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Epidemiology
Epidemiology
Middle aged and older individuals
Disturbing number of younger adults
Oral Cancer overall Mortality: 50-55%
Three categories
Oral cavity proper, lip vermilion, oropharynx
AfrAm > Cau: advanced stage
Male:Female=2:1 5-year survival rate has not improved significantly
Incidence: 8/100,000 in the past several decades
Cau males 65 or older have the highest incidence Tongue: 47% Cau; 27% AfrAm
AfrAm middle-aged males have the highest incidence rate of oral cavity Floor of mouth: 52% Cau; 33% AfrAm
proper and oropharynx Lip: 95%
Cau males highest of lip vermilion
AfrAm increasing incidence; Cau decreasing
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Statistics for MN (1988-2002)
Statistics for MN (2002)
520 cases; 110 die of the disease
2.3% of all cancers; 1.2% of all cancer deaths Incidence: 3%M; 1.6%W
Incidence rate similar to national; mortality rates slightly Mortality: 1.5%M; 0.9%W of oral cancer
lower Incidence/site: Tongue, lip, gum other mouth, tonsils,
Incidence: Significant decline by 2.2% per year among salivary glands, floor of mouth
men Death/site: Tongue, gum other mouth, other oral
Mortality: Among women there is a 1.9% decrease per cavity/pharynx, salivary glands, tonsil, oropharynx,
year nasopharynx, hypopharynx, floor of mouth, lip
Less than 20% are diagnosed in patients less than 50 yo 4th most common in Native Americans (21.4%)
More men than women Mortality: Blacks, Asians, Whites, Native Americans
Extent of disease at diagnosis and 5-year relative Most cases are preventable
survival The single most effective measure to lower the
Localized 48.5% 82.1% risk is to reduce exposure to tobacco and alcohol
Regional 38.5% 51.3%
Distant 5.4% 27.6%
Tobacco Smoking
(Squamous Cell Carcinoma)
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Smokeless tobacco Betel quid (paan)
Users have increased risk
Most cancers develop at the site of placement
Areca palm nuts, betel leaf, slaked lime, tobacco leaf
West Virginia: oral cancer incidence less that national average
Oral submucous fibrosis
SCCa of the placement location more common among women
than men in geographic areas where more women than men use 600,000,000 people use it
dry snuff 8% lifetime risk
Much lower cancer risk than smoked
Swedish snuff (non-fermented and lower nitrosamine levels) not
associated with increased risk
Alcohol
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Alcohol
Phenols Radiation
Workers in the wood product industry
Nasal and nasopharyngeal carcinoma Actinic radiation
X-irradiation: therapeutic & dental
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Iron deficiency
Plummer-Vinson syndrome
Cancer of the upper aerodigestive tract
Esophageal webs
Analysis of English language case reports
published in the literature during the last 7 years
(19992005) revealed that 25 out of the 28 adult
patients with Plummer-Vinson syndrome were
women (89 %)
Vitamin A deficiency
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Syphilis Candidal infection
Tertiary stage Hyperplastic candidiasis
Dorsal tongue Certain strains at the laboratory level have
Arsenic and heavy metals that were used in the produced nitrosamines that have been implicated
past have carcinogenic agents to carcinogenesis
Oncogenic viruses
Immunosuppression
HPV: 16, 18, 31, 33
AIDS
HSV: most likely not
HIV : indirectly immunosuppression Immunosuppression therapy
EBV: lymphoma, nasopharyngeal carcinoma
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Squamous cell carcinoma
Squamous Cell Carcinoma
Tongue White
More than 50% of cases Red
posterior lateral border and ventral surfaces
White and red
Floor of mouth (more common in men than women)
Exophytic (fungating, papillary, verruciform)
Extension to soft palate/tonsils; horseshoe area Indurated
Less common: gingiva, buccal mucosa, labial mucosa, Endophytic (ulcerated, invasive, burrowing)
hard palate Rolled borders
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61-year-old male
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61-year-old male
Staging
TNM System for SCCa
Stage I T1N0M0 85% 5-year survival
Stage II T2N0M0 66%
Metastases Stage III T3N0M0 41%
X Distant metastasis was not assessed Stage III T1N1M0
0 No evidence of distant metastasis Stage III T2N1M0
Stage III T3N1M0
1 Distant metastasis present
Stage IV Any T4, 9%
any N2 or N3
any M1
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Metastasis
Metastatic nodes are firm and feel fixed
Extracapsular spread
Homolateral and contralateral
Lower lip, floor of mouthsubmental nodes
Posterior mouthsuperior jugular and digastric
Oropharynxjugulodigastric nodes
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