Transcript 8 Oral cancer

Oral cancer
Oral cancer is a subtype of head and
neck cancer, is any cancerous tissue
growth located in the oral cavity.
Signs and symptoms
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Skin lesion, lump, or ulcer that do not resolve in 14 days located:
On the tongue, lip, or other mouth areas
Usually small
Most often pale colored, be dark or discolored
Early sign may be a white patch (leukoplakia) or a red patch
(erythroplakia) on the soft tissues of the mouth
• Usually painless initially
• May develop a burning sensation or pain when the tumor is advanced
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Additional symptoms that may be associated with this disease:
Tongue problems
Swallowing difficulty
Mouth sores
Pain and paraesthesia are late symptoms.
Leukoplakia
• Leukoplakia is a clinical term used to describe
patches of keratosis. It is visible as adherent
white patches on the mucous membranes of the
oral cavity, including the tongue, but also other
areas of the gastro-intestinal tract, urinary tract
and the genitals. The clinical appearance is highly
variable. Leukoplakia is not a specific disease
entity, but is diagnosis of exclusion. It must be
distinguished from diseases that may cause
similar white lesions, such as candidiasis or lichen
planus. The lesions of leukoplakia cannot be
scraped off easily
The white lesion is an example of
leukoplakia.
Incidence and prevalence
• Leukoplakic lesions are found in approximately
3% of the world's population. Like
erythroplakia, leukoplakia is usually found in
adults between 40 and 70 years of age, with a
2:1 male predominance.
Causes
• Leukoplakia is primarily caused by the use of
tobacco. Other possible etiological agents
implicated are HPV, Candida albicans and possibly
alcohol. Simultaneously serum levels of patients
with leukoplakia were found to be low in Vit A,B12,C & folic acid,in a study conducted in India.
Most result from chronic irritation of mucous
membranes by carcinogens.[citation needed]
Bloodroot, otherwise known as sanguinaria, is
also believed to be associated with leukoplakia
Treatment
• The treatment of leukoplakia mainly involves
avoidance of predisposing factors — tobacco cessation,
smoking, quitting betel chewing, abstinence from
alcohol — and avoidance of chronic irritants, e.g., the
sharp edges of teeth. A biopsy should be done, and the
lesion surgically excised if pre-cancerous changes or
cancer is detected.
• Taking beta-carotene orally seems to induce remission
in patients with oral leukoplakia. Further research is
needed to confirm these results
Squamous cell papilloma
• A Squamous cell papilloma is a generally
benign papilloma that arises from the
stratified squamous epithelium of the skin, lip,
oral cavity, tongue, pharynx, larynx,
esophagus, cervix, vagina or anal
canal.Squamous cell papillomas are a result of
infection with human papillomavirus (HPV).
Oral squamous cell papilloma
• Squamous cell papilloma of the mouth or throat
is generally diagnosed in people between the
ages of 30 and 50, and is normally found on the
inside of the cheek, on the tongue, or inside of
lips. Oral papillomas are usually painless, and not
treated unless they interfere with eating or are
causing pain. They do not generally mutate to
cancerous growths, nor do they normally grow or
spread. Oral papillomas are most usually a result
of the infection with types HPV-6 and HPV-11
Treatment
• While most cases require no treatment,
therapy options include cryotherapy,
application of a topical salicylic acid
compound, surgical excision and laser
ablation.
Squamous Papilloma
Quick Review
• The papilloma is a benign mucosal mass produced by a
strain of the papillomavirus, the virus which produces
skin warts. It seldom is large but may become a couple
of centimeters across. It is painless, usually white but
sometimes pink, and has long or short surface
projections with rounded or pointed ends. It often is
on a stalk and only one lesion is usually found. Once
present, it remains indefinitely. In the throat a similar
lesion may occasionally go on to cancer, but in the
mouth this has never been reported. The papilloma is
not contagious, like a wart, and can be removed by
conservative surgery or laser destruction.
Keratoacanthoma
• Keratoacanthoma (KA) is a common low-grade
(unlikely to metastasize or invade) skin tumour
that is believed to originate from the neck of
the hair follicle.
Keratoacanthoma.
Etiology
• The tumors usually occur in older individuals
(mean age 64 years old). Like squamous cell
cancer, data suggests ultraviolet light from the
sun causes the development of KA.[9] Just like
its close relative, the squamous cell cancer,
sporadic cases have been found co-infected
with the human papilloma virus (HPV)
Diagnosis
• Diagnosis is best done with clinical exam and
history. It presents as a fleshy, elevated and
nodular lesion with an irregular crater shape
and a characteristic central hyperkeratotic
core. Usually the patient will notice a rapidly
growing dome-shaped tumor on sun-exposed
skin
Skin keratoacanthoma whole slide.
Treatment
• On the trunk, arms, and legs, electrodesiccation and
curettage often suffice. Excision of the entire lesion is often
required if one wants to confirm the clinical diagnosis of
keratoacanthoma. On the nose and face, Mohs surgery
allows for good margin control with minimal tissue
removal; unfortunately, many insurance companies require
the correct diagnosis of a malignancy before allowing such
procedure. Recurrence after electrodesiccation and
curettage is common, and usually can be identified and
treated promptly with either further curettage or surgical
excision. Allowing the KA to grow and necrose
spontaneously is not acceptable in today's standard of care.
Bowen's disease
• Bowen's disease (BD) (also known as
"squamous cell carcinoma in situ"[1]:655) is a
neoplastic skin disease, it can be considered
as an early stage or intraepidermal form of
squamous cell carcinoma. It was named after
Mark Bowen. Erythroplasia of Queyrat is a
form of squamous cell carcinoma in situ
arising on the glans or prepuce, possibly
induced by HPV
Bowen's disease as seen under a
microscope
Causes
• Causes of BD include solar damage, arsenic,
immunosuppression (including AIDS), viral
infection (human papillomavirus or HPV) and
chronic skin injury and dermatoses.
Signs and symptoms
• Bowen's disease typically presents as a gradually
enlarging, well demarcated erythematous plaque
with an irregular border and surface crusting or
scaling. BD may occur at any age in adults but is
rare before the age of 30 years - most patients
are aged over 60. Any site may be affected,
although involvement of palms or soles is
uncommon. BD occurs predominantly in women
(70-85% of cases). About 60-85% of patients have
lesions on the lower leg, usually in previously or
presently sun exposed areas of skin.
Histology
• Bowen's disease is essentially equivalent to
squamous cell carcinoma in situ. Atypical
squamous cells proliferate through the whole
thickness of the epidermis. The entire tumor is
confined to the epidermis and does not invade
into the dermis. The cells in Bowen's are often
highly atypical under the microscope, and may
in fact look more unusual than the cells of
some invasive squamous cell carcinomas.
Treatment
• Photodynamic therapy (PDT), Cryotherapy
(freezing) or local chemotherapy (with 5fluorouracil) are favored by some clinicians over
excision. Because the cells of Bowen's disease
have not invaded the dermis, it has a much better
prognosis than invasive squamous cell carcinoma.
Outstanding results have been noted with the use
of imiquimod for Bowen's disease of the skin,
including the penis (erythroplasia of Queyrat),
although Imiquimod is not FDA approved for the
treatment of squamous cell carcinoma
Additional images
Actinic keratosis
• Actinic keratosis (also called "solar keratosis" and
"senile keratosis") is a premalignant condition of
thick, scaly, or crusty patches of skin.:719 It is
more common in fair-skinned people. It is
associated with those who are frequently
exposed to the sun, as it is usually accompanied
by solar damage. Since some of these pre-cancers
progress to squamous cell carcinoma,they should
be treated. Untreated lesions have up to twenty
percent risk of progression to squamous cell
carcinoma
Actinic keratosis on the lip
Classification
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Hyperkeratotic actinic keratosis
Pigmented actinic keratosis
Lichenoid actinic keratosis
Atrophic actinic keratosis
Prevention
• Not staying in the sun for long periods of time
without protection (e.g., sunscreen, clothing,
hats).
• Frequently applying powerful sunscreens with
SPF ratings greater than 30 and that also block
both UVA and UVB light.
• Wearing sun protective clothing such as hats,
long-sleeved shirts, long skirts, or trousers.
• Avoiding sun exposure during noon hours is very
helpful because ultraviolet light is the most
powerful at that time.
Diagnosis
• Doctors can usually identify AK by doing a
thorough examination. A biopsy may be
necessary when the keratosis is large and/or
thick, to make sure that the bump is a
keratosis and not a skin cancer. Seborrheic
keratoses are other bumps that appear in
groups like the actinic keratosis but are not
caused by sun exposure, and are not related
to skin cancers. Seborrheic keratoses may be
mistaken for an actinic keratosis
Histopathology
• Actinic keratosis usually shows focal parakeratosis
with associated loss of the granular layer, and
thickening of the epidermis. The normal ordered
maturation of the keratinocytes is disordered to
varying degrees, there may be widening of the
intracellular spaces, and they may also have some
cytologic atypia, such as abnormally large nuclei.
The underlying dermis often shows severe actinic
elastosis and a mild chronic inflammatory
infiltrate
Treatment
• Diclofenac sodium 3% gel, a nonsteroidal anti-inflammatory drug[6].
Recommended duration of therapy is 60 to 90 days.
• Cryosurgery, e.g. with liquid nitrogen, by "freezing off" the AKs
• 5-fluorouracil (a chemotherapy agent): a cream that contains this
medication causes AKs to become red and inflamed before they fall off
• Photodynamic therapy:[8] this new therapy involves injecting a chemical
into the bloodstream, which makes AKs more sensitive to any form of
light[9].
• Laser, notably CO2 and Er:YAG lasers. A Laser resurfacing technique is
often used with diffuse AKs.
• Electrocautery: burning off AKs with electricity
• Immune Response Modifier: topical treatment with imiquimod[10]
(Aldara), an immune enhancing agent
• Different forms of surgery
Cutaneous horn
• Cutaneous horns, also known by the Latin
name cornu cutaneum, are unusual keratinous
skin tumors with the appearance of horns, or
sometimes of wood or coral. Formally, this is a
clinical diagnosis for a "conical projection
above the surface of the skin." They are
usually small and localized, but can in very
rare cases be much larger. Although often
benign, they can also be malignant or
premalignant.
Etiology
• The cause of cutaneous horns is still unknown,
but it is believed that exposure to radiation
can trigger the condition. This is evidenced by
a higher rate of cases occurring on the face
and hands, areas that are often exposed to
sunlight. Other cases have reported cutaneous
horns arising from burn scars. As with many
other wart-like skin conditions, a link to the
HPV virus family, especially the HPV-2 subtype
has been suggested.
Prominent cases
• Zhang Ruifang, aged 101 (living in Linlou Village, Henan
province, China), has grown a cutaneous horn on her
forehead, resembling what those who have examined her
and her family call "Devil's Horns." Notably, this growth has
expanded to reach a total of 6 centimeters in length.
Another is forming on the opposite side of her forehead.[5]
• Madame Dimanche, called Widow Sunday, a French woman
living in Paris in the early 19th century, grew, in six years
from the age of 76, a 24.9 cm (9.8") horn from her forehead
before it was successfully removed by French surgeon Br.
Joseph Souberbeille (1754–1846). A wax model of her head
is on display at the Mütter Museum, The College of
Physicians of Philadelphia, US
Mortality/Morbidity
• The lesion at the base of the keratin mound is
benign in the majority of cases. Malignancy is
present in up to 20% of cases, with squamous
cell carcinoma being the most common type.
The incidence of squamous cell carcinoma
increases to 37% when the cutaneous horn is
present on the penis.[7] Tenderness at the
base of the lesion is often a clue to the
presence of a possible underlying squamous
cell carcinoma.
Treatments
• As the horn is composed of keratin, the same
material found in fingernails, the horn can
usually be removed with a sterile razor.
• However, the underlying condition will still
need to be treated. Treatments vary, but they
can include surgery, radiation therapy, and
chemotherapy.