CC OS - CANCERS

• Cancer is a prevalent disease in society
• Cancer is the third leading cause of morbidity and mortality in the Philippines
• Annually, one out of every 1800 Filipinos will develop cancer
• Premalignant conditions cancer is just as easily missed as premalignant conditions
• Reasons premalignant conditions are missed


  • They present practically no symptoms
  • Patients do not come for periodic screening
  • Dentists do not preform thorough clinical examination
  • Lack of public awareness
• Dentist's role


  First line of defense against oral cancer
• Reasons dentists are in an important position


  • Dentists are professionals seen by patients regarding their oral concerns
  • Dentist have the opportunity of doing mouth examinations as part of their routine diagnostic protocol
  • Dentist are trained to recognized disease processes in the oral cavity
• Diagnostic process


  • Overall Health Status
  • History of past and present medications
  • Social History
  • Family History
  • Disease History
• Overall health status


  Certain systemic conditions may predispose to malignancy
• Systemic conditions predisposing to malignancy


  • HIV/AIDS predisposes person to Kaposi's sarcoma
• History of past and medications


  • Hydrochlorothiazide a diuretic used to treat hypertension may be associated with lip cancer
  • Hyoscyamine a drug that decreases motion of stomach and intestines is associated with non Hodgkin Lymphoma
  • Nifedipine a calcium blocker use for hypertension is associated with lip and laryngeal cancer
• Social history factors


  • Smoking
  • Drinking
  • Betel nut chewing
  • Diet
  • Occupation
• Occupations associated with cancer


  • Nickel and chromium workers highly associated with lung and nasal cancer
  • Perchloroethylene - a solvent used for dry cleaning is associated with non-Hodgkin Lymphoma
• Family history


  • Mutation of cells are the basis of cancer development
  • Inheriting mutated genes from parents increases the risk of developing cancer
• Cancers that may follow genetic patterns


  • Prostate cancer
  • Breast cancer
  • Colon cancer
• Factors to consider in disease history


  • Rate Of Growth Of The Lesion
  • Behavior Of The Lesion
  • Associated Symptoms
  • Risk Factors
• Rate of growth of a lesion


  • Malignant conditions tend to increase in size in a short period of time
  • Inflammatory and reactive conditions may also manifest in short period of time but a causative factor is usually readily identified
  • Malignant conditions tend to follow a somewhat slower course unless there is traumatic insult
• Behavior of a lesion

  • Growths that respond to antibiotics or non cancer medications are unlikely to be malignant
  • Lesions that change locations are unlikely to be malignant
  • Lesions that come and go are unlikely to be malignant
  • Lesions that regress in size spontaneously are unlikely to be malignant
• Associated signs and symptoms


  • Pain is not an early sign of malignancy
  • Pain is usually related to later stages
  • Numbness may be associated with malignancy due to destruction of nerves
  • Spontaneous bleeding
• Risk factors


  • Tobacco use
  • Alcohol abuse
  • Betel nut chewing
  • Diet
• Tobacco use


  • Cigarette smoking
  • Cigars
  • Pipe smoking
  • Smokeless tobacco
  • Second hand smoke
• Smoking is implicated in approximately 90% of lung cancer
• Tobacco is thought to be implicated in well over 80% of cases of squamous cell carcinoma of the head and neck
• Tobacco use increases the risk of developing cancer by 25 times
• Influence of smoking on cancer development


  • Number of cigarettes smoked a day
  • Number of year of smoking
• Transformation to cancer


  • 61 years old, male
  • Smoking & drinking
• Alcohol


  • Dose-response relationship
  • Heavy drinkers being at greater risk
  • Determine quantity
  • Determine frequency
  • Determine type of alcohol
  • Drinkers of spirits may be at a greater risk
  • It is not clear if alcohol influences malignant change directly or indirectly
• Combination of alcohol and tobacco further increases the risk of cancer
• Betel chewing


  • Part of many Asian and Pacific cultures
  • The International Agency for Research on Cancer (IARC) regards betel nut to be a known human carcinogen
• Dietary factors


  Dietary deficiencies, particularly of vitamin A, vitamin C, vitamin E, iron, selenium, folate and other trace elements have been linked to increased risk of oral cancer
• Early diagnosis is the single most important factor in successfully combating oral cancer
• According to some studies early detection of cancer can increase survival rate up to 81%
• 1. year Survival Rate By Stage


  • Early
  • Late
• It is better to see and not know rather than to know and not see
• Leukoplakia


  • White lesion that cannot be rubbed off and cannot be clinically identified as other known lesions
  • Most frequent potentially malignant disorder of the oral cavity
  • Between 5-25 % are premalignant and should be treated as such until otherwise proven
  • May occur anywhere in the oral cavity
  • Not always white and may be yellowish or grayish

  
• Classification of oral leukoplakia


  • Homogenous- flat, thin homogenous appearance
  • Non homogenous
  • Speckled or erythematous. Also known as erythroleukoplakia
  • Nodular
  • Verrucous

  
• Conditions that can be mistaken for leukoplakia


  • Hereditary or congenital condition
  • Infection
  • Tissue response
  • Auto immune disorders

  
• White Sponge Nevus


  • Appears as spongy tissue folds
  • Mostly congenital but may appear early childhood or adolescence
  • Mutation of keratin 4 and keratin 13 genes
  • Familial patterns may be noted

  
• Leukoedema


  • Intracellular edema of superficial epithelial cells
  • No loss of pliability or flexibility
  • Considered a variation of normal
  • Retention of superficial parakeratin
  • Stretching may cause the lesion to disappear
  • No malignant potential

  
• Papilloma


  • Benign epithelial growths
  • Solitary
  • Lesions are small, between 0.5 1cm
  • Harmless
  • No malignant transformation or potential