Oral and maxillofacial tumors

Transcription

1 Oral and maxillofacial tumors Zhiyuan Zhang College of Stomatology Shanghai Jiao Tong University

2 Conception of Tumor: Perspective Due to internal and external pathogenic factors, the mutations of human tissue cells' genetic material-deoxyribonucleic(dna) make cell growths and divisions out of control, which leads to abnormal growths and malfunctioins disorders resulting the formation of tumor tissue.

3 多步骤癌变理论 分子事件 生长信号增加肿瘤抑制缺失癌基因活化间质改变逃避宿主防御凋亡信号降低遗传不稳定导致快速生长的肿瘤进化 浸润 转移亚克隆 正常增生增生异型原位癌浸润癌转移癌 分子功能 组织病理学 正常增生癌前病变癌症转移 临床

4 Cysts and tumor-like lesions. Despite the fact of not being an authentic tumor, they do occupy some biological features and clinical manifestation of tumor.

5 Anatomic sites Head and neck cancer: UICC. lips, mouth, maxillary sinus, pharynx(nasopharynx, oropharynx, laryngeal pharynx), salivary glands, throat and thyroid. general conception of oral: lips, teeth, gums, buccal mucosa,body of tongue, floor of mouth, oropharynx( root of tongue, tonsils, parapharyngeal, pharynx posterior wall, soft palate and uvula)

6 epidemiology Global incidence rate: oral cancer is ranked as the sixth of holistic body malignant tumors, /year. India:30%~40% China: 3.5/100000(ranked tenth) XinJiang:8.1/ Guangzhou:1.06~1.09/

7 Incidence rate Incidence rate is referred to the number of new cases of a disease which occurs in the exposed population in a slecific period of time. Generally means the number of new cases in one year, which often marked as number per Calculation formula:incidence rate=(new cases in certain place in certain year/average exposed population in cartain place in certain year)*100000

8 Prevalence rate Prevalence rate is referred to a certain type of disease cases occupy the overall proportion of old and new cases in specific period of time. Prevalence can be divided into period prevalence rate and point prevalence rate. Calculation formula: period prevalence rate=(the number of old and new cases of certain disease in certain place during a period of time/the area average population)* point prevalence rate=(the number of old and new cases of certain disease in specific time-point/the number of exposed population in this time-point)*10000.

9 Mortality mortality: the ratio of death toll to the total population in a certain period of time(often one year). it is also called as total mortality, referring to the frequency of death in a certain period of time, usually illustrated in permillage. Different causes of death of mortality expressed in ten thoudsand rate, namely the frequency of some causes in every people. Calculation formula:(death population of certain disease in certain year/average population)*100000

10 Survival rate survival rate refers to the frequency of survival cases of particular disease cases in the total surveyed population, used for different methods or measures to compare therapeutic effects. Calculation formula:(the overall number of survival oral cancer cases in specific period of time/the surveyed oral cancer population during same period of time)*100000

11 The 5-year survival rate of oral squamous carcinoma patients: 64.0% stage I stage II stage III stage IV 68.1% 52.9% 41.3% 26.6%

12 in Shanghai The prevalence rate of head and neck cancer 年 全 身 头颈部癌瘤 口腔颌面部癌瘤 舌 癌 份 男 女 男 女 男 女 男 女 * 居第 10 位以后

13 6 6 4 gender and age ÄÐ ÐÔ Å ÐÔ 0 The Incidence rate of woman is on the rise 50Äê ú 80Äê ú 年代 90 年代 USA 6:1 2:1 China 2.82:1 1.70:1 The trend of aging China > % Developed country >65 50%

14 origin of tumor benign tumor:mainly seen as teeth-derived and epithelial tumor, like ameloblsdtoms, pleomorphic adenoma;mesenchymal derived tumor;fibroma, myxoma,odontoma,hemangioma,etc. malignant tumor:the epithelial derived tumors compose the most, especially squamous cell carcinoma which account for 80% or more. Then is gland-derived epithelial carcinoma, undifferentiated carcinoma,sarcoma and lymphoma, etc.

15 predilection sites benign tumor: gums, oral mucosa, jaw and oral and maxillofacial regions. malignant tumor: commonly seen in tongue,buccal mucosa, gum, palate, maxillary sinus; cancer of lips are rare. predilection sites are often related with geographical locations, climate, race, living habits and customs.

16 predilection sites of malignsnt tumor 报告者好发顺序 Cunningham (1986) 舌口底下龈颊上龈硬腭赵福运等 (1990) 舌下龈颊上龈硬腭口底张陈平 邱蔚六 (1990) 舌颊下龈硬腭上龈口底张志愿等 (1999) 舌颊下龈硬腭上龈口底唇

17 predilection sites of oral cancer Éà ¼Õ ÏÂ ö Ó² ëñ ÉÏ ö Ú µ ½ Æä Ëü 1986 年 年在 1322 例口腔癌中 舌 507 例占 38.4% 颊 174 例占 13.2% 下龈 108 例占 8.1% 硬腭 107 例占 8.0% 上龈 92 例占 7.0% 口底 86 例占 6.5% 唇 74 例占 5.6% 其它 174 例占 13.2%

18 The cause of oral cancer 15 危 10 险 5 度 支 支 支 >40 支 吸烟量 / 天 g 170g (60Z) g (90Z) g (100Z) Òû ¾Æ Á /Ìì chemical factor Smoking : Benzopyrene, N - nitroso gung organism, arsenic:interfering DNA Alcohol : Chemical burns + cell membrane permeability, mutagens absorption soluted in alcohol

19 The cause of oral cancer physical factor optical radiation:ultraviolet ray Caucasian,Outdoor workers are susceptible to lip cancer.

20 The cause of oral cancer stimulant and injury residual crown and root poor oral hygiene --cancer of buccal,tongue cigarette butts in mouth --cancer of lip

21 The cause of oral cancer biotic factor:hpv infection

22 The cause of oral cancer external factors physical factor (Iatrogenic causes) chemical factor biotic factor trophic factor internal factors psychic factor Endocrine factors immune status genetic factor mutation

23 pathology of oral and maxillofacial tumors benign

24 pathology of oral and maxillofacial tumors (1) 浸润型 (2) 外生型 + 浸润型 (3) 溃疡型 + 浸润型 malignant

25 cancer of the Tongue

26 cancer of the Tongue

27 cancer of the Buccal mucosa

28 cancer of the Gingival

29 II I V III IV Regional lymph nodes

30 diagnosis of oral and maxillofacial tumors history-taking clinical examination imageological examination:x--ray US CT MRI radionuclide puncture and cytological examination biopsy biomarker examination

31 X-ray

32 B ultrasound

33 MRI

34 CT

35 Biopsy and Pathological Diagnosis

36 TNM staging:t in oral cancer TX Primary tumour cannot be assessed T0 No evidence of primary tumour Tis Carcinoma in situ T1 Tumour 2 cm or less in greatest dimension T2 Tumour more than 2 cm but not more than 4 cm in greatest dimension T3 Tumour more than 4 cm in greatest dimension T4a (lip) Tumour invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin (chin or nose) T4a (oral cavity) Tumour invades through cortical bone, into deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), maxillary sinus, or skin of face T4b (lip and oral cavity) Tumour invades masticator space, pterygoid plates, or skull base; or encases internal carotid artery Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumour as T4.

37 TNM staging:t in oropharynx TX Primary tumour cannot be assessed T0 No evidence of primary tumour Tis Carcinoma in situ T1 Tumour 2 cm or less in greatest dimension T2 Tumour more than 2 cm but not more than 4 cm in greatest dimension T3 Tumour more than 4 cm in greatest dimension T4a (oropharynx): The tumor has spread to the larynx, tongue, or jawbone.t4b ( lip and oral cavity)tumour invades masticator space, pterygoid plates, or skull base; or encases internal carotid artery T4b (oropharynx): The tumor has moved into the nasopharynx, skull base, or nearby arteries and muscles.

38 TNM staging:t in maxillary sinus X Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1 Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone T2 Tumor causing bone erosion or destruction, including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of the maxillary sinus and pterygoid plates T3 Tumor invades any of the following: bone of the posterior wall of the maxillary sinus, subcutaneous tissues, floor or medial wall of the orbit, pterygoid fossa, ethmoid sinuses T4a Moderately advanced local disease Tumor invades the anterior orbital contents, skin of the cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses T4b Very advanced local disease Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

39 TNM staging:t in salivary gland TX Primary tumor cannot be assessed. T0 No evidence of primary tumor. T1 Tumor 2 cm in greatest dimension without extraparenchymal extension.b T2 Tumor >2 cm but 4 cm in greatest dimension without extraparenchymal extension.b T3 Tumor >4 cm and/or tumor having extraparenchymal extension.b T4a Moderately advanced disease. Tumor invades skin, mandible, ear canal, and/or facial nerve. T4b Very advanced disease. Tumor invades skull base and/or pterygoid plates and/or encases carotid artery Extraparenchymal extension is clinical or macroscopic evidence of invasion of soft tissues. Microscopic evidence alone does not constitute extraparenchymal extension for classification purposes

40 TNM staginf: N - Regional Lymph Nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension N2 Metastasis as specified in N2a, 2b, 2c below N2a Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension N2b Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension N2c Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension N3 Metastasis in a lymph node more than 6 cm in greatest dimension Note: Midline nodes are considered ipsilateral nodes.

41 TNM staging: M MX Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis 代号 : 肺 PUL 淋巴结 LYN 皮肤 SKI 骨髓 MAR 肝 HEP 胸膜 PLE 脑 BRA 腹膜 PER 其他部位 OTH

42 staging T1 T2 T3 T4a T4b N0 Ⅰ Ⅱ Ⅲ ⅣA ⅣB N1 Ⅲ Ⅲ Ⅲ ⅣA ⅣB N2 ⅣA ⅣA ⅣA ⅣA ⅣB N3 ⅣB ⅣB ⅣB ⅣB ⅣB M1 ⅣC ⅣC ⅣC ⅣC ⅣC

43 Thanks!