Keganasan Rongga Mulut

goeno subagyo
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Kesehatan Oral - Kesehatan Umum

Speaking Chewing Tasting Swallowing

Laughing

Smilling Kissing Happiness Crying Socializing

The essence of our humanity

You are not healthy without good oral health.

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Inter-Relationships Between Oral and Systemic Health and Disease

ORAL

SISTEMIK

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Its a Two-Way Street

The mouth mirrors the body Penyakit mulut dapat mempengaruhi perawatan penyakit sistemik Perawatan penyakit sistemik dapat mempengaruhi kesehatan mulut Penyakit mulut dapat meningkatkan risiko penyakit sistemik Kesehatan mulut mempengaruhi kualitas hidup
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dokter gigi mempunyai tanggung jawab profesional dan moral untuk mempelajari kesehatan umum pasien sebelum memberikan perawatan dental

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Wanita usia 65 tahun dengan polimedikasi untuk penyakit kardiovaskuler, dengan rampant caries (karies yang berkembang cepatmelibatkan beberapa gigi)
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75 year-old women with polymedication drill fill bill for cardiovascular diseases

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WHO Oral Health Program

(a) oral health is integral and essential to general health, (b) oral health is a determinant factor for quality of life (c) oral health and general health are interrelated (d) proper oral health care reduces premature mortality

(Petersen 2003).
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Manifestasi Keganasan di Mulut

Lokal

Sistemik

Keganasan
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Manifestasi Oral keganasan

Non-Hodgkin lymphoma (large ulcer on the soft palate)

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Manifestasi Oral Keganasan

Chronic lymphocytic leukemia (ulcer on the palate)

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Manifestasi Oral Keganasan

Chronic lymphocytic leukemia (severe gingival enlargement and ulcerations)

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Manifestasi Oral Keganasan

Spontaneous gingival bleeding of same patient with cirrhosis

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Manifestasi Oral Keganasan

Swollen, shiny, bleeding gingiva of a patient with acute myelogenous leukemia

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Manifestasi Oral Keganasan

ANEMIA KEGANASAN

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Manifestasi Oral Keganasan

Laki-laki 60 tahun dengan ulkus kronis pada sisi lateral lidah kiri. Mempunyai kebiasaan merokok dan minum minuman keras.

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Leukoplakia Candidiasis Lichen Planus Oral Cancer

Laki-laki perokok 57 th. dg nonpainful lesion pd dasar mulut selama 7 bln.

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ORAL CANCER
Silent Killer

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Oral Cancer

ORO-PHARYNGEAL CANCER IS THE ELEVENTH MOST COMMON CANCER WORLDWIDE

World Health Organization 2005

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Oral Cancer
Incidence and Survival of Oral or Pharyngeal Cancer 30,000 new cases diagnosed yearly
8,000 deaths each year
5 year survival rate: 50%
Oral cancer is the sixth most common cancer among men
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Oral Cancer
The overall survival rate for oral cancer in the general population is 50%. A survival rate worse than prostate, uterine, breast, bladder and colon cancers.

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Oral Cancer
A 5 -year survival rate for African American men with oral cancer is approximately 34%.
With early detection and treatment, the 5year year survival rate can increase up to 85%.
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Oral Cancer

Early Detection Saves Lives

5-year survival for localized disease is 85% 5-year survival for metastatic disease is 19%

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Early Cancer Detection

Early Oral Cancer Detection is Often Possible

Tissue changes in the mouth that may signal cancer can often be seen and felt easily
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Early detection Chemoprevention

High-risk: P53; ploidy

BDJ

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A Precancerous Lesion
A morphologically altered tissue in which cancer is more likely to occur than in its apparently normal counterpart
(WHO publication,1997))

Potentially malignant disorders (WHO 2005)

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Potentially malignant disorders (WHO 2005)

The risk of malignancy being present in a lesion or condition either at the time of initial diagnosis or at a future date.

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Clinical Lesions Potentially malignant disorders

Leukoplakia Erythroplakia Lichen planus

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Leukoplakia
A predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion.
(WHO, 1997)

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White Lesions

Lichen planus Frictional keratosis Tobacco pouch keratosis Nicotine stomatitis Actinic cheilitis Leukoedema Linea alba Hypertrophic candidiasis Hairy leukoplakia White spongue nevus Squamous cell carcinoma etc
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Leukoplakia: Clinical Features

Leukoplakia usually affects people over the age of 40 years (average age is 60 years). Prevalence increases rapidly with age particularly in males. Approximately 8 % of the males over the age of 70 years are reportedly affected.
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Leukoplakia: Clinical Features

Approximately 70 % of the oral leukoplakias are found on the lip vermilion, buccal mucosa and gingiva. Note: Lesions of the tongue, lip vermilion and floor of the mouth account for more than 90 % of those that show dysplasia or carcinoma upon histologic examination.

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Leukoplakia: Clinical Features

Individual lesions vary in clinical appearance and tend to change over time. Early/mild lesions usually appear as slightly elevated gray or gray-white plaques, which may appear translucent, fissured or wrinkled and are typically soft and flat. Early/mild lesions are usually well demarcated but may blend into the surrounding normal mucosa.

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Leukoplakia: Clinical Features

Early/mild thin leukoplakia, which seldom shows dysplasia on biopsy, may disappear or continue unchanged. If the cause (s) of the lesion are not removed, many lesions will gradually become thicker and larger. The clinical appearance (s) of leukoplakia and the anticipated underlying histopathologic changes are presented in the following diagram.
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Clinical classification
1. Homogeneous oral leukoplakia
Most common type Consists of uniformly white plaques Occurs mainly on buccal mucosa Low transformation potential

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2. Non-homogeneous leukoplakia
Speckled leukoplakia Less common More serious Consists of white flecks or fine nodules on an atrophic erythematous base Stronger malignant potential than homogeneous leukoplakia Regarded as a combination of or a transition between leukoplakia and erythroplasia. Speckeled leukoplakia Nodular leukoplakia Small aggregated hemispherical red or white surface alterations or excrescences, may show a red background or substrate.Stronger risk of dysplasia or malignant potential than in homogeneous leukoplakia.
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3. Proliferative verrucous leukoplakia

Least common type of oral leukoplakia High risk of intervening dysplasia and carcinoma developing Progressive and multifocal in nature High rate of recurrence and histological progression toward carcinoma.
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Homogeneous leukoplakia

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NON-HOMOGENEOUS LEUKOPLAKIA Nodular (N) and Verrucous (V) leukoplakia

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Erythroplakia
Definition: A red patch that cannot be clinically or pathologically diagnosed as any other condition Most (~90%) do represent epithelial dysplasia, carcinoma in situ, or squamous cell carcinoma May be combined with leukoplakic areas = erythroleukoplakia, speckled leukoplakia

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Erythroplakia

-Erythroplakia - histology: SCC

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Potentially malignant disorders

Lichen planus

- Lichen planus is an inflammotory disease of skin and mucosa of unknown aetiology, though alterations in cellmediated immunity may be important.

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Red form:

Erythematous /atrophic Ulcerated /erosive Bullous

Lichen planus
White form

Retculer Papuler Plaque

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A predominantly white lesion with verrucous,nodular, ulcerated or erythematous features.

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Annular form of lichen planus on the right buccal mucosa. Note the pigmentation and the ring-like pattern of Wickham striae (yellow arrows).
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A reticular form of lichen planus. Note the bilaterally symmetrical patterns, which are characteristic of lichen planus.
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Annular form of lichen planus on the right buccal mucosa. Note the ring-like pattern of white striae (yellow arrows).
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Tanda & Gejala Awal Oral Cancer

Lesi putih atau merah yang menetap Ulkus yang tidak sembuh Pembengkakkan yang progresif Perubahan ciri permukaan yang tidak wajar Gigi goyah tanpa penyebab jelas Perdarahan /mimisan yang tidak wajar Suara serak yang berkepanjangan
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Late Oral Cancer

Daerah indurasi Pembengkakan rahang Paresthesia, dysesthesia lidah / bibir Trismus Dysphagia Sumbatan jalan nafas Cervical lymphadenopathy Nyeri menetap atau menyebar Gangguan pengelihatan

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Oral Cancer Clinical features:

Ulcerated Verrucous Swelling

Rolled border Indurated margins Bleeding and friable
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Factors Delaying the Diagnosis of Oral Cancer

Pasien lambat berobat ke dokter Dokter lambat mendiagnosis Tidak ada keluhan gangguan dalam jangka lama ( asimptomatik )

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What to look for during screening?

Changes in the mouth:

1. Oral mucosal changes

2. Bony changes
3. Tooth movements

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Screening Examination for Oral Cancer

Screening exam requires:
Good light Use of a dental or laryngeal mirror Inspection of high-risk areas Palpation

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Tiga langkah pemeriksaan diri sendiri

Bibir Lidah Dasar mulut
Dengan melaksanakan tiga langkah pemeriksaan diri sendiri dapat menyelamatkan hidup anda. Dengan cara demikian dapat membantu menemukan kanker mulut tahap dini, sehingga perawatan kanker dapat dilakukan sedini mungkin.
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 Bibir
amati bibir pada keadaan terbuka dan tertutup Dengan menggunakan telunjuk dan ibu jari periksalah bibir untuk mengetahui adanya pengerasan/kelainan di bibir.

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LIDAH
Julurkan lidah dan amati adanya

perubahan pada permukaan lidah; warna, luka, pembengkakan, Tariklah ujung lidah dengan menggunakan kain kasa, dan amati permukaan lateral lidah

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Dasar Mulut
Dengan menggunakan ujung lidah, sentuhlah permukaan dasar mulut, rasakan adakah abnormalitas? Bukalah mulut lebar, amati dasar mulut dan permukaan ventral lidah.

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pertanyaan yang perlu dipahami

Mengapa harus melakukan pemeriksaan mulut sendiri? (agar kanker dapat di deteksi dini) Kapan waktu yang paling baik untuk memeriksa mulut? (setiap 2 bulan sekali setelah membersihkan mulut dan gigi) Langkah apa yang harus dilakukan setelah menemukan abnormalitas di mulut? (memeriksakan diri ke dokter gigi )
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Waspadai Tanda-tanda Oral Cancer

luka yang tidak sembuh selama dua minggu pembengkakan atau benjolan di mulut lesi putih (leukoplakia) atau merah (erythroplakia) di dalam mulut pembengkakan penyebab gigi tiruan tidak dapat dipakai Gigi menjadi goyah tanpa penyebab pasti
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 Manifestasi oral keganasan bervariasi karena keganasan lokal di mulut atau manifestasi keganasan di tempat lain/sistemik. Mencermati dan mewasdai tanda gejala keganasan di mulut merupakan cara deteksi dini oral cancer. Deteksi dini oral cancer akan menyelamatkan jiwa penderitanya Pemebelajaran pemeriksaan diri sendiri dapat menjadi salah satu sarana untuk deteksi dini kanker mulut, sehingga pemeriksaan dan perawatan dapat segera dlakukan.
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PENUTUP

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