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CANCER

Cell is the structural and functional unit of the body CELL Grows old and dies

Grows and divides

NEW CELL Sometimes this process may go wrong and extra cells accumulate. These extra cells can form a mass of tissue called a growth or tumor. Benign tumors are not cancer can be removed do not spread to other parts of the body. Malignant tumors are cancer can be removed, but sometimes they grow back. tumors can spread to other parts of the body The spread of cancer is called metastasis.

ORAL CANCER
Cancer that affects the mouth (oral cavity) and the part of the throat at the back of the mouth (oropharaynx). The oral cavity and oropharynx have many parts: Lips Lining of your cheeks Salivary glands Roof of mouth(hard palate)

Back of mouth(soft palate and uvula)


Floor of mouth(under the tongue) Gums and teeth Tongue Tonsils Begin in flat cells squamous cells- covering surface of mouth, tounge and lips

CAUSES AND RISK FACTORS


1. Tobacco Smoking and other tobacco use. Irritation of the mucous membranes of the mouth from smoke and heat of cigarettes, cigars, and pipes. Tobacco contains over 60 known carcinogens.

2. Alcohol Very strong synergistic effect with smoking

Constant exposure to alcohol containing mouth washes also increases risk.

3. Human papillomavirus Infection with human papillomavirus (HPV)

type 16 (there are over 120 types)

Other factors : Chronic irritation (from rough teeth, dentures, or fillings) Taking medications that weaken the immune system (immunosuppressants) Poor dental and oral hygiene Chewing betel, paan and Areca

PREVELANCE
Men are affected twice as often as women. Also, Blacks over whites (2 to 1)

STATISTICS FOR USA, year 2010: 37,000 Americans diagnosed with oral or pharyngeal cancer. 66% of the time- found as late stage three and four disease. Over 8,000 deaths Approximately, over 640,000 new cases will be found each year. The death rate for oral cancer is higher than that of other cancers.

Comparison between 3 countries : INDIA 40% of all cancers UK US 4% of all cancers 8% of all cancers

STATISTICS
Areas where the Cancer Affected :

EMINENT PERSONALITIES
Babe Ruth - American Baseball player Diagnosed in 1946 Died 1947 Ulysses S. Grant - 18th President of U.S Diagnosed in early June 1884. Death 1885 Grover Cleveland - 24th president of US Diagnosed in 1893 Sigmund Freud - Austrian psychologist Diagnosed at the age of 67 Died in 1939

SYMPTOMS
Early detection Regular checkups can detect the early stages of oral cancer or conditions that may lead to oral cancer. Symptoms Patches inside your mouth or on your lips White patches (leukoplakia) are the most common. Sometimes become malignant. Mixed red and white patches (erythroleukoplakia). More likely to become malignant. Red patches (erythroplakia) brightly colored. Often become malignant. A sore on your lip or in your mouth that won't heal for more than 14 days. Bleeding in your mouth Loose teeth Difficulty or pain when swallowing Difficulty wearing dentures A lump in your neck Earache Not necessary to be cancer but better to get checked.

DIAGNOSIS
The diagnosis of Oral Cancer is done by the following steps : Check your mouth and throat for red or white patches, lumps and swelling If present : Local anesthesia

Small sample of tissue removed from abnormal area BIOPSY

GUM Biopsy

TOUNGE Biopsy

A biopsy is the only sure way to know if the abnormal area is cancerous. In a biopsy--- tissue is collected, fixed on a slide and examined. Two levels :Macroscopic (naked eye) and Microscopic. Done to find abnormal growth of cells.

STAGES
The stages of oral cancer is based on the size of the tumor and whether the cancer has spread. Endoscopy: Thin-lighted tube into the throat, windpipe, and lungs. Inserted through nose or mouth. Imaging tests: Dental x-rays: An x-ray of your entire mouth can show whether cancer has spread to the jaw. Chest x-rays: Images of your chest and lungs can show whether cancer has spread to these areas. CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your body MRI: A powerful magnet linked to a computer is used to make detailed pictures of your body.

GENETIC BASIS
Many gene alterations have been implicated in the development and progression of oral squamous cell carcinomas 1. Loss of heterozygosity at tumour suppressor genes : FHIT gene (Fragile Histidine Triad Gene) - 3p14.2 CDKN2A gene - 9p21 TP53 gene - 17p13.1 2. Gene amplification and overexpression of particular oncogenes CCND1 (cyclinD1 gene) - 11q13 PIK3CA (Phosphatidylinositol 3-kinase gene) - 3q26.3 3. Mutations in Ras genes: variation between different populations due to exposure to different carcinogens Eg: In India where oral cancer is linked to tobacco chewing mutations in H-Ras are often seen.

4. Telomerase activation observed 5. Overexpression of : Cyclooxygenase-2 (COX2) gene Phospho-epidermal growth factor receptor (pEGFR) - 7p11.2 6. Polymorphisms in genes involved in the metabolism of carcinogens contained in tobacco and alcohol. Gluthione S-transferase enzymes (GSTM1 and GSTT1) Expressed in oral tissue Play a role in detoxifying certain carcinogens in tobacco People with a null genotype for either GSTM1 or GSTT1 have a increased risk of oral cancer

METHODS OF TREATMENT
1. Surgery Common treatment Removes lymph nodes in the neck as well as other tissues in the mouth and neck region. Surgeries for oral cancers include: Maxillectomy (removal of upper jaw) -can be done with or without Orbital exenteration Mandibulectomy (removal of the mandible or lower jaw) Glossectomy (tongue removal - can be total, hemi or partial) Radical neck dissection

During surgical procedures, feeding tube is placed to sustain nutrition.

2. Radiation therapy also called radiotherapy. treatment of cancer with ionizing radiation deposits energy destroys cells in the area being treated (the target tissue) by damaging the genetic material in the individual cells, making it impossible for them to continue to grow. radiation damages both cancer cells and normal cells Normal cells- able to repair themselves and return to proper functioning. It is a type of local therapy - affects cells only in the treated area X-rays and Gamma rays both given to destroy the cells. Two types of radiation therapy to treat oral cancer. External radiation: The radiation comes from a machine. Patients go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks. Internal radiation (implant radiation): The radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes put directly in the tissue. The patient stays in the hospital. . One of the advantages of this type of therapy is there is less radiation exposure to other parts of the body.

3. Chemotherapy
Anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body. Chemotherapy is usually given by injection. Eg of drug: Cetuximab is a chimeric (mouse/human) monoclonal antibody, an epidermal growth factor receptor (EGFR) inhibitor, given by intravenous infusion. It is indicated for the treatment of patients with squamous cell carcinoma of the head and neck in combination with platinum-based chemotherapy.

SIDE EFFECTS
Cancer treatment often damages healthy cells and tissues Thus, unwanted side effects.
Surgery: feel tired or weak for a while cause tissues in your face to swell.

Radiation: depends on amount of radiation given. Dry mouth Tooth decay (extra-soft toothbrush and fluoride toothpaste ) Sore or bleeding gums Sore throat or mouth painful ulcers and inflammation Infection Jaw stiffness Changes in the sense of taste and smell, voice quality Chemotherapy: Similar to radiotherapy. Affects cells that divide rapidly Blood cells, Cells in hair roots, Cells that line the digestive tract

INSTITUTIONS FOR ORAL CANCER


The Oral Cancer Foundation is a website devoted to in depth medical information about all oral cancers including treatment, side effects and even lists of the nation's best cancer treatment centers.

The Oral Cancer Foundation has a forum where patients and their caregivers assist each other. It is monitored by the founder and administrators who ensure accurate up to date information is exchanged.
International Academy of Oral Oncology is a group of Doctors that meet up to discuss the recent advances in the field of Oral Oncology. The inaugural meeting of the International Academy of Oral Oncology took place on 19 April 2005 in Greece.

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