6. 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
7. Insensitivity to inhibitory
growth signals
Balance between growth and maintenance is achieved
by various stimuli.
Tumerogenic conditions this balance is lost
8. Evasion of apoptosis
Apoptosis is important for organogenesis,
embryogenesis, cellular homeostasis
Antiapoptotic and proapoptotic balance is lost in
malignancy
11. 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
13. 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
17. Symptoms of oral cancer
Lump or a swelling
Pain/burning sensation
Bleeding
Loose teeth
Restriction of
tongue movement /mouth opening
Ill-fitting dentures
29. 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%
35. 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
36. 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.
37. 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)
38. 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
39. 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…
40. 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…
41. 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…
42. 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…
43. 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
44. 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…
45. 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.
46. 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
47. The toxic effects of chemotherapy : mucositis,
nausea, vomiting, and bone marrow suppression.
Methotrexate
Bleomycin
Cisplatin and Platinum derivatives
5-fluorouracil
Combinations of these