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Oral carcinoma and management of oral cancer

Oral carcinoma and management of oral cancer. Azmi Darwazeh BDS, MSc, PhD, FFDRCSI Professor in Oral Medicine Jordan University of Science & Technology. Aetiological factors for oral squamous cell carcinoma (OSCC). Tobacco use: In all of its forms is the most important Dose dependent.

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Oral carcinoma and management of oral cancer

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  1. Oral carcinoma and management of oral cancer Azmi Darwazeh BDS, MSc, PhD, FFDRCSI Professor in Oral Medicine Jordan University of Science & Technology

  2. Aetiological factors for oral squamous cell carcinoma (OSCC) • Tobacco use: • In all of its forms is the most important • Dose dependent

  3. Type of cigarettes Bidi

  4. Pipe and cigar smoking are linked to lip carcinoma

  5. Reverse smoking is linked to carcinoma of the palate

  6. Chewing of betel quid is associated with • Oral leukoplakia • Oral submucousfibrosis • Squamous cell carcinoma.

  7. Aetiological factors for oral squamous cell carcinoma (OSCC) • Alcohol consumption: • Independent risk factor • Difficult to quantify since many who drink also smoke • The effect of tobacco and alcohol is synergistic (multiplicative) “not only added risk”

  8. Aetiological factors for oral squamous cell carcinoma (OSCC) Diet & nutrition: Vitamin A, C, & E deficiency is a predisposing factor Fe deficiency is a predisposing factor High consumption of fresh fruit and vegetable may be protective patients with head and neck cancers have a high fat and red meat intake

  9. Aetiological factors for oral squamous cell carcinoma (OSCC) • Sunlight is an aetiological factor for the lip cancer • Chronic candidal infection: candidal leukoplakia • Viral infections: HPV type 16 • Immune deficiency

  10. Clinical features Are all OSCC preceded by a recognizable potentially malignant lesion ?

  11. Self study You must be able to clinically differentiate between malignant and reactive lymph node

  12. Diagnosis of OSCC • Recognizing the lesion • Biopsy • Adjuncts • Toluidine Blue • Brush Biopsy

  13. Clinical features The floor of the mouth then the tongue are the most common sites in Jordanians Leukoplakia Proliferative mass The male/female ratio was 3:1 Erythroplakia Ulcer

  14. Staging systems for OSCC S: size T: site N: lymph node involvement M: metastasis P: pathology

  15. Prognosis of OSCC • Early detection • Site • Size • Lymph node involvement • Gender • Staging • ? Molecular markers

  16. The management of oral carcinoma Teamwork Maxillofacial surgeons Oncologists Radiotherapists Speech therapists Oncology nurses Other personnel involved in rehabilitation Psychologist Specialists in palliative care

  17. The management of oral carcinoma • The treatment of choice depends on • Patient preference • Biological age • General health • Site • Staging of the tumour

  18. Management regimens for cancer must focus on • Longevity • Quality of life

  19. Mucositis Taste alteration Xerostomia 2ry infections Demineralization of teeth Hypersensitivity of teeth Radiation caries Osteo-radio-necrosis Trismus

  20. Oral Complications of Radiotherapy Early onset Late onset Direct damage to the mucosa End-arteritis obliterans • Direct damage of the ionizing radiation to the mucosal cells

  21. General complications of radiotherapy Hair loss Skin erythema Carotid stenosis Nausea Vomiting

  22. Management of radiation mucositis • Non-astringent mouth washes • Salt & water • Bicarbonate & water • Benzydamine hydrochloride • Miconazole oral gel • Soft and bland diet • Saliva substitute • Topical fluoride • Oral hygiene • Sugar-free diet

  23. Osteoradionecrosis End-arteritis obliterans

  24. Osteoradionecrosis - Prevention • Controlling the radiation dose • Radiation protection • Pre-radiation dental procedures • Avoid trauma • Antibiotic cover • Chlorhexidine MW

  25. Osteoradionecrosis-Management Debridement Antibiotics Hyperbaric oxygen therapy

  26. Hyperbaric oxygen therapy Allows more oxygen to reach the damaged tissue Helps prevent tissues from dying from lack of blood and oxygen flow Greater blood vessel formation Advanced wound healing Improved infection control Preservation of damaged tissue Elimination of toxic substances

  27. What is the role of dentists in the prevention of oral cancer? • Primary prevention • Tobacco cessation • Alcohol cessation • Dietary advice • Removing trauma • Identifying suspected lesions

  28. Secondary prevention (potentially malignant lesions) • Always screen entire oral mucosa • Recognize abnormalities (e.g. change of colour) • If candidal infection present, identify cause and treat • Refer any suspicious lesion to specialist, especially if there is no improvement within 2 weeks of removing possible causative factor

  29. Tertiary prevention (prevention of recurrence) • Regular review • Extraoral and intraoral examination • Low threshold for re-referral • Dietary advice (fresh fruit, vegetables) • Chemoprevention may play a role in the future

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