Oral Carcinoma | Medical Science Optional Notes for UPSC PDF Download

Oral Carcinoma

Oral Cavity - Boundaries

Causes of Mouth Ulcers

• Candidiasis (Oral Thrush)
• Infections with Herpes Simplex Virus
• Hand, Foot, and Mouth Disease
• Gastroesophageal Reflux Disease (GERD)
• Lichen Planus
• Syphilis
• Systemic Lupus Erythematosus (SLE)
• Tubercular Ulcers
• Aphthous Ulcers
• Drug-induced Reactions
• Pemphigus and Pemphigoid

Etiology of Oral cancer

• Tobacco use
• Alcohol consumption
• Epstein-Barr Virus (EBV) infection
• Persistent irritation from dentures
• Inadequate nutrition
• Insufficient oral hygiene

Premalignant Lesions

Lesions with Elevated Risk

• Erythroplakia
• Leukoplakia with speckled features
• Chronic hyperplastic candidiasis

Medium-Risk Lesions

• Oral submucous fibrosis 
• Syphilitic glossitis 
• Sideropenic dysphagia (Paterson Kelly syndrome)

Low-Risk/Equivocal-Risk Lesions

• Lichen planus affecting the oral cavity
• Oral manifestation of discoid lupus erythematosus
• Congenital discoid keratosis

The potential risk for malignant transformation:

• Rises with the advancing age of the patient
• Grows with the increasing age of the lesion
• Demonstrates a higher occurrence in smokers
• Elevates with alcohol consumption
• Varies based on the anatomical site of the premalignant lesion

Field Cancerisation

"Distinct primary tumors might not indicate separate genetic mutational events; instead, they may arise from the same clonal origin of cells that migrate to different locations in the upper aerodigestive tract."

Management

• TNM Classification
• General Principles in the Management of Oral Cancer
• Management of Tongue Cancer

TNM Staging
Primary Tumor (T)

• TX Primary tumour cannot be assessed 
• T0 No evidence of primary tumour 
• Tis Carcinoma in situ 
• T1 Tumour <2 cm in greatest dimension 
• T2 Tumour >2 but <4 cm 
• T3 Tumour >4 cm but <6 cm
• T4 Tumour invades adjacent structures, e.g. mandible, skin

Regional Lymphnodes (N)

• NX Regional lymph nodes cannot be assessed 
• N0 No regional lymph node metastasis 
• N1 Metastasis in a single ipsilateral lymph node <3 cm in greatest dimension 
• N2a Metastasis in a single ipsilateral lymph node >3 cm but not more than 6 cm 
• N2b Metastasis in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension 
• N2c Metastasis in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension 
• N3 Metastasis in any lymph node >6 cm

Distant Metastasis (M)

• M0 No evidence of distant metastasis 
• M1 Evidence of distant metastasis

Investigation

• MRI
• CT
• FNAC/BIOPS

General Principles in Management

• Collaborative Team Approach
• Objectives:
  a) Achieve Cure
  b) Optimize Functional Outcome
• Primary Treatment Modality: Surgery
• Considerations for Previous Radiation Therapy?
• Evaluation of Field Changes

Clinical Presentation

• Ulcer
• Tongue pain
• Ankyloglossia
• Fetor oris
• Disarticulation
• Dysphagia

Management of Carcinoma Tongue

Oral Carcinoma - Repeats 

1. Enumerate the various etiological factors of oral cancer (1996). 
2. What are the etiological factors in the genesis of oral cancer? Enumerate the malignant lesions that are likely to affect the oral cavity. Briefly describe their histopathologic features (2002). 
3. Enumerate the premalignant lesions of oral cavity. How would you manage a 40 yrs. old smoker with a 2 x 2 cm ulcer on the right lateral border of tongue (2009)? 
4. What are the predisposing factors in the etiology of oral cancer? Briefly describe the malignant lesions that are likely to affect the oral cavity. (2010) 
5. What are the boundaries and parts of oral cavity? Enumerate various factors predisposing to oral cancers. Briefly enumerate the assessment and treatment of a patient with ulceroproliferative growth involving anterior third of tongue. (2013) 
6. Discuss pathogenesis of oral cancer. Briefly describe the malignant lesions that are likely to affect the oral cavity. (2013) 
7. Describe the pre-malignant lesions in oral mucosa. (2014) 
8. List the causes of tongue ulcer. State the predisposing factors which may lead to development of tongue carcinoma. What is the preferred modality of treatment in carcinoma of the tongue? (2015)