1. DR MOHAMMED MALIK AFROZ ORAL CANCER – ETIOLOGY AND CLINICAL FEATURES

2. SPECIFIC LEARNING OBJECTIVE To know what are the different etiologies for oral cancer To know the important clinical features To know the extent of the disease through TNM classfication

3. FORMAT INTRODUCTION ETIOLOGY CLINICAL FEATURES

4. Etiology for Oral Cancer  Tobacco use  Alcohol use  Age over 40

5. Additional Etiologic Factors  Exposure to UV radiation  Human Papilloma Virus (HPV)  Nutritional deficiencies  Oral lichen planus  Immuno-supression  Syphilis  Marijuana use  Chronic irritation  Chronic candidiasis

6. Tobacco Use  The risk of oral cancer increases with the  amount of tobacco used and the  duration of the habit.  All tobacco types are associated with oral cancer, for example: -cigarettes-cigars-pipes -quid-snuff-chew

7. Age And Oral Cancer  95% of oral cancers occur in individuals over age 40, and the average age of diagnosis is in the 60s  Because 1/3 of the world population is now over age 45, oral cancer will be a significant problem in upcoming years  Changes in biochemical and biophysical processing occur in aging cells  Chemicals, viruses, hormones, nutrients, and physical irritants further affect aging cells, and may contribute to the development of oral cancer Silverman, 1999

8. Viruses  Human papilloma virus (HPV) and herpes simplex (HSV) may play a role in oral cancer development  2/3 rds of oral cancers have HPV DNA in their cells  DNA from Epstein-Barr, cytomegalovirus, herpes simplex, and HVP detected in oral cancer biopsies (NIDCR, 2004)  Viruses contribute to the oral cancer transformation in the presence of other contributing factors

9. Chronic Irritation  Irritation may be caused by ill-fitting dentures and broken teeth or fillings  Chronic irritation does not initiate oral cancer, but it is possible it may hastens its progress  The debate as to chronic irritation as a risk factor is ongoing

10. Relationship Between Cell Events and Lesion Appearance DNA Adducts Smoking Environmental Factors Virus Diet DNA Damage Oral Leukoplakia [White Lesions] Erythroplakia [Red Lesions] Premalignant Oral Carcinoma Malignant DNA Repair DNA Content Cell Growth Apoptosis

13. Tools and Time Proper lighting Dental mouth mirror Gauze squares Gloves 5 minutes

14. Intra Oral Examination Procedure

16. Clinical Features Usually starts as a redness followed by an ulcer formation Ulcer is usually seen at a site where the person used to keep the irritant The ulcer is indurated with a yellowish slough. Patient may not have pain initially unless the ulcer reaches to the deeper tissues There is occasional or no bleeding at all Ulcer causes discomfort always

19. Thank You Any Questions ????