GASTROINTESTINAL TRACT
Lecture oneOral Cavity and Oropharyngeal Cancer
TUCOM-DEP OF PATHOLOGY DR. IHSANBackground Info.
Oral Cavity = Mouth Lips, inside lining of the lips and cheeks, the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth below the tongue, the bony roof of the mouth (hard palate), and the area behind the wisdom teeth.inflammations
Herpes Simplex Virus infection: Type 1, keratoconjunctivitis, encephalitis. Oral are cold sores. In children Vesicles, acute gingivostomatitis. Clear in 3-4 weeks, dormant in local ganglia. Reactivation is poorly understood, cold, wind, sunlight and allergic reactions. Recurrent 4-6 days.Aphthous ulcers
40% of population. Obscure cause. Emotional stress, hypersensitivity, pregnancy, menstruation, autoimmune reaction, IBD.Oral candidiasis:
Glossitis. Oral manifestations of systemic disease. Reactive proliferations: as irritation fibroma and giant cell granuloma.Oral tumors and precancerous lesions
The oral cavity and oropharynx assist in: breathing, talking, eating, chewing, and swallowing. Minor salivary glands located throughout the oral cavity and oropharynx make saliva that keeps the mouth moist and helps digest food. Contain several types of tissue and each of these tissues contains several types of cells.Leukoplakia, Erythroplakia, and Dysplasia
Leukoplakia and Erythroplakia: an abnormal area in the mouth or throat. Leukoplakia: is a white area. Erythroplakia: is a slightly raised, red area that bleeds easily if scraped. These white or red areas may be a cancer, or they may be a precancerous condition called dysplasia. They could also be some relatively harmless condition.Squamous papilloma and condyloma acuminatum
HPV serotype 6 & 11.Oral cancer
Oropharyngeal cancer develops in the part of the throat just behind the mouth, called the oropharynx. The oropharynx begins where the oral cavity stops. It includes the base of tongue (the back third of the tongue), the soft palate, the tonsils and tonsillar pillars, and the back wall of the throat.Malignant Oral Cavity and Oropharyngeal Tumors
More than 90% of cancers of the oral cavity and oropharynx are squamous cell carcinomas, also called squamous cell cancer. Squamous cells are flat, scale-like cells that normally form the lining of the oral cavity and oropharynx. Invasive squamous cell cancer means that the cancer cells have spread beyond this layer into deeper layers of the oral cavity or oropharynx.Risk Factors
Tobacco: About 90% of people with oral cavity and oropharyngeal cancer use tobacco Alcohol: Drinking alcohol strongly increases a smoker's risk of developing oral cavity and oropharyngeal cancer. Ultraviolet light: More than 30% of patients with cancers of the lip have outdoor occupations associated with prolonged exposure to sunlight. Irritation: Long-term irritation to the lining of the mouth caused by poorly fitting dentures, sharp teeth.Risk Factors Cont… Poor nutrition: A diet low in fruits and vegetables is associated with an increased risk Mouthwash: Some studies have suggested that mouthwash with a high alcohol content Human papilloma virus (HPV) infection: Immune system suppression: Age: The likelihood of developing oral and oropharyngeal cancer increases with age, especially after age 35. Gender: Oral and oropharyngeal cancer is twice as common in men as in women
Tobacco & Alcohol
We know that tobacco and alcohol can damage cells in the lining of the oral cavity and oropharynx, and that cells in this layer must grow more rapidly to repair this damage. Many of the chemicals found in tobacco cause damage to DNA, which contains the cell's instructions for repair and growth. Scientists are not sure whether alcohol directly damages DNA, but they have shown that alcohol increases penetration of many DNA-damaging chemicals into cells
How to Detect and Diagnose Oral Cancer
Many cancers of the oral cavity and oropharynx can be found early, during routine screening examinations by a doctor or dentist, or by self-examination.Symptoms
a sore in the mouth that does not heal (most common symptom) pain in the mouth that doesn't go away (also very common) a persistent lump or thickening in the cheek a persistent white or red patch on the gums, tongue, tonsil, or lining of the mouth a sore throat or a feeling that something is caught in the throat that doesn't go awayMore Symptoms
difficulty chewing or swallowing difficulty moving the jaw or tongue swelling of the jaw that causes dentures to fit poorly or become uncomfortable loosening of the teeth or pain around the teeth or jaw voice changes a lump or mass in the neck weight loss persistent bad breathmicroscopy
microscopyOral Cancer Photos
What's new in oral cavity and oropharyngeal cancer research and treatment?
DNA changes: One of the changes often found in DNA of oral cancer cells is a mutation of the p53 gene. Recent studies suggest that tests to detect these p53 gene alterations may allow very early detection of oral and oropharyngeal tumors. These tests may also be used to better define surgical margins
What’s New… Tumor growth factors: Oral and oropharyngeal cancers with too many EGF receptors tend to be especially aggressive. New drugs that specifically recognize cells with too many EGF receptors are now being tested in clinical trials. These drugs work by preventing EGF from promoting reproduction of cancer cells, and may also help the patient's immune system recognize and attack the cancer
What’s New… New chemotherapy New radiotherapy methods Vaccines: Some oral and oropharyngeal cancers contain DNA from human papilloma viruses, vaccines against these viruses are being studied as a treatment for these cancers . Gene therapy: Another type of gene therapy adds new genes to the cancer cells to make them more susceptible to being killed by certain drugs
Other microscopic types
1- Adenoid squamous cell c. 2- basaloid sq.c.c. 3- spindle cell. 4- small cell. 5- lymphoepithelioma like.Other tumors
1- Tumors of salivary glands 2- tumors of odontogenic epithelium. 3- tumors of melanocytes. 4- tumors and tumor like lesions of lymphoid tissue. 5- others: giant cell granuloma, granular cell tumor, vascular proliferations, others.Cysts of the Oral Region
A cyst may be defined as an epithelium-lined pathologic cavity that may contain fluid and cellular debris.Some cysts are not “true” cysts because they are not epithelium-lined. Therefore, the name - pseudocyst.Radicular or Periapical Cyst
Usually a result of dental caries. Usually seen as a well-circumscribed radiolucency around the apex of a tooth. By definition, the presence of non-vital pulp is necessary for the clinical diagnosis of a radicular cyst to be made. No distinct difference between a radicular and periapical granuloma.Neck swellings Differential diagnosis
Neck divided into anterior and posterior triangles by sternocleidomastoid m. Cervical lymphadenopathy commonest cause of neck swellingNeck Swellings D/D (benign)
Congenital swellings; branchial cleft swellings, thyroglossal duct cyst, laryngocoele, haemangiomas, cystic hygromas, dermoid. Inflammatory: acute & chronic lymphadenitis (infectious mononucleosis, toxoplasmosis, cat scratch fever, actinomycosis, histoplasmosis, tuberculosis) traumatic: aneurysms, av malformation, torticollis, etc Miscellaneous: Pharyngeal pouch, cervical ribs, thyroid, etcNeck swellings
Branchial cleft cyst Remnants of incompletely obliterated branchial clefts/pouches Located anterior & deep to sternomastoid Painless swelling Young adults M= F ratio Unilateral, 75% on left sideNeck swellings
Thyroglossal duct cyst 70% of all congenital cysts Arrested migration of thyroid Painless midline swelling Sistrunk operationThyroglossal Tract Cyst
Most common developmental cyst of the neck. Its etiology relates to thyroid gland development.Thyroglossal Tract Cyst
Remember, the thyroid gland originates in the area of the foramen cecum. From there, it grows downward to its permanent location in the neck. The embryonic tract of thyroid tissue between the foramen cecum and the cervical location of the thyroid gland eventually atrophies.Thyroglossal Con’t Residual epithelial elements that do not completely atrophy may give rise to cysts in childhood or adulthood that may present in the posterior portion of the tongue(lingual thyroid) or in the neck. The majority occur at the midline of the neck below the level of the hyoid bone. Asymptomatic - Surgical Excision
Neck swellings
Cystic hygroma Collection of lymph sacs Present at the root of neck (post. Triangle), arm, groin. Pharyngeal pouch Pulsion diverticulum Uncoordinated swallowing Sternomastoid tumour Birth trauma, infarcted segment , fibrosis, torticollisNeck swellings
Cervical rib Extra cervical rib < 1% population Neurological and vascular problems Ranula Mucous containing cyst in floor of mouth Painless midline, spherical, smooth, fluctuant, transilluminant Dermoid cyst Midline, asymptomatic, painful when infected Laryngocoele Diverticulum of laryngeal ventricle Lined by epithelium Common in glass blowers/wind instruments musicians, etcNeck swellings Tumours
Benign; Carotid body tumour, lipoma, soft tissue tumour Malignant: skin tumours( SCC, BCC, melanomas), thyroid tumours, salivary gland tumoursSalivary Glands
Three paired glands Parotid; largest of the major salivary glands Two Lobes divided by facial nerve Submandibular gland Deep to mylohyoid, superficial to hyoglossus Sublingual; Smallest of the salivary glands Common surgical disease; infection/calculiSalivary Glands {Benign conditions}
Mumps: Acute painful parotitisViral in aetiologySelf limitingMikulicz’s SyndromeBilateral enlargement of salivary & lacrimal glandsSjogren’s SyndromeTriad of dry eyes, dry mouth, dry jointsAutoimmuneLymphocytic infiltrationPyogenic parotitisSurgical, debilitated patientsStaphylococcusSwollen, painful parotid glandsPus from stensen’s ductSalivary glands {Benign Tumours}
Comprise 3% - 6% of all head & neck tumours Pleomorphic Adenoma Commonest tumour (53% - 71%) Slowly growing, painless, solitary, firm, smooth, moveable without nerve involvement MICRO: Both mesenchymal/epithelial elements DX by: FNA, CT, MRI Superficial parotidectomySalivary Glands Tumours
Warthin’s tumour(adenolymphoma, papillary cystadenoma lymphomatosum)6% - 10%Benign, bilateral, parotid gland only, Older age groupSuperficial locationMalignant potential non existent