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Profilaxia Cancerului Oral

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Profilaxia Cancerului Oral
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PROFILAXIA CANCERULUI ORAL
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  • PROFILAXIA CANCERULUI ORAL

  • Prevalenta cancerului oralIn 1999,- s-au depistat 30,200 cazuri noi de cancer oral in USAIn anul 2004 au fost depistati 28,260 adulti in USA, dupa datele furnizate de American Cancer Society. Aprox. 50% dintre pacientii cu cc.oral diagnosticat decedeaza in primii 5 ani, cauzind peste 8.000 de decese annualDecesele prin melanoame reprezinta 7.000 /anRata mortalitatii aociata cc.oral nu s-a amelioratFrecventa sex.masc este mai mare decit a sexului femInsa procentul femeilor afectate de cc. oral reprezinta 30% dintre cazuri,, in crestere comparativ cu frecventa inregistrata in urma cu 30 de ani (15%)

  • Cauzele cancerului oralTabacul (90% dintre cei cu cc.oral folosesc tabacul prin tigari, tigarete, pipa, mestecare si prizare))Folosirea de alcoolExistenta unor leziuni precanceroase:leukoplazia- pete albicoase la nivelul cavitatii orale sau faringeluierithroplazia leziuni rosii , la nivelul cav.oraleExpunerea excesiva la soare, care poate favoriza cancerul de buzaAHC - cancer

  • Factori de risc:realizeaza Iritatie locala + sistemicaFactori iritativi mecanici :Margini taioase (dinti carii, cuspizi ascutiti, malerupti, resturi radiculareTartru, obturatii neadaptate, lucrari protetice, proteze,, croseteFactori bacteriani: placa b, tartru, igiena deficitChimici: alcool, tutunTermici: tigara, pipaAntecedente heredo-colaterale de cancer

  • PROFILAXIA CANCERULUI ORALProfilaxia primara: Cunoasterea factorilor de risc si reducerea factorilor de risc Factori de risc fumatul, alcoolul si asocierea celor 2 factoriProfilaxia secundara = depistarea precoce are un impact asupra mortalitatii ( rata de supravietuire dupa 5 ani este de 80% in cazul depistarii precoce, fata de 19% in situatia dgs-arii in stadii avansate)Examinarea cavitatii orale: parte integranta a examinarii

  • PROFILAXIA CANCERULUI ORAL

    Profilaxia primara = reducerea factorilor de riscProfilaxia secundara = depistarea precoce (Early dedetection)Pacientii in categoria de risc crescut: fumatori si consumatori de alcoolExaminarea pt depistarea cancerului oral parte integranta a examinarii

  • Profilaxia cancerului oralSimptome:Factori de riscRegiuni de risc in aparitia cancerului oralLeziuni cu potential de risc oncologic, de malignizare si diagnosticul lorFactori favorizanti inductari (genetici, virusuri, toxice)

  • Simptomele cc. oralO leziune sau ulceratie a cav.orale ce nu se vindeca(simptomul cel mai frecvent)O ingrosare, tumefiere la nivelul obrazului,faringeluiPete nedurereroase albe sau rosii la nivel gingival, pe limba, amigdale sau la nivelul mucoasei oraleSingerare neobisnuita, durere sau anestezie la nivelul cav, oraleDureri oticeModificarea vociiO faringita cronicaSenzatia ca ceva este in faringeDurere sau dificultate in deglutitie sau masticatie

  • Fumatul si tabacul sub diferite formeRisc de:Cancer pulmonar, esofagian, laringian, oralPMC, halena, modificari de culoare a dintilorConsiliere impotriva fumatMiloane de oameni au renuntat la fumatFumul contine particule carcinogene Cu rol de promotori ai mutatiei genetice celulare90% dintre pacientii cu cc.oral sunt consumatori de tabacTabacul afecteaza celulele mucoasei orale si oro-faringeului, favorizind crestera ale unor celule aberante Se considera ca substantele continute in tabac modifica ADN-ul cu cresterea riscului de cc.oral (potriit Societatii Americane de CC.oral)

  • AlcoolulPotenteaza fenomenele anterioareTransformarea in celulele maligneFenomene de hiper-parakeratoza, dikeratoza, acantoza, atipie celularlAgitatie celulara la debutInvazia prin membrana bazalaDiviziune celulara anormala70-80% din pacientii cu cc. oral folosesc frecvent alcoolulIn asociere cu tabacul, se potenteaza efectul de penetrarea substantelor chimice din tabac, care distrug ADN-ul de la nivelul mucoasei oro-faringiene

  • Expuneri prelungite la razele solare(ultraviolete)Expunerea prelungita la radiatiile ultraviolete solare pot cauza cc tegumentarIndivizii care stau in aer liber, la soare pt o perioada prelungita de timp cresc sansele de cc.de buzaPeste 30% dintre pacientii cu cc de buza diagnosticat au profesii in aer liber

  • OMS certifica drept factori inductori:

    Asocierea intre tutun + alcool + lipsa igienei orale

  • Iritatii cronice ale mucoasei oralePrin lucrari iritative, incorect adaptateSau alte motive]Cresc riscul de cc. oral.

  • Alimentatie saraca in fructe si vegetaleFructele si vegetalele :Contin antioxidantiDeficitul de vit. A, C, Fe creste riscul de cc.oralIndivizii cu aport scazut de fructe si vegetale apartin categoriei de risc pt cc. oral

  • Ape de gura cu alcoolStudii stiintifice au aratat ca apele de gura cu alcool pot creste riscul la cc.oral

    Fumatorii si indivizii care folosesc alcool, au tendinta de al folosi apa de gura mult mai frecvent, potentind astfel efectul celor 3 factori de risc

  • Zone de risc oncologic in cavitatea oralaPlanseul oralFata ventrala a limbiiMarginile limbiiSantul gloso-alveolarTrigonul retromolarSanturile perituberozitareMucoasa jugalaOrofaringeleComisura intermaxilara

  • Cancer al planseului oral

  • Fata ventrala a limbii

  • Reg. retromolara (cancer)

  • Cancer al mucoasei jugale

  • Formele de debut in cancerul oralUlceratia / fisuraForma tumorala, vegetantaForma infiltrativa, schiroasaForma nodulara

  • Formele de debut in cancerul oralForma vegetanta, tumoralaForma ulcerativaForma nodularaForma infiltrativa

  • Caracterele ulceratiei maligne

    Baza infiltrataMargini reliefate, indurate, rulate in interiorTesutul vecin poate fi modificat in sens:LeucoplazicDisplazicdiskeratozic

  • Carcinom scuamo-cel al buzei

  • Cancerul oralOrice ulceratie orala care nu se vindeca in 2 saptamini trebuie suspicionata, biopsiataDe impune examinarea (screening-ul tututor pacientilor in zonele de risc majore, mai ales in partea anterioara a cavitatii orale si la nivel lingual)Carcinomul scuamos celular:Apare frecvent in cavitatea orala Si la fumatori

  • Protocol terapeuticAsanarea, igienizarea profesionalaInstruireaBadijonarea locala cu: antiseptice, epitelizante, anestezice, antiinflamatoriiUrmarirea 7 zile daca nu se vindeca leziunea suspiciune de leziune maligna!!!Urgent- trimitere in serviciu de chirurgie maxilor-faciala examinari complementare, coloratii intravitale, citologice(incerta), biopsie, stadializarea tumorii - tratament

  • Leziuni cu potential de malignizare (premaligne)EritroplaziaLichen planLeucoplaziePapilomatoza floridaLupus eritematos

  • EritroplaziaPata rosie, catifelata, dimensiuni diverseDgs diferential cu:Stomatita infectioasa, traumatica (mecanic, chimic)Enantem medicamentosCandidoza cronicaLuesTbcLichen eroziv

  • Lichen plan= hiperkeratoza, atrofie, eroziuneDgs. Dif cu:PapilomStomatite ulcerative/buloase

    Lichen plan eroziv al limbii

  • LeucoplaziaDgs diferential cu:Lupus eritematos diseminatEritroplaziaLichen planLuesDermatoze buloaseLeucoedemNev alb songiosDiskeratoza benignaCarcinom

  • Papilomatoza florida= hiperkeratoza, mase de vilozitati, placarde mucoaseDgs dif. Cu:Lichen planKeratoza tabagicaBenigna acantoza, parakeratozaMaligna carcinom verucos Ackermann, metastazant rapid

  • Lupus eritematosDgs dif cu:LichenLeucoplazieLupus tbcEritem multiform

  • Diagnosticul cancerului oralExaminareIstoricBrush -biopsyBiopsieCTUltrasonografieRMNOdata pus dgs. de cc. oral , acesta va fi stadializat , dupa care se va stabili planul de tratament

  • Examinare exobucalaInspectia (fetei, git si cap)Palparea ganglionilor bilateralExaminare regiunilor:PreauriculareSubmandibulareCervicale

  • Examinarea periorala si endobucalaExaminarea buzelor (cav.orala deschisa si inchisa)Se vor observa orice modificare de culoare, textura sau alte abateri

  • Mucoasa labialaInspectia; mucoasa labiala si fundul de sac vestibular, frenulSe apreciaza culoarea, textura si orice tumefiere sau abatere

  • Mucoasa bucalaSe examineaza de la comisura bucala pin la pilierii amigdalieniSe noteaza orice modificare de culoare, textura, mobilitate

  • Examinarea limbiiCu cav orala pe jumatate deschisa, se inspecteaza limba (tumefiere, ulceratie, incarcatura sau modificare de dimensiune, culoare sau textura. De asemenea se observa modificari ale papilelor care acopera suprafata limbiiSe examineaza virful limbiiApoi pacientul va scoate limba si medicul va observa orice modificare a mobilitatii sau pozitiei acesteia

  • Cu oglinda se inspecteaza marginile linguale (dr. si stg)Cu un tifon se tractioneaza virful limbii , pt a evalua zonele posterioare ale marginilor laterale linguale

  • Examinarea fetei ventrale ale limbiiInspectiePalpare (pt a depista tumefieri)

  • Planseul bucalCu limba ridicata, se inspecteaza planseul bucal, in vedere depistarii unor modificari de culoare, textura, volum sau alte modificari de suprafata

  • PalatulCavitatea orala deshisaSe apasa partea dorsala a limbii cu oglindaSe inspecteaza palatul dur apoi cel moae

  • Examinarea palatului moale si a tesuturilor oro-faringiene

  • Palparea bimanla a planseului bucalToate tesuturile mucosale sau faciale care par sa prezinte modificari trebuie palpate

  • Examinarea capului si gituluiPacientul pozitie sezindaSe indeparteaza toate lucrarile adjuncte inainte de inceperea examinariiTesuturile extraorale si periorale se examineaza mai intiiApoi tesuturile intraorale

    In 1999, an estimated 30,200 new cases of oral cancer were diagnosed in the U.S. Approximately 50 percent of the patients diagnosed with oral cancer will die within 5 years, causing more than 8,000 deaths annually, as compared to melanoma, which accounts for more than 7, 000 deaths per year.The mortality rate associated with oral cancer has not improved in decades.Males are more likely to get oral cancer than females, but one third of oral cancer patients are women, up from 15 percent 30 years ago.The main causes of oral cancer are:tobacco use (90 percent of people with oral cancers use tobacco by smoking cigarettes, cigars, pipes, chewing tobacco, and dipping snuff)alcohol useOther causes of oral cancer may include the following:leukoplakia - a condition characterized by a whitish patch that develops inside the mouth or throat.erythroplakia - a condition characterized by a red, raised patch that develops inside the mouth.excessive sun exposure, which, like elsewhere on the body, can cause cancer on the lip

    What are the symptoms of oral cancer?The following are the most common symptoms for oral cancer. However, each individual may experience symptoms differently. Symptoms may include:a lip or mouth sore that does not heala white or red patch on the gums, tongue, or lining of moutha lump on the lip or in the mouth or throatunusual bleeding, pain, or numbness in the mouth areaswelling of the jawpain in the earchange in voicea chronic sore throatfeeling as if something is caught in the throatpain or difficulty in swallowing or chewingThe symptoms of oral cancer may resemble other disorders or medical problems. Always consult your physician for a diagnosis.What are the symptoms of oral cancer?The following are the most common symptoms for oral cancer. However, each individual may experience symptoms differently. Symptoms may include:a lip or mouth sore that does not heala white or red patch on the gums, tongue, or lining of moutha lump on the lip or in the mouth or throatunusual bleeding, pain, or numbness in the mouth areaswelling of the jawpain in the earchange in voicea chronic sore throatfeeling as if something is caught in the throatpain or difficulty in swallowing or chewingThe symptoms of oral cancer may resemble other disorders or medical problems. Always consult your physician for a diagnosis.Suspicious Symptoms:Dysphagia.Odynophagia and referred pain to ear.Prosthetic fit change.Heamoptysis, nasal stuffiness, malar swelling, diplopia.Trigeminal / glossopharyngeal pain.Hot potato voice .Hyoid/ thyroid fullness.Low grade fever.Risk FactorsTobacco/Alcohol UseTobacco and excessive alcohol use increase the risk of oral cancer. Using both tobacco and alcohol poses a much greater risk than using either substance alone.SunlightExposure to sunlight is a risk factor for lip cancerAgeOral cancer is typically a disease of older people usually because of their longer exposure to risk factors. Incidence of oral cancer rises steadily with age, reaching a peak in persons age 64-74. For African Americans, incidence peaks about 10 years earlier.GenderOral cancer strikes men twice as often as it does women.RaceOral cancer occurs more frequently in African Americans than in whites.The majority of patients with oral cancer (90 percent) use tobacco in one form or another. Tobacco can damage cells in the lining of the oral cavity and oropharynx, causing abnormal cells to grow more rapidly to repair the damage. Researchers believe that the DNA-damaging chemicals in tobacco are linked to the increased risk of oral cancer, according to the American Cancer Society. Other problems associated with chewing tobacco and snuff include periodontal disease, tooth discoloration, and bad breath, among others. The majority of patients with oral cancer (75 to 80 percent) use alcohol frequently. Paired with tobacco use, patients who drink and smoke increase their risk of developing oral cancer even more. Researchers have found that alcohol increases the penetration of DNA-damaging chemicals in the lining of the oral cavity and oropharynx, according to the American Cancer Society. Prolonged exposure to ultraviolet radiation from the sun can cause skin cancer. People who are outdoors for an extended period of time increase their risk of lip cancer, as well. More than 30 percent of lip cancer diagnoses are in persons with outdoor occupations. The risk factors:Age > 55 Y.O.Tobacco (including smokeless tobacco).Alcohol use. Infection with HPV-16 virus has been associated with an excess risk of developing squamous cell carcinoma of the oropharynx. Radiation & UV exposure.Family history, which is + for cancer.Occupational factorsE.g. leather manufacturing and textile industrySyphilisMouthwash Increased risk if high EtOH contentImmunosuppression.Nutrition: Deficiency of vit. A, C, Iron increase the risk.

    Chronic irritation to the lining of the mouth, due to poorly fitting dentures or other reasons, may increase a person's risk for oral cancer. Research has suggested that fruits and vegetables, which contain antioxidants that can "trap" harmful molecules, can decrease the risk for oral cancer (and other cancers). Thus, it is speculated that persons with a low intake of these types of foods are at an increased risk for (oral) cancer. Immunosuppression.Nutrition: Deficiency of vit. A, C, Iron increase the risk.

    Some studies have shown that mouthwash with alcohol content increases the risk for oral cancer. In addition, other studies have shown that smokers and people who drink alcohol tend to use mouthwash more often, linking all three factors together. The oral cavity includes:the lips, teeth, and gumsthe lining inside the lips and cheeks (buccal mucosa)the floor of the mouth (under the tongue)the top of the mouth (hard palate)the small area behind the wisdom teethThe oropharynx includes:the back one-third of the tonguethe soft palatethe tonsilsthe back of the throat

    Oral CancerSquamous cell carcinoma occurs frequently in the mouth, most commonly in smokers. Any nonhealing ulcer of more than 2 weeks' duration should be biopsied. Screening by the primary physician, especially in the front of the mouth and under the tongue, can lead to early diagnosis and treatment, along with fewer disfiguring surgeries. (American Academy of Family Physicians 52nd Annual Scientific Assembly [Family Medicine Conference Summaries - 2000 Medscape, Inc.] CONFERENCE SUMMARY INDEXDiagnosis and Treatment of Oral Conditions by Family PhysiciansBruce Gardner, MD)How is oral cancer diagnosed?In addition to a complete medical history and physical examination, diagnostic procedures for oral cancer may include one or more of the following:biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.computed tomography (CT or CAT scan) - a non-invasive procedure that takes cross-sectional images of the brain or other internal organs; to detect any abnormalities that may not show up on an ordinary x-ray.ultrasonography - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.magnetic resonance imaging (MRI) - a non-invasive procedure that produces two-dimensional view of an internal organ or structure, especially the brain and spinal cord.Once a diagnosis is made, the cancer will be staged (to determine the extent of the disease) before a treatment plan is established.The Extraoral ExaminationThe extraoral assessment includes an inspection of the face, head, and neck. The face, ears, and neck are observed, noting any asymmetry or changes on the skin such as crusts, fissuring, growths, and/or color change. The regional lymph node areas are bilaterally palpated to detect any enlarged nodes, and if detected, their mobility and consistency. A recommended order of examination includes these regions:Preauricular Submandibular Anterior Cervical Posterior Auricular Posterior Cervical Perioral and Intraoral Soft Tissue ExaminationLipsBegin examination by observing the lips with the patient's mouth both closed and open. Note the color, texture and any surface abnormalities of the upper and lower vermilion borders. Labial MucosaWith the patient's mouth partially open, visually examine the labial mucosa and sulcus of the maxillary vestibule and frenum and the mandibular vestibule. Observe the color, texture, and any swelling or other abnormalities of the vestibular mucosa and gingiva. Buccal MucosaRetract the buccal mucosa. Examine first the right then the left buccal mucosa extending from the labial commissure and back to the anterior tonsillar pillar. Note any change in pigmentation, color, texture, mobility and other abnormalities of the mucosa, making sure that the commissures are examined carefully and are not covered by the retractors during the retraction of the cheek. TongueWith the patient's tongue at rest, and mouth partially open, inspect the dorsum of the tongue for any swelling, ulceration, coating or variation in size, color, or texture. Also note any change in the pattern of the papillae covering the surface of the tongue and examine the tip of the tongue. The patient should then protrude the tongue, and the examiner should note any abnormality of mobility or positioning With the aid of mouth mirrors, inspect the right and left lateral margins of the tongue. Grasping the tip of the tongue with a piece of gauze will assist full protrusion and will aid examination of the more posterior aspects of the tongue's lateral borders. Then examine the ventral surface. Palpate the tongue to detect growths. Then examine the ventral surface. Palpate the tongue to detect growths. FloorWith the tongue still elevated, inspect the floor of the mouth for changes in color, texture, swellings, or other surface abnormalities.PalateWith the mouth wide open and the patient's head tilted back, gently depress the base of the tongue with a mouth mirror. First inspect the hard and then the soft palate. Examine all soft palate and oropharyngeal tissues.Bimanually palpate the floor of the mouth for any abnormalities. All mucosal or facial tissues that seem to be abnormal should be palpated.Routine Head & Neck Exam TutorialThe examination is conducted with the patient seated. Any intraoral prostheses (dentures or partial dentures) are removed before starting the examination. The extraoral and perioral tissues are examined first, followed by the intraoral tissues.


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