Diagnosis of Oral Cancer 1446 PDF

‫المملكة العربية السعودية‬ ‫وزارة التعليم‬ ‫جامعة نجران‬ ‫كلية طب األسنان‬ Diagnosis of oral...

‫المملكة العربية السعودية‬ ‫وزارة التعليم‬ ‫جامعة نجران‬ ‫كلية طب األسنان‬ Diagnosis of oral cancer shahad Mohammad Al sari] 2024 - 1446 ‫العام‬ Prepared by Doaa Adel Habba Assistant Professor of Oral Pathology Department of oral and maxillofacial surgery and diagnostic science  Cancer Neoplasm  Definition: An abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after  Cancer A new mass of tissue, the growth of which: 1.Independent= spontaneous, autonomous 2.Capable of unlimited proliferation 3.Exceeds and uncoordinated Potential ly Malignan t Oral Lesions (PMOL): 10/30/2024 Asst Prof. Doaa Adel 21/04/46  Types of intraoral malignancies 1- Tumors originate from surface epithelium: a. Squamous cell carcinoma(most common type 90-95%). b. Melanoma 2- Tumors originate from glandular tissues : a. Adenocarcinoma. b. Adenoid cystic carcinoma. c.Mucoepidermoid carcinoma. 3- Tumors originate from mesenchymal tissues: d. Sarcoma (osteosarcoma, chondrosarcoma, fibrosarcoma). e. Lymphoma. Asst Prof. Doaa Adel 20/04/46 Clinical Assessment: 1. Risk Factor Assessment (Etiology). 2. Extra-Oral Examination. 3. Intra-Oral Examination. 4. Abnormal Examination Findings. 5. Diagnosis. 6. Referral & Surveillance. Asst Prof. Doaa Adel 21/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 21/04/46  Extra-Oral Examination Asst Prof. Doaa Adel 21/04/46 Asst Prof. Doaa Adel 20/04/46  Intra-Oral Examination Asst Prof. Doaa Adel 21/04/46 6a. Erythroleukoplakia involving the right buccal mucosa. The red changes are subtle and the white changes are non-homogeneous and >2cms. There are two areas of involvement (anterior and posterior). The toluidine blue staining is positive and there is equivocal loss of autofluorescence. The anterior lesion was a squamous cell carcinoma, and posterior lesion was severe epithelial dysplasia. 6b. Erythroleukoplakia with ulceration left lateral tongue. Multiple biopsies revealed moderate dysplasia to carcinoma-in-situ. Note positive toluidine blue and loss of autofluoresence. 6c.Leukoplakia left floor of mouth. The lesion is slightly raised and firm. The toluidine blue staining is strongly positive and the autofluorescence is equivocal. This was a squamous cell carcinoma. 6d. Erythroleukoplakia palate. Also note the non homogeneous pigmented lesion anteriorly. There is a strong loss of autofluorescence associated with the erythroleukoplakia, the pigmented area, and patchy loss on the patient’s right of the pigmented area. Biopsy of the toluidine blue stained area revealed a squamous cell carcinoma. The pigmented area was a benign melanotic macule, and biopsy of the patchy loss of autofluorescence revealed moderate epithelial dysplasia. 7a. Leukoplakia left buccal mucosa. There were no apparent traumatic etiologies. Biopsy revealed mild epithelial dysplasia. 7b. Leukoplakia left maxillary buccal gingivae stretching onto the alveolar mucosa. Note fissured surface. Biopsy revealed verrucous hyperplasia and with mild dysplasia. 7c. Leukoplakia left palate. Biopsy revealed epithelial hyperkeratosis/hyperplasia. Autofluorescence and toluidine blue staining were negative. 7d. Leukoplakia left lateral tongue. This lesion was originally thought to be a frictional keratosis. The teeth were polished and the patient, who was on a number of xerogenic medications, was placed on dry mouth products. The lesion persisted and was classified as a leukoplakia. Biopsy revealed epithelial hyperkeratosis and hyperplasia. The patient is on surveillance. Asst Prof. Doaa Adel 20/04/46 Orthopantomograph showing ill-defined destruction of bone with ragged borders in the anterior portion of the mandible. Asst Prof. Doaa Adel 21/04/46 Orthopantomograph showing extensive destruction of bone in the anterior portion of the mandible extending to the molars on either side. Blue arrow indicates thinning of the lower cortical plate. White arrows show ‘teeth floating in space’. Asst Prof. Doaa Adel 21/04/46 Asst Prof. Doaa Adel 20/04/46 Excisional biopsy Asst Prof. Doaa Adel 21/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 21/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 21/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 5a. Stage IV (T4N2bM0) squamous cell carcinoma involving lateral tongue, floor of mouth, and alveolar ridge. This cancer was nodular and indurated. Note the friability (bleeding upon slight provocation) which demonstrates that cancer cells are not cohesive and there is a production of angiogenic factors leading to increased vascularity. 5b. Stage 1 (T2N0M0) squamous cell carcinoma involving the buccal mucosa. This patient complained of biting her cheek. The lesion measures slightly more than 2cm diameter. Note the solitary ulceration with rolled borders. What makes this a highest risk lesion is the palpable induration and deep ulceration. 5c. Stage III (T2N1M0) squamous cell carcinoma involving the floor of mouth. The mass is indurated and painful to palpation. There is submental lymphadenopathy. Note the surface shows mixed red white changes and is friable. 5d. This patient presents with a hard, fixed, non-tender mass in the lateral neck. Radiographically, there is extra-capsular spread of the Asst Prof. Doaa Adel 21/04/46 lymph node, a poor 5a. Stage IV (T4N2bM0) squamous cell carcinoma involving lateral tongue, floor of mouth, and alveolar ridge. This cancer was nodular and indurated. Note the friability (bleeding upon slight provocation) which demonstrates that cancer cells are not cohesive and there is a production of angiogenic factors leading to increased vascularity. 5b. Stage 1 (T2N0M0) squamous cell carcinoma involving the buccal mucosa. This patient complained of biting her cheek. The lesion measures slightly more than 2cm diameter. Note the solitary ulceration with rolled borders. What makes this a highest risk lesion is the palpable induration and deep ulceration. 5c. Stage III (T2N1M0) squamous cell carcinoma involving the floor of mouth. The mass is indurated and painful to palpation. There is submental lymphadenopathy. Note the surface shows mixed red white changes and is friable. 5d. This patient presents with a hard, fixed, non-tender mass in the lateral neck. Radiographically, there is extra-capsular spread of the lymph node, a poor prognostic sign. A fine need aspiration revealed squamous 10/30/2024 cell carcinoma and the primary cancer was discovered in the floor of mouth. Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46 Asst Prof. Doaa Adel 20/04/46