6 - Oral Cancer

• Oral submucous fibrosis - Chronic, progressive, oral potentially malignant disorder. Associated with betel quid/areca nut. Pale coloured mucosa, firm to palpate. Increasing submucosal fibrosis leading to very marked trismus. Fibrous bands which affect buccal mucosa, soft palate and labial mucosa
• Epithelial dysplasia - Atypical epithelial alterations limited to the surface squamous epithelium. Can involve any site in the mouth
• Epithelial dysplasia is graded mild moderate severe, severe = carcinoma in situ. Grading is subjective
• Not all epithelial dysplasias progress to cancer
• All the features of epithelial dysplasia may be seen in oral squamous cell carcinoma, however in dysplasia the atypical cells are confined to the surface epithelium. In squamous cell carcinoma, the atypical cells invade into the underlying tissue
• Management of epithelial dysplasia - Modify risk factors, antifungal tx, excision/CO2 laser excision, close clinical review, rebiopsy
• Oral cancer refers to squamous cell carcinoma (>90% cases)
• Unlike other cancers, there is currently no screening programme for oral cancer
• OC risk factors - Tobacco, alcohol, previous oral cancer, exposure to UV light (light), use of betal quid/areca nut, poor diet, immune suppression, oral potentially manlignant disorders, family history
• Oral cancer early detection - The earlier lesions are found, the greater the chance of cure and better quality of life and function
• Low risk sites of oral cancer - Hard palate and dorsum of tongue. High risk sites - Lateral/ventral tongue, FoM, retromolar trigone (tonsils/soft palate)
• Considerable variation in signs and symptoms - Lumps and bumps, ulcers, white patches, red patches, speckled patches, non healing socket, tooth mobility not associated with periodontal disease, induration/fixation of mucosa, dysphagia, pain/paraesthesia, bleeding
• Referral of patients with suspected cancers. Urgent 'suspicion of cancer'. To specialist management team ie for suspected oral cancer refer to oral and maxillofacial surgery. Pt should be seen within 2 weeks