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Oral cancer pwr.pnt.
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Oral cancer

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Oral Cancer

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Oral cancer

  1. 1.  Associated with cell dysregulation  More common to see below 50  Certain chromosomal alterations
  2. 2.  Awareness level  Access to health care system  Late diagnosis
  3. 3.  even after treatment  Quality of life  Pain  Death
  4. 4. Hallmarks of Carcinoma
  5. 5. Autonomy in growth signaling  Normal cells require external stimuli for growth.  Cancer cells usurp this growth and proliferative pathways.  Resulting in aberrant tumour cell multiplication
  6. 6. Insensitivity to inhibitory growth signals  Balance between growth and maintenance is achieved by various stimuli.  Tumerogenic conditions this balance is lost
  7. 7. Evasion of apoptosis  Apoptosis is important for organogenesis, embryogenesis, cellular homeostasis  Antiapoptotic and proapoptotic balance is lost in malignancy
  8. 8. Limitless replication  Transformed cells acquire the ability to undergo unlimited cycles of mitosis  immortalization
  9. 9. Angiogenesis  Tumor cells acquire the ability to sustain continued new vessel growth
  10. 10. Invasion and metastasis  Ability to invade, spread to regional lymphatics, metastasis to distant organs  Loss of intercellular adhesion  Degradation of basement membrane  Epithelial-mesechymal transition
  11. 11. Oral Cancer
  12. 12. Introduction  400,000 new cases every year  5th most common cancer in men  7th most common cancer in female  10th common cause for death  Carcinomas 96%  Sarcomas 4% Most common squamous cell carcinoma
  13. 13. Etiology Multifactorial Predisposing factors:  Tobacco-chewing or smoking  Chewing Betel quid  Alcohol  Chronic irritation
  14. 14. Other contributing factors  Natural carcinogenic agents  Industrial pollutants  Actinic radiation  Malnutrition  Familial/genetic
  15. 15. Contd…  Immune suppression  Plummer Vinson syndrome  Syphylitic glossitis  Avitaminosis  Viral infections  Candida albicans
  16. 16. Symptoms of oral cancer  Lump or a swelling  Pain/burning sensation  Bleeding  Loose teeth  Restriction of tongue movement /mouth opening  Ill-fitting dentures
  17. 17. Contd…  Anesthesia/Parasthesia  Paralysis  Diplopia  Dysphagia  Voice change  Halitosis
  18. 18. Clinical appearance  Exophytic (mass forming)  Endophytic,Indurated (ulcerating,Non-ulcerating)  White patch  Red patch
  19. 19. Investigation  Toludine blue staining: uptake in dysplasia & malignant tissues  DNA synthesis in malignant cells  Greater diffusion through haphazardly arranged tumor cells
  20. 20. Before staining
  21. 21. After staining
  22. 22. Biopsy  Incisional biopsy  Excisional biopsy  Needle biopsy (FNAC)  Exfoliative cytology
  23. 23. Imaging  Routine radiographs  CT  MRI  Nuclear scintigraphy  Ultrasound
  24. 24. TNM staging T4 Tumor invades adjacent structures
  25. 25. Stage TNM Classification Survival Rate Stage I T1 N0 M0 85% Stage II T2 N0 M0 66% Stage III T3 N0 M0 T1,T2,T3,N1, M0 41% Stage IV Any T4 lesion, or Any N2 or N3 or Any M1 9%
  26. 26. Treatment  Surgery  Radiotherapy  Chemotherapy  Combination of these
  27. 27. Surgical modality  Blade  Laser  Electrosurgery  Cryosurgery
  28. 28. Surgery Indication  If tumor not radiosensitive  Recurrence in already irradiated area  Situation in which side effect of radiation are more severe than surgical defects  Neoplasms involving bone, lymph node, salivary gland  In palliative cases reduce the bulk
  29. 29. Contd…  Surgical management of clinically positive cervical nodes is the treatment of choice.  Surgery is needed when bone is involved, and radiotherapy alone cannot be considered adequate to produce a cure.
  30. 30. Radiation therapy  Radiation may be administered to a localized lesion by using implant techniques (brachytherapy) or to a region of the head and neck by using external-beam radiation (Teletherapy)
  31. 31. Radiation therapy Choice of treatment should be done according to  Relative cure that can be obtained with radiation as compared with surgery or any other modality  Relative morbidity associated with radiation therapy  Cosmetic & functional result of radiation versus surgery or a combination
  32. 32.  Radiation kills cells by interaction with water molecules in the cells, producing charged molecules that interact with biochemical processes in the cells. DNA is disrupted, and chromosomal damage occurs.  The affected cells may die or remain incapable of division. Contd…
  33. 33.  60 -65 Gy in 30 fractions , 1.8 to 2 Gy / fraction spread over 5 weeks.  The biologic effect of radiation depends on the dose per fraction, the number of fractions per day, the total treatment time, and the total dose of radiation. Contd…
  34. 34.  Cell survival is influenced by the repair of sublethal damage, oxygenation of the cells, total dose, fraction size, and the type of radiation used. Contd…
  35. 35.  Radiation therapy has the advantage of treating the disease in situ and avoiding the need for the removal of tissue, and it may be the treatment of choice for many T1 and T2 tumors. Contd…
  36. 36. BRACHYTHERAPY  Interstitial and intracavitary implants are used to treat primary cancers in the head and neck.  Primary treatment modality for localized tumors in the anterior two thirds of the oral cavity
  37. 37.  For treatment of superficial tumors, radiation with a low penetration may be used.  Deep-seated tumors may be treated with heavy particle irradiation, such as neutron beam radiation. Treatment Contd…
  38. 38. Treatment planning for radiation  The radiation treatment plan is determined by tumor site, tumor size, the total volume to be radiated, the number of treatment fractions, the total number of days of treatment, teeth in the line of radiation, and the tolerance of the patient.
  39. 39. Chemotherapy  Chemotherapy has been considered for treatment of individuals with advanced tumors or recurrent disease in whom surgery or radiation is unlikely to achieve result
  40. 40.  The toxic effects of chemotherapy : mucositis, nausea, vomiting, and bone marrow suppression.  Methotrexate  Bleomycin  Cisplatin and Platinum derivatives  5-fluorouracil  Combinations of these
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Oral Cancer

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