Epithelial malignancies CHI (Recovered).pdf

V20 EPITHELIAL MALIGNANCIES Angela Chi, DMD Professor [email protected] taking photos or video recording during this live class session is not permitted ...

V20 EPITHELIAL MALIGNANCIES Angela Chi, DMD Professor [email protected] taking photos or video recording during this live class session is not permitted  Learning Objectives Discuss the epidemiology, etiopathogenesis, clinical features, staging, management, and prognosis of epithelial malignancies involving the oral, head and neck region. Compare and contrast squamous cell carcinomas arising in the oral cavity and oropharynx. Discuss oral health considerations and side effects for patients receiving antineoplastic therapy.  ORAL CANCER ~95% of oral cancers are squamous cell carcinoma (SCC) TERMINOLOGY  “Oral” lip vermilion oral cavity proper (oro)pharynx  Anatomy Oral Cavity Lip Vermilion Oral Cavity Oropharynx Fig 8.53 Agur AMR et al. Moore's Essential Clinical Anatomy. Available from VitalSource Bookshelf, (6th Edition). Wolters Kluwer Health, 2018.  Anatomic Subsites prognosis has better ORAL CAVITY: OROPHARYNX: Hard palate Soft palate Anterior 2/3 of tongue Posterior 1/3 (base) of tongue Labial mucosa Palatine tonsils Buccal mucosa Palatoglossal folds Floor of mouth Valleculae Alveolar ridge/gingiva Posterior pharyngeal wall Retromolar trigone EPIDEMIOLOGY  Oral SCC: Epidemiology M>F, risk increases with age https://seer.cancer.gov/statfacts/html/oralcav.html ETIOLOGY  Oral SCC: Etiology Extrinsic factors: Intrinsic Factors: tobacco* nutritional deficiencies (Fe, vitamin A) EtOH* immunosuppression betel quid genetic mutations (e.g., TP53, RB1, sunlight (lip vermilion)* CDKN2A, RAS, MYC, EGFR, x-irradiation PIK3CA) microbiome dysbiosis, syphilis oncogenic viruses—e.g., HPV 16* CLINICAL FEATURES  Oral SCC Morphology: outward – Exophytic grows mucosa – Endophytic growsinto plague broad base – Leukoplakic White – Erythroplakic or erythroleukoplakic I redplace red3 whiteplane +/- pain, induration, destruction of underlying bone, paresthesia Nicolás Bolesina, Fabián L. Femopase, Silvia A. López de Blanc, Rosana A. Morelatto and María Alicia Olmos (March 14th 2012). Oral Squamous Cell Carcinoma Clinical Aspects, Oral Cancer, Kalu U. E. Ogbureke, IntechOpen, DOI: 10.5772/32968. Available from: https://www.intechopen.com/chapters/31751 Creative Commons Attribution 3.0 Unported License (CC BY 3.0) EXOPHYTIC  erythroleukoplakia Ramos GO, Meyer Gd, Visioli F, Manoela MD, Oliveira MG. Carcinoma cuniculatum in the tongue of a patient with oral lichen planus: Unusual presentation. Indian J Dent Res [serial online] 2018 [cited 2021 Sep 7];29:525-8. Available from: https://www.ijdr.in/text.asp?2018/29/4/525/239384 Creative Commons Attribution-NonCommercial- ShareAlike License (CC BY-NC-SA erythroplakia Fig 15.4 Kumar V, et al. Robbins Basic Pathology E-Book. Available from: VitalSource Bookshelf, (10th Edition). Elsevier Limited (UK), 2017. Credé A, Locher M, Bredell M. Tongue cancer in young patients: case report of a 26-year-old patient. Head Neck Oncol. 2012;4:20. Published 2012 May 14. doi:10.1186/1758-3284-4-20 Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0) erythroleukoplakia texophytic  leukoplakia Ligia Buloto Schmitd, Kellen Cristine T jioe, Agnes Assao and Denise T ostes Oliveira (July 8th 2015). Oral Squamous Cell Carcinoma in Young Population — Risk Factors, Clinical Presentation, and Prognosis, Contemporary Issues in Head and Neck Cancer Management, Loredana G. Marcu, IntechOpen, DOI: 10.5772/60712. Available from: https://www.intechopen.com/chapters/48574. Creative Commons Attribution 3.0 Unported License (CC BY 3.0)  Oral Cavity SCC high-risk sites = tongue (esp. posterior lateral and ventral) and floor of mouth https://commons.wikimedia.org/wiki/File:NIH_DOC_9_TongueLeftMargin.jpg BodyParts3D/Anatomography, Public domain, via Wikimedia Commons other sites: gingiva, buccal mucosa, labial mucosa, hard palate Alan Hoofring (Illustrator), Public domain, via Wikimedia Commons; https://commons.wikimedia.org/wiki/File:Mouth_and_tongue.jpg  Lip Vermilion SCC ~90% lower lip chronic UV light exposure light-skinned relatively slow growing mets late (3-6cm cm with DOI >10 mm or tumor N2b=multiple ipsilateral nodes (none >6cm) >4cm with DOI up to 10mm N2c=bilateral or contralateral nodes (none>6cm) T4a invades cortical bone, deep N3=massive node (>6 cm) extrinsic tongue muscle, mx sinus, facial skin T4b invades masticator space, pterygoid plates, skull base, ICA (unresectable)  TNM Categories for HPV-positive OPSCC* T CLINICAL N M T1=primary tumor 2 cm but 1 regional ipsilateral M1=distant mets nodes 4 cm or extension N2=mets to contralateral or to lingual surface of epiglottis bilateral nodes 6 cm pterygoid, hard pal,, mand,, or beyond *Amin MB, Edge SB, Greene FL, et al, editors. American Joint Committee on Cancer staging manual. 8th ed. New York: Springer; 2017.  TNM Categories for HPV-negative OPSCC* T CLINICAL N M T1=primary tumor 2 cm but 3 but