Wednesday, 2 November 2011

oral cancer

Oral Carcinoma

Oral Cancer
Oral carcinoma is one of the most prevalent cancers & is one of the 10 major cause of death. Majority of oral carcinomas are squamous cell carcinomas. it is disease of increasing age with 95%cases in people older then 40 years of age.
Cancer is a commonly used term for all malignant tumors. In Latin language, cancer means crab which has a fat main body and mass extention which springs and invade the surrounding tissues.
Tumor is an autonomous new growth of tissue or it is an abnormal mass of tissue the growth of which exceedds and is uncoordinated with that of normal tissue and persists in the same excessive manner even after the cessation of stimuli which evoked the changes.

Characteristic of malignant lesion

  • Lesion body- they exhibit ill defined borders which are very irregular and ragged
  • rapid growth- it increase in size very rapidly
  • Metastasis- they always metastasize either by direct spread, by lymphatics or through bloodstream
  • Adjacent cortical bone- grows by invasion & cause destruction of adjacent structures. bony cortex will be destroyed rather than expand.
  • Radiodensity-Radiolucent or may be mixed
  • Dental involvement- root intact & tooth in position

symptoms of oral cancer

Oral cancer may start as a sore or lump in the mouth that does not go away. Problems with eating, swallowing and talking may occur, and the sense of taste may be altered. Lymph nodes in the neck may be enlarged and unexplained weight loss may occur.

Common symptoms of oral cancer

Common symptoms of oral cancer include:
  • Altered sense of taste
  • Bleeding
  • Cracking of an area of the mouth
  • Difficulty eating or swallowing
  • Difficulty talking
  • Lump that does not go away
  • Nonhealing sore, which may be white, pale, red, dark, or otherwise discolored
  • Oral pain
  • Swollen lymph nodes in the neck
  • Thickened area in the mouth
  • Etiology and risk factors for oral cancer

    some risk factors are

    Actinic radiation

    • It is a minor etiologic factor in case of lip cancer.
    • lip cancer occurs more commonly in fair skinned people who are generally engaged in outdoor occupation, such as farming, fishing

    Familial & genetic

    • there is little evidence
    • lip cancer is amongst the sites which show strongest cancer clustering with in families. but it also reflects the fact that families tend to have same occupation,i.e farming, which is related with ultraviolet exposure
    • it is more prevalent in black as compared to white

    atmospheric pollution

    • difference in incidence in part of rural & urban have been related to atmospheric pollution
    • SULPHUR DIOXIDE AND SMOKE CONCENTRATION IN THE ATMOSPHERE ARE POSITIVELY CORRELATED WITH SQUAMOUS CANCER OF LARYNX & PHARYNX
    • Blue collar workers exposed to dust or inhalation of organic agents are at increased risk of cancer of mouth

    Orodental factors

    more prevalent in patients with poor oral hygiene,faulty restorations, sharp teeth, ill fitting dentures and those with syphilitic glossitis

    Immunity

    • Increasing incidence is age related, which may reflect declining immune surveillance with age
    • It may occur in immunosuppressed patients following organ & bone marrow transplantation.
    • HIV/AIDS patent are at increased risk of oral cancer

    Tobacco use

    Smokeless tobacco

    It contains potent carcinogens like nitrosamine, polycyclic hydrocarbons and polonium & metabolites of these constituents have been suggested etiologic factor in oral cancer

    Common forms of oral smokeless tobacco

    • Pan/betel quid- it contains areca nut, betel nut, betel leaf, slaked lime, catechu, condiments with or with out tobacco
    • Khaini- contains tobacco & lime
    • Mishri- it is burned tobacco
    • Zarda- boiled tobacco
    • Gadakhu- Tobacco & molasses
    • Mawa- tobacco, lime, & areca
    • Nass- tobacco, ash, cotton or sesame oil
    • Naswar/Niswar- Tobacco ,lime, indigo, cardamom oil, & menthol
    • Shammah- tobacco, ash, & lime
    • Toombak- tobacco & sodium bicarbonate

    Smoking tobacco

    • Tobacco smoke contains carbon monoxide.It ia an important factor in the development of oral cancer
    • smoking is strongly associated with soft palate cancer than anterior sites

    Alcohol

    • All forms of alcohol
    • Beverage congeners include nitrosamines & impurities which can act as carcinogens.

    Syphilis

    it is associated with oral cancer

    Diet Deficiency & Deficiency status

    The relationship between sideropenic dysphagia & oral cancer is well established

    Ionizing Radiation

    Carcinoma of buccal mucosa may occur as complication of long term radiotherapy

    Trauma

    Trauma in combination with other factors like chronic cheek biting, denture use & irregular teeth may act as as co-carcinogen & may promote transformation of epithelial cells

    Intraoral Lesions

    • Chronic ulceration & fissure
    • Lichen planus
    • Cansidosis
    • Leukoplakia
    • Median rhomboid glossitis
    • plummer-vinson syndrome
    • Submucus fibrosis
    • Oral melanosis
    • Discoid Lupus erythematosus
    • Epidermolysis bullosa

    Treatment

    Treatment of oral cancer begins with seeking regular medical care throughout your life, including regular dental care. Regular medical care allows a health care professional to provide early screening tests. Regular medical care also provides an opportunity for your health care professional to promptly evaluate symptoms and your risks for developing oral cancer.
    The goal of oral cancer treatment is to permanently cure the cancer or to bring about a complete remission of the disease. Remission means that there is no longer any sign of the disease in the body, although it may recur or relapse later.

    Common treatments for oral cancer

    Common treatments for oral cancer include:

    • Chemotherapy to attack cancer cells
    • Participation in a clinical trial that is testing promising new therapies and treatments for oral cancer
    • Radiation therapy to attack cancer cells
    • Surgery to remove the cancer and evaluate how far it has spread

    Other treatments for oral cancer

    Other therapies may be added to help with your general state of health and any side effects of cancer treatment:
    1. Antinausea medications if nausea occurs
    2. Blood cell growth factors to increase the number of white blood cells if these get too low
    3. Blood transfusions to temporarily replace blood components (such as red blood cells) that have dropped to low levels
    4. Dietary counseling to help maintain strength and nutritional status
    5. Reconstructive surgery to restore structures that have been removed
    6. Occupational and physical therapy to help with eating, swallowing, or talking problems
    7. Pain medications as needed to increase comfort

    Complementary treatments

    Some complementary treatments may help some people to better deal with oral cancer and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments

    Complementary treatments may include:
    1. Acupuncture
    2. Massage therapy
    3. Yoga
    4. Ayurvedic treatment

    potential complications of oral cancer

    Complications of untreated oral cancer can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of oral cancer include:
    • Decreased ability to eat, drink, talk or breathe
    • Hemorrhage (uncontrolled bleeding)
    • Recurring cancer after treatment
    • Spread of cancer into nearby structures
    • Spread of cancer to distant areas of the body
    • Spread of cancer to lymph nodes in the neck

    Hospice care

    In cases in which oral cancer has progressed to an advanced stage and has become unresponsive to treatment, the goal of treatment may shift away from curing the disease and focus on measures to keep a person comfortable and maximize the quality of life. Hospice care involves medically controlling pain and other symptoms while providing psychological and spiritual support as well as services to support the patient's family.

oral cancer

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