Blok 14 Skenario 2

Angkatan 2014
 Difficult Word
Ciprofloxacin, medicine in the group of fluorquinolon and affect the DNA
enzym. Should be use only for infection that cant be treated with a saver
antibiotic.
Analsik, combination of metamphiron (analgesik and atipiretic) and
dizepam (anti anxiety), that combination to decrease pain.
Benzydamine gargle, It relife pain and inflamation associated with sore
throath or mouth sore by radiation teraphy. Can be use for pharyngitis
following tonsilectomi or use of nasogastrictube, aptose ulcer and oral
ulceration due to radiation teraphy.
Exophytic lesion, nodul lesion, the color is red, the location usually in the
bucal mucose and lateral of tongue. The clinic sign of carsinoma cell
squamosa. Lie outside the margin of originated organ.
Induration, hardening proces of a normal soft tissue due to infalamtion
and infiltration of a neoplasm and accumulation of blood
 Topic
Oral Carcinoma cell squamosa
 Question
1. What are the classification of oral cancer ?
2. What is the definition of KSSO ?
3. What are the etiology of KSSO ?
4. What are the sign and symptom for KSSO ?
5. What are the risk factor of KSSO ?
6. What are the complction of KSSO ?
7. What is the stage of KSSO ?
8. How to diagnose KSSO ?
9. Why the drug cant resolve the problem ?
10.What is the drug that should be given and the
additional treatment for the patient ?
11.What are the Prognosis and DD for KSSO ?
12.How to prevent KSSO ?
13.What are the side effect of the treatment for
KSSO ?
14.The overview of histopatology from KSSO !
 What are the classification of oral
cancer ?
Squamose cell carcinoma, include vericouse carcinoma.
Melanoma, cell that attacked is a melanocyt that
produce a skin color in body.
Adenocarcinoma, cell that attack is a secretory gland
that distribute a mucose througout the body.
Minor salivary gland carcinoma.
Limphoma, tonsil and the base of the tongue contain in
immune system or lymphoid tissue where cancer called
lymphomas and can start.
 What is the definition of KSSO ?
KSSO is carcinoma cell squamosa oral.
Uncontrolable grouth of cell and the invade
and cause damage to surounding tissue and
appears as a growtth or sore in the mouth
that doesnt go away.
Some of invasive neoplasm in epitelial tissue
of oral cavity.bmbcfbhvv
 What are the etiology of KSSO ?
Intrinsik : Mallnutrition, Iron deficiency
anemia, Herediter
Ekstrinsik : Pengion Radiation, Tobaco,
Alcohol, Betel Quid, Draining osteomielitys
necrobiosis
 What are the sign and symptom for
KSSO ?
White or red lesion in the mouth, the development of
velvety white
Swolen in limphatic regio
Pain the tongue
Sponatenous bleeding
Unable to speak, swalow, and voice change
The sore in mouth and the lips that wont heal
Weight loss
Lumps inside the mouth
Theres amount of ceratinization
Fully developed lesion, exophitic bulkylesion that is grey to
greis red and has rough and shaggy surface
 What are the risk factor of KSSO ?
Immunosupresan and actimic keratosis
Eldery above 45 years especialy male
Smoker (cigrate are 6x more likely than non smoker), 65%
lead to oral cancer
Alcoholic, 30%
Poor diet
Infection of HPV, oral sex, 13%
UV ray
Pigmentation
Peterson brown keli syndrom, lead to iron defeciency
that increase the risk
 What are the complction of KSSO ?
Disfagia
 What is the stage of KSSO ?
T is the size of primary tumor, N is the involvement of regional
lymphonodi , M is metastase
TX is primary tumor
T0,no efidence of primary tumor, pre invasive cancer ( carcinoma insitu
)
T1,tumor 2 cm or less in greatest dimention
T2,tumor larger then 2 cm but less then 4 cm
T3,tumor is larger the 4 cm
T4a,through cortical bone, deep/extrinsik muscle of tongue , maxilary
sinus, skin
T4b,masticator space, pterigoid plate, skull base, internal carotid artery
N & M, staging definition are the same for all areas of the upper
aerodisgestive track.
 NO N1
The cancer hasnt The cancer has spread
spread to nearby lymph to 1 lymph node on the
node same side the head or
neck
 M0 M1
No spread The cancer has spread
 How to diagnose KSSO ?
Anamnetion, collect patien history
Aditional diagnose :
Test to classification the stage of cancer itself by
endoscopy, rontgent, CT scan, MRI, PET scan.
Dentist can do 2 way
Biopsy
Brush biopsy to collect suspecious sample of cell
Scalpel Biopsy to collect affected sample
 Why the drug cant resolve the
problem ?
Becaus the drug that given is not specific to
treat cancer
 What is the drug that should be given
and the additional treatment for the
patient ?
Additional treatment, chemoterphy and
radioteraphy
EGFR inhibitor
Photodynamic
Cetumixab teraphy, include in EGFR inhibitor
Electrodesication
Cyroteraphy
Surgery
 What are the Prognosis and DD for
KSSO ?
DD , keratoacantoma
Prognosis , in T1 and T2 lesion, after radioteraphy
and surgical excision it has equivalent result : 5
year disease free survival rate range from 80
90% with patient treated
5 year survival rate of patient in stage 3 and 4 30 -
50 % decreasing to 15 30% in patient with
lymph node metastase
How to prevent KSSO ?
What are the side effect of the
treatment for KSSO ?
What are the specific characteristic of
the KSSO lesion ?
 LO
1. What are the etiology of KSSO ?
2. What are the sign and symptom for KSSO ?
3. What are the complction of KSSO ?
4. What is the stage of KSSO ?
5. What is the drug that should be given and the
additional treatment for the patient ?
6. What are the DD for KSSO ?
Skenario 2 Pertemuan 2

BLOK XIV
 What are the etiology of KSSO ?
Genetic, a person who has a family history of cancer have an
increase risk of cancer as much as 3 to 4x greater then that do not
have a family history of cancer. Specific cromosomal change in
cromosom 3, 9, 11, 17. The cromosomal changing is TSG (tumor
supresor gene) it is assist growth control, if it changing itll lead to
mutation or overgrowth.
Virus, HPV which is STD has been assosiated with cancer of
orofaringeal region that is the part of the throat at the back of the
mouth, the cancer typicaly develop in the throat and the base of
tongue and near on the tonsil making them difficult to detect.
Sunlight exposure, predispose lip cancer and usually in farmer.
 Mechanic, ex : Bite mark on bucal
Squamose cell carcinoma of tongue may also come from any
chrinic iritation such as dental caries , overuse of mouthwash,
and chewing tobaco.
Pathogenesis, NNK or nitrosamin-4-metilnitrosamino-1-3-pyridil-
1-butanon and NNitrosononicotin (NNN) are present in tobaco
product. NNK and NNN form kovalen bond with genomic DNA
resulting in genomic instabilty and are tough to be the primary
mediator of malignant transformation.
Alcohol, may lead to malignant transformation by acting as a
solven to increase permeabilty of tobaco carsinogen, inpairing
immunity, and causing nutritional deficiency. Modifying the
basal cell of the oral epithelium, make them more susceptible to
carcinogenik compound and aldehid metabotis of alcohol are
believe to have some mutagenic properties.
 Genetic Syndrome, like fanconi anemia, is a condition that
can be caused by inherediter defect in several gene that
contribute to repair of DNA and have blood problems.
Diskeratosis Kongenital, is a genetic syndrom that can cause
aplastic anemia.
Tobaco and saliva relation, in our saliva theres redox active
metal, if the RAM intreacte with low reactive free radicals
in cigrate smoke, the result the saliva loses its antioxidan
capacity and its become a potent prooxidant miliou.
Diet and nutrition, Iron can affect to the thciknes of the
epitelium and deficiency can lead to epitelia atrophy.
Lose of heterozigot gnome p21, gene that can cause cancer,
if someone lose a gnome on p21 will increase the risk of
tumor.
 What are the sign and symptom for
KSSO ?
Sour in the mouth that doesnt heal
Trouble chewing and swalowing
Trouble to move the jaw and tongue
Change in voice
Xerostomia
Development of velvety white, red, or speckled (red and white)
patches in the mouth.
Unexplained bleeding in the mouth
Persisten sore on the face, neck, or mouth that bleed easily and do
not heal within 2 weeks
Hoarseness, chronic sore throat, or change in voice,
Ear pain
Dramatic weight loss
 What are the sign and symptom for
KSSO ?
KSSO begin as a small nodule and as it enlarge the center
become necrotic and sloughs and the nodule turns into
ulcer.
The ulcer or redish skin plaque, is slowly growing.
Intermiten bleeding from the tumor especially on the lips,
usually the tumor presents as an ulcerated lesion with hard
and rising edge.
The tumor may be in the form of hard plaque or papule
often with an opalescent quality with tiny blood vessel.
The ulcer usually fails to heal and intermiten bleeding.
The risk of metastasis is higher in KSSO arising in scar and
people with immunosupresed.
 What are the complction of KSSO ?
Caries
Priodontal disease
Emotional and physicological stress
Disfagia
Lose of taste sensation
Discomfort eating chewing and swalowing
Speech problem
 What is the stage of KSSO ?
T1N2aM0
 What is the drug that should be given
and the additional treatment for the
patient ?
Herbal : Garlic, Mushrom, Aloivera, Kurkuma, Flafanoid, etc.
Cyrosurgeey, its a treatment with liquid netrogent and argon
gas, use to destroy abnromal tisssue.
Hypertrmia, use with high temperature that expose to the areas.
The high heat can damage and kill cancer cell or make them
more sensitif to radiation and certain kemoteraphy drug. It use
high energy radiowave to generate heat.
Laser, it use to shrink or destroy tumors that might turn into
cancer and also use to cut very acurately on tiny area.
 What are the DD for KSSO ?
Ecthinic keratosis, UV light induced lession of
the skin that may progress to invasive KSS, it is
by far the most common lesion with
malignant potential to arise on the skin.
Closing