissection
surgery:
•Radical neck
dissection. All
the tissue on
the side of the
neck from the
jawbone to the
collarbone is
removed. The
muscle, nerve,
salivary gland,
and major
blood vessel
in this area
are all
removed.
•Modified
radical neck
dissection. This
is the most
common type of
neck dissection.
All lymph nodes
are removed.
Less neck tissue
is taken out
than with
radical
dissectio
n. This
surgery may also
spare the
nerves
in the neck and,
sometimes, the
blood vessels or
muscle.
•Selective neck
dissection. If
cancer has not
sp far, fewer
lymph nodes have
to be removed.
Muscle, nerve,
and blood vessel
in the neck may
Prevention of oral
cancer
Always brush and floss your
teeth regularly
•Do not smoke (or chew) any
type of tobacco product.
•Drink alcohol in
moderation, avoid of
necproduct
•Limit your exposure to the
sun
Choose cancer-fighting
diet
your dentist regularly
Exercise regularly
