Management protocol of

Oral Pre-malignant &

Malignancies

Dr. A. N. M. Musa Siddik

BDS, MCPS, FCPS
Professor & Head
Dept. of Oral & Maxillofacial Surgery
Rangpur Community Dental College & Hospital
 What Is Cancer?
Diseases containing abnormal cells that divide
and spread uncontrollably
 What is Oral cancer..?

 Cancer that starts in the mouth and oral

cavity
– Includes lips
– Inside lining of cheeks (buccal mucosa)
– Gingiva (gums)
– Floor of the mouth
– Anterior 2/3rds of the tongue
– Hard palate
 Benign Vs. Malignant
 Does not spread  Spreads to other parts of
 Rarely life threatening the body
 Can be removed  Life threatening
 Can be removed, but it
may grow back
Major Risk Factors for Oral Cancer are:

 Tobacco use - 90%

 Alcohol use - 75-80%

 Age over 40

 UV – exposure – 30%
association with lip
cancer.
 Additional Risk Factors Linked To Oral
Cancer Include:
 HPV – 20 – 30% association
 HSV
 Nutritional deficiencies (Vit.A)
 Oral lichen planus
 Immuno- Supression
 Syphilis
 Chronic irritation (ill-fitted dentures, broken
tooth)
 Chronic candidiasis
 Signs and Symptoms
 Ulcers that do not heal
within 14 days
 Bleeding in mouth
 Lump in neck
 Earache
 Loose teeth
 Dentures will not fit
well
 Pain or numbness in
mouth
 Difficulty chewing or
swallowing
 Bad breath
 Patches on the lip or in
the mouth that are red,
white, or a mixture of
both
 CARCINOGENESIS
 This is the process of formation of
malignant tumor.

 A carcinogen is an agent that induces

certain changes with in a cell and
promotes the formation of a tumor.
Molecular Model of Carcinogenesis
 MODE OF SPREAD OF TUMOR

 LOCAL spread

 LYMPHATIC spread

 HEMATOGENOUS spread
Detecting
Oral
Cancer
 Early
Detection

Erythroplakia

Leukoplakia Saves
Lives
 Warning Signs

Lump or Soreness or Difficulty

thickening of “lump” in chewing or
oral soft tissue throat swallowing

Difficulty
Ear pain moving jaw or Hoarseness
tongue

Numbness of
Swelling of the
tongue or
jaw
mouth
 Examination Preparation

• Head & neck exam should be routine

• Review history of alcohol and tobacco use
Overvi • Follow-up on suspicious signs
ew

• Proper lighting
• Dental mouth mirror
• Gauze squares
Arma • Disposable gloves
menta • 5 minutes of time
rium
Extraoral Examination

Examine

Face, head and neck – note

asymmetry or changes

Lymph nodes – palpated

bilaterally
Perioral & Intraoral Soft Tissue Exam

Lips

Labial Mucosa
Perioral & Intraoral Soft Tissue Exam

Labial Mucosa

Buccal Mucosa
Perioral & Intraoral Soft Tissue Exam

Buccal Mucosa

Gingiva
Perioral & Intraoral Soft Tissue Exam

Dorsum of Tongue

Left Margin of
Tongue
Perioral & Intraoral Soft Tissue Exam

Right Margin of
Tongue

Ventral Surface of
Tongue
Perioral & Intraoral Soft Tissue Exam

Floor of Mouth

Hard Palate
Perioral & Intraoral Soft Tissue Exam

Oropharynx

Floor of Mouth -
Bimanual
Suspicious Oral Lesions

Homogenous
Leukoplakia

Leukoplakia
with Early
Squamous Cell
Carcinoma
Suspicious Oral Lesions

Nodular
Leukoplakia with
Severe Epithelial
Dysplasia

Erythroleukoplakia
with Candida
Infection
Points To Remember When Screening for Oral Cancer

Most oral cancers are located on the lateral borders

of the tongue, floor of the mouth and lips – special
attention should be focused in these areas

Always note any changes in color and texture of all

soft tissues or any swelling.

Remove all removable prostheses before starting the

examination.
 Prognosis
Stage 1: 80 – 90 %

Stage 2: 70 – 80 %

Stage 3: 30 – 50 %

Stage 4: 20 – 30 %
 Death in Oral Cancer
 Erosion of major vessels

 Erosion of the cranial base

 Cachexia

 Secondary RTIs
 Diagnosis

• Proper History

• Thorough Clinical Examinations

• Biopsy (if suspicious)

 Treatment Modalities
• Cancer treatment depends on Site, Size,
Extension, Distant Spread, Grading-Staging,
Economy of the patient and General Health of
the patient.
 Options are…...
 SURGERY

 RADIOTHERAPY

 CHEMOTHERAPY

 COMBIATIONS OF ALL

 PALLIATIVE THERAPY (symptom relieving

therapy)