HEAD NECK 11 Oral cancer

5.2 ORAL CAVITY

 

Ten  percent of all malignant tumours of the head and neck  occur

in the oral cavity and 95% being squamous carcinomas.

 

Risk is higher in male than in females.

 

ETIOLOGY

 

There  is a strong relation between smoking and oral  carcinomas,

in regions where oral cancer has the highest mortality.

 

IN ANDHRA PRADESH

 

A state in India-there is prevalence of a carcinoma of the palate

called "Chutta Cancer" in smokers.

 

It  is possible that thermal trauma and tobacco tar  provide  the

carcinogenic stimulus.

 

IN UTTAR PRADESH AND BIHAR

 

Tobacco  and  slaked  lime is habitually sucked by  men  in  some

districts.

 

A quid is kept in the lower gingivo-labial fornix for hours during

the day.

 

A high incidence of carcinoma is found at this site.

 

Betal  nut  chewing  is  practice  among  Indian,  Javanese   and

Malayans.   Ground  betal nut and slaked lime used results  in  a

high incidence of cancer.

 

Alcohol  has a suggested role in oral cancer, poor  oral  hygiene

and  oral  sepsis are also present in this group and may  have  a

contributary role.

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HEAD NECK 10 Malignant tumors Lip

5. MALIGNANT TUMOURS

Sqaumous cell carcinoma make up the majority of all carcinomas of

the oral cavity, highly differentiated tumours occur less  often,

anaplastic lesions are rare.

Adenocarcinomas are met with and originate in the minor  salivary

glands.

5.1 LIP

Squamous cell carcinomas are the common malignant tumours of  the

lip  and  represent  nearly 15% of all  head  and  neck  cancers.

Basal cell carcinomas are less frequent.

ETIOLOGY

Important relationship exists between tumours of lip and exposure

to sunlight.

*  Complexion plays a role, susceptible are the fair skinned  and

   ligh haired.

*  Dark haired and dark skinned individuals are resistant.

*  Tobacco   chewing  and pipe smoking have been suspected  as  a

   cause of lip cancer.

*  It  is possible that the stems of wood and clay pipes soak  up

   tobacco tar directly and cause the disorder.

PATHOLOGY

*  The  tumour is a squamous carcinoma and occurs most  often  on

   the lower lip.

*  It is low grade well diffentiated lesion

CLINICAL

*  Lower lip in the site in 70%

*  Though slow growing, some patients may present when the lesion

   has reached a large size, destroying the entire lip.

*  There may be cervical lymphnodes, usually submental nodes.

*  An  ulcer of the lip which fails to heal should  be  suspected

   early.

TREATMENT

*  Treatment  for  small lesions is local  excision  under  local

   anaesthesia.

*  Radiation can also achieve good results in lesion below 2  cm.

   and can be given as outpatient therapy.

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HEAD NECK 9 Leukoplakia

HYPERKERATOSIS

White patches are sometimes seen on oral mucosa called

leukoplakia.  

This is a specific premalignant lesion.

 

*  Microscopic change show hyperplasia, keratosis and

   dyskeratosis, i.e. loss of normal stratification, irregularity

   in   the   size  and  shape  of   cells,   abnormal   staining

   characteristics.

 

*  Palpation will reveal a definite firmness of the mucosa.

 

*  Cancer will develop in 5% of such patients.

 

*  Local irritant associated with this lesion are smoking, sepsis,

   sharp  tooth,  spirits  and spices (in  betel  chewing)  these

   should be eliminated.

 

Local   excision   may   be   useful.    

Radiation therapy is contraindicated.

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HEAD NECK 8

4.4 GIANT CELL (REPARATIVE) GRANULOMA

 

Usually  occurs on the gums as a red epulis or intra bony  lesion

of  maxillary  or mandibular bones because of a bleed in  to  the

marrow and is slow growing, reddish, smooth sessile tumour  which

bleeds easily.

 

Histologically  lesions show stratified squamous epithelium  with

interspersed  fibroblastic  proliferation,  multinucleated  giant

cells and heamosiderin pigments, all these constitute  diagnostic

microscopic criteria.

 

Treatment of this soft tissue lesion is by complete excision  and

curreting  

 

4.5 HEMANGIOMA

 

Capillary hemangioma are sometimes seen on the mucosa of the oral

cavity  in  infants and like hemangiomas elsewhere  they  regress

spontaneously.

 

*  Rarely  large vascular malformations will involve  the  entire

   side  of  the mouth including the tongue; gingiva  and  buccal

   mucosa.

 

Treatment  is  difficult expectant treatment in follow up they  do regress with age

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HEAD NECK 7 Mouth ulcers Cysts

Usually  a  single ulcer opposite a sharp tooth  or  ill  fitting

denture usually along lateral margin of tongue.

A dental consultation is required.

Cysts  are a common lesion occuring in the posterior  surface  of

the lip, floor of the mouth; tongue and buccal mucosa.

* These are the salivary gland-bearing areas.  These cysts  mucus

  result  from  the  obstruction of the duct  of  minor  salivary

  glands.

* Treatment is by excision under local anaesthesia.

4.3 RANULA

This is a cyst caused by obstruction or damage of the mouth of  a

sub-lingual gland of the floor of the oral cavity. Fig.14.1

*  The cyst elevates the floor of the mouth and pushes the tongue

   to the opposite side.

*  Treatment is by excision of the cyst.

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