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Questions and Answers
What is one effective method for preventing oral cancer?
What is one effective method for preventing oral cancer?
- Use UV-AB-blocking sunscreen on the face (correct)
- Avoid regular dental check-ups
- Increase alcohol consumption
- Eat a diet high in processed foods
At what age should individuals begin having oral cancer screenings every three years?
At what age should individuals begin having oral cancer screenings every three years?
- After age 60
- At age 18
- At age 50
- Between ages 20 and 40 (correct)
What might be a recommended course of action for a patient with a newly noticed, non-painful neck swelling?
What might be a recommended course of action for a patient with a newly noticed, non-painful neck swelling?
- Perform a self-diagnosis before acting
- Consult a dentist for cosmetic solutions
- Ignore it as it will likely go away
- Refer to a medical doctor for evaluation (correct)
What dietary recommendation is suggested for oral cancer prevention?
What dietary recommendation is suggested for oral cancer prevention?
What is the recommended frequency for recall dental visits for patients with oral cancer?
What is the recommended frequency for recall dental visits for patients with oral cancer?
What is the most common type of cancer found in the oral mucosa?
What is the most common type of cancer found in the oral mucosa?
Which of the following risk factors is NOT associated with oral cancer?
Which of the following risk factors is NOT associated with oral cancer?
Which clinical manifestation is least likely to be associated with oral cancer?
Which clinical manifestation is least likely to be associated with oral cancer?
Which diagnostic method is primarily used to assess the tumor extent in oral cancer?
Which diagnostic method is primarily used to assess the tumor extent in oral cancer?
In which stage of oral cancer is the tumor size 2 centimeters or less?
In which stage of oral cancer is the tumor size 2 centimeters or less?
Which treatment option is typically used for inoperable oral tumors?
Which treatment option is typically used for inoperable oral tumors?
What is a common complication of treatment for oral cancer?
What is a common complication of treatment for oral cancer?
Which statement about HPV-positive tumors in oral cancer is accurate?
Which statement about HPV-positive tumors in oral cancer is accurate?
Which of the following is the most common type of oral cavity cancer?
Which of the following is the most common type of oral cavity cancer?
What is a significant risk factor associated with the development of oral cancer?
What is a significant risk factor associated with the development of oral cancer?
In the staging of oral cancer, what does T3 indicate about the tumor size?
In the staging of oral cancer, what does T3 indicate about the tumor size?
Which diagnostic method assesses the spread of the tumor?
Which diagnostic method assesses the spread of the tumor?
Which combination of treatments is typically used for oral tumors with local spread?
Which combination of treatments is typically used for oral tumors with local spread?
What is a common clinical manifestation of oral cancer?
What is a common clinical manifestation of oral cancer?
Which treatment might be employed for inoperable oral cancer tumors?
Which treatment might be employed for inoperable oral cancer tumors?
What complication can result from the treatment of oral cancer involving radiation?
What complication can result from the treatment of oral cancer involving radiation?
What is a recommended action for individuals aged 20 to 40 regarding oral cancer screening?
What is a recommended action for individuals aged 20 to 40 regarding oral cancer screening?
Which of the following lifestyle changes is least likely to contribute to preventing oral cancer?
Which of the following lifestyle changes is least likely to contribute to preventing oral cancer?
What is the most appropriate next step for a dentist observing a non-painful neck swelling in a 60-year-old man with a smoking history?
What is the most appropriate next step for a dentist observing a non-painful neck swelling in a 60-year-old man with a smoking history?
What is one of the recommendations for dental care in a patient diagnosed with oral cancer?
What is one of the recommendations for dental care in a patient diagnosed with oral cancer?
Which dietary practice is recommended as part of oral cancer prevention?
Which dietary practice is recommended as part of oral cancer prevention?
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Study Notes
Oral Cancer Definition
- Refers to malignant tumors in the oral mucosa, tonsils, and salivary glands
Epidemiology
- Peaks in incidence between 55-60 years old
- Occurs more in men than women (2:1)
- Most common head and neck cancer
Etiology
- Oral Mucosal Cancer: Most common type is squamous cell carcinoma (SCC)
- Usually presents as ulcerative or verrucous growths
- Salivary Gland Cancer: Primarily mucoepidermoid carcinoma
- Tonsillar Cancer: Most common type is SCC (>70%)
- Lymphoma is another type of tonsillar cancer
Risk Factors
- Tobacco Consumption
- Alcohol
- Chronic Mechanical Irritation: Badly positioned dentures
- Human Papillomavirus (HPV)
- Precancerous Lesions:
- Leukoplakia
- Erythroplakia
- Erythroleukoplakia
Clinical Manifestations
- Halitosis (Bad Breath)
- Pain
- Dysphagia (Difficulty Swallowing)
- Non-Healing Ulcer
- Unusual Bleeding in the Mouth
- Facial Swelling
- Lymphadenopathy (Swollen Lymph Nodes)
Stages
- T1: Tumor size ≤ 2 cm
- T2: Tumor size > 2 cm but ≤ 4 cm
- T3: Tumor size > 4 cm
Diagnostics
- Biopsy and Histopathology: Confirms diagnosis
- Panendoscopy: Evaluates tumor extent
- HPV Testing: Indicates presence of HPV infection
- Chest X-Ray & Axial CT Scan: Determine tumor spread
- PET-CT: Imaging tests for tumor diagnosis and staging
- Tumor Markers: Proteins or enzymes released by tumor cells
Management
- Localized Tumors
- Surgical Resection: Removal of tumor
- Tumors with Local Spread:
- Surgery: Usually involves neck dissection
- Radiation Therapy
- Chemotherapy: May be combined with surgery or radiation
- Inoperable Tumors:
- Radiation Therapy: Primary treatment option
- Adjuvant Chemotherapy: Used in conjunction with radiation
Surgical Procedures
- Maxillectomy: Removal of part of the upper jaw
- Mandibulectomy: Removal of part of the lower jaw
- Glossectomy: Removal of the tongue
- Laryngectomy: Removal of the larynx
- Neck Dissection: Removal of lymph nodes in the neck
Complications of Treatment
- Altered Oral Flora: Changes in the natural bacteria in the mouth
- Dysphagia: Difficulty swallowing
- Candida Infection
- Lymphedema: Swelling due to lymph fluid buildup
- Mucositis: Inflammation of the mucous membranes in the mouth
- Radiation Carries: Side effects of radiation therapy
- Stomatitis
- Trismus (Restricted Jaw Movement)
- Xerostomia (Dry Mouth)
Prognosis
- Early diagnosis and treatment usually result in a good curative rate.
- HPV-positive tumors are more responsive to chemo- and/or radiotherapy and have a better prognosis.
Oral Cancer Prevention
- Stop Smoking, Chewing Tobacco, and Waterpipe Use
- Stop Alcohol Consumption
- Sun Protection: UV-AB-blocking sunscreen on the face and sunblock
- HPV Vaccination
- Balanced Diet
- Regular Dental Check-ups:
- Ages 20-40: Oral cancer screening every 3 years
- Ages 40+: Annual oral cancer screenings
Dental Care for Patients with Oral Cancer
- Regular Recall Visits: Every 3-6 months
- Monitor for:
- Recurrence
- Progression
- Recognize:
- Complications of treatment
Practice Question
- Correct Answer: A. Referral to a medical doctor for further evaluation
- Explanation: The patient's symptoms require further investigation by a medical professional. A 5 cm neck swelling in a smoker is a significant finding, possibly indicating oral cancer or other serious health conditions.
References
- Harrison's Principles of Internal Medicine (20th Edition)
- Burkett's Oral Medicine (12th Edition)
Oral Cancer Definition
- Oral cancer refers to malignant tumors of the oral mucosa, tonsils, and salivary glands
Epidemiology
- Peak incidence is between 55-60 years old
- Men are affected more often than women (2:1 ratio)
- Most common form of head and neck cancer
Etiology
- Oral mucosal cancer: Most common type is squamous cell carcinoma which presents as ulcerative or verrucous growth
- Salivary gland cancer: Most common type is mucoepidermoid carcinoma
- Tonsillar cancer: Most common type is squamous cell carcinoma (>70%) and lymphoma
Risk Factors
- Tobacco consumption
- Alcohol consumption
- Chronic mechanical irritation (e.g., badly positioned dentures)
- Human papillomavirus (HPV)
- Precancerous lesions such as leukoplakia, erythroplakia, and erythroleukoplakia
Clinical Manifestations
- Halitosis (bad breath)
- Pain
- Dysphagia (difficulty swallowing)
- Non-healing ulcer
- Unusual bleeding in the mouth
- Facial swelling
- Lymphadenopathy (swollen lymph nodes)
Oral Cancer Stages
- Stage T1: Tumor in the mouth is 2 centimeters or less
- Stage T2: Tumor is 2 centimeters or more but not larger than 4 centimeters
- Stage T3: Tumor is larger than 4 centimeters
Diagnostics
- Biopsy and histopathology of the lesion
- Panendoscopy to assess tumor extent
- HPV testing
- Chest x-ray and axial CT scan to assess tumor spread
- Positron emission tomography-computed tomography (PET-CT) scan
- Tumor markers
Management
- Localized tumor: Surgical resection
- Tumors with local spread: Surgery (usually with neck dissection) plus radiation therapy, with or without chemotherapy
- Inoperable tumors: Radiation therapy with adjuvant chemotherapy
Surgical Procedures
- Maxillectomy (removal of the upper jaw)
- Mandibulectomy (removal of the lower jaw)
- Glossectomy (removal of the tongue)
- Laryngectomy (removal of the larynx)
- Neck dissection (removal of lymph nodes in the neck)
Complications of Treatment
- Altered oral flora
- Dysphagia (difficulty swallowing)
- Candida infection (yeast infection)
- Lymphedema (swelling due to lymphatic fluid buildup)
- Mucositis (inflammation of the mucous membranes)
- Radiation caries (tooth decay due to radiation)
- Stomatitis (inflammation of the mouth)
- Trismus (difficulty opening the mouth)
- Xerostomia (dry mouth)
Prognosis
- Early diagnosis and treatment generally result in a good cure rate.
- HPV-positive tumors have a better prognosis as they respond better to chemo- and/or radiotherapy.
Oral Cancer Prevention
- Stop smoking, chewing tobacco, and using water pipes
- Stop drinking alcohol
- Use UV-AB-blocking sunscreen on the face and sunblock
- Get vaccinated for human papillomavirus (HPV)
- Eat a balanced diet
- Have regular dental check-ups
- People aged 20-40 should have an oral cancer screening every three years and annual exams after age 40.
Dental Care for Patients with Oral Cancer
- Regular recall visits (every 3-6 months)
- Monitor for:
- Disease recurrence
- Disease progression
- Recognize complications of treatment
Practice Question
- A 60-year-old man with a long history of smoking presents to the dental clinic for routine scaling. The dentist notices a 5 cm painless neck swelling that the patient didn't notice before.
- The best course of action is to refer the patient to a medical doctor for further evaluation.
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