Transcript Malignant Tumors

Tumours of the Jaws
Dr Abdin
Malignant Tumors
Tumor:
– Is a mass of cells,
tissues or organs
resembling those
normally present
but arranged
atypically and
behave abnormally.
Behavior is very
essential and is of
great importance.
Malignant Tumors
Classification:
–
Histogenetic:
Epithelial origin
connective tissue
origin
–
Histological:
Degree of
differentiation.
–
–
–
Well
moderate
poorly differentiated
Malignant Tumors
– Clinical behavior:
Benign:
– slowly growing and expanding causing pressure atrophy
but remain within the capsule.
– Very few mitosis could be seen.
Malignant:
– Invade surrounding tissues and locally invasive.
– Progressive growth and metastasize to distant organs,
embolic spread due to lack of cell adhesion
– Mitosis.
Intermediate:
– Locally invasive, no metastasis. Basal cell carcinoma
and Ameloblastoma
Malignant Tumors
Oral lesion are:
– Carcinomas:
Non-secreting epithelial
– Squamous cell
90%
Secreting epithelial
– Adenocarcinoma
5%
– Sarcomas:
Lymphomas
Others
Malignant Tumors
Early diagnosis is very essential for
management
Clinical diagnosis from the signs and
symptoms
Referral for essential investigation
Malignant Tumors
CLINICAL DIAGNOSIS OF ORAL CANCER
– Symptoms vary according to the site of the lesion
painless in the early stages
painful and tender when secondarily infected or involves
a sensory nerve
painless lump or ulcer on the lip
Posteriorly no symptom until it reach a size of 2-3 cm
swelling,
– pain and difficulty in deglutition
absence of symptoms until the tumor metastasize to
regional lymph nodes
– hard lump on the neck
Malignant Tumors
late symptoms:
–
–
–
–
pain due to secondary infection or nerve involvement
excessive salivation
difficulty in deglutition, speech
haemorrhage
Within bone:
– painless swelling involving the buccal and lingual or
palatal sulci
– teeth become loose and painful -acute alveolar
abscess
– edentulous pt. the denture does not fit
– denture hyperplasia
– anaesthesia of the upper or lower lip and the cheek.
Malignant Tumors
Carcinoma of lip:
age 50-70 years. Male
lower class.
– Predisposition factor:
dirty, jagged and stained
teeth
irritation.
tobacco smoker
leukoplakia.
intense solar
radiation - blistering
cheilitis due to sunshine.
Lower lip affected in
93%
Upper lip affected in 5%
Angle of mouth affected
in 2%
Metastases within a
year - submental,
submandibular and
upper jugular.
D.D.:
– Molluscum pseudocarcinomatosurn lower lip.
Death due to infection and
bronchopneumonia.
Malignant Tumors
Carcinoma of tongue
Anterior 2/3, affect males
Posterior 1/3 equal in both sexes.
Age over 60 years.
– Predisposing factors:
Female with cancer tongue suffer from Paterson-Kelly
syndrome.
Bad oral hygiene
Heavy alcoholic with element of Vit.B deficiency. Producing
precancerous mucosal atrophy
Syphilitic and leukoplakia. 25% and 5%.
Superficial glossitis, papilloma, fissures and non-specific
ulcers.
Malignant Tumors
Site & Types:
–
–
–
–
1. lateral edge of tongue 58%
2. tip of tongue
2-4%
3. dorsum. of tongue
7-15%
4. posterior 1/3
21-33%
1. ulcerative
2. fissured malignant
3. papillary
4. flat nodules
5. scirrhous or atrophic type
Malignant Tumors
Clinically:
– Painless swelling
– Painful infected ulcer, referred pain to the
ear.
– Excessive salivation, marked factor oris,
haemorrhage
– loss of mobility due to fixation to the floor
of the mouth.
Malignant Tumors
– Fixation occur at first on one side, when tongue
is protruded it deviate toward the affected side
– indurations, fungation or ulceration which spread
to the floor of the mouth and alveolar process
and from post. 1/3 to the fauces, valleculae and
epiglottis bilaterally.
– Spread to regional lymph nodes.
– Death: Inhalation bronchopneumonia,
haemorrhage, cachexia and starvation and
asphyxia.
Malignant Tumors
Carcinoma of the mouth:
– Floor of the mouth.
Typical malignant ulcer extend to alveolar process
& tongue.
– The cheek:
warty and proliferative.
– The alveolar process:
warty, nodules or proliferative.
Malignant Tumors
– Palate:
spread extensively before involving bone papillary
or ulcerative.
– Soft palate and fauces:
Poor prognosis. bilateral Lymph node involvement
Proliferative, fungating lesion spread to base of
tongue.
Pain, dysphagia and death due to erosion of
carotid artery
Malignant Tumors
Malignant neoplasm of antrum:
– Squamous cell carcinoma 93% of cases.
– Infiltrate soft tissue, destroys bone, fungate
either through cheek, mouth or pharynx.
– Spread to deep upper cervical lymph nodes.
Adenocarcinoma
lympho-epithelioma
sarcoma rare
Malignant Tumors
Clinically:
– earliest symptom:
unilateral sera-sanguineous discharge or frank
epistaxsis in elderly.
unilateral swelling of cheek, buccal sulcus or
palate
dislodging denture, loose Painful and periostitic
teeth &alveolar abscesses
Denture hyperplasia or granuloma.
Malignant Tumors
Anaesthesia of cheek due to involvement of
infra orbital nerve.
Anaesthesia and/or paraesthesia of the
palate due to involvement of sphenopalatine
ganglion
Malignant Tumors
– Medial spread:
occlusion of nasolacrimal duct (epiphora)
blocked nostril and blood-stained discharge of pus
– Superior spread:
Eye is proptosed and with involvement of Ms & Ns
strabismus, limitation of movement, diplopia
– Trismus due to involvement of medial pterygoid
muscle.
– Pain due to secondary infection.