Module 3

1
Module 3

• Clinical Manifestations

2
Introduction

• Intraoral cancers occur most frequently on the
• Tongue
• Floor of the mouth
• Soft palate and
• Oropharynx
• Squamous cell carcinoma is the most common type,
  accounting for 90 of oral cancers.

3
Types of Tumors
4
Squamous Cell Carcinoma

• The most common presentations of intraoral
  squamous cell carcinoma are
• exophytic (mass-forming)
• endophytic (ulcerated)
• leukoplakic (white patches)
• erythroplakic (red patches) and
• erythroleukoplakic (combined white and red
  patches)

5
Leukoplakia
Leukoplakia describes a white patch or plaque on
the oral mucosa that cannot be wiped off and
cannot be classified as another disease
condition.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200329.
6
Leukoplakia
Leukoplakias are considered precancerousthe
longer the lesion is present, the greater the
chance of transformation to cancer.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200330.
7
Leukoplakia Snuff-related
Used with permission from Dr. Joel Schwartz,
University of Illinois at Chicago
8
Leukoplakia Snuff-related
Used with permission from Dr. Joel Schwartz,
University of Illinois at Chicago
9
Leukoplakia
Used with permission from Dr. Joel Schwartz,
University of Illinois at Chicago
10
Plaque Form of Candidiasis
Candidiasis can be wiped off with gauze or an
instrument.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200341.
11
Verrucous Leukoplakia
Verrucous leukoplakia should be treated
aggressively.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200339.
12
Leukoplakia
Recurrences of white and/or red lesions are
common, so frequent follow-up is necessary.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200339.
13
Proliferative Verrucous Leukoplakia
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200339.
14
Hairy Leukoplakia
Hairy leukoplakia is a benign condition that
signals HIV infection.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200342.
15
Leukoplakia
All chronic white and/or red lesions should be
carefully monitored and biopsied.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200331.
16
Erythroplakia
Erythroplakia appears as a red lesion that may
demonstrate an erosive component.
Image used with permission from Dr. Mark Bride,
DDS, and ViziLite, Zila Pharmaceuticals, 2004
17
Erythroleukoplakia
Erythroleukoplakia has both white and red
components.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200336.
18
Erythroleukoplakia
These lesions are 4 times more likely to undergo
a malignant transformation than other types.
Image used with permission from Dr. John L.
Giunta, BS, DMD, MS, 1998, http//www.forsyth.org/
oralpathology
19
Erythroleukoplakia
Red lesions present after 14 days should be
biopsied or referred to a specialist.
Image used with permission from Dr. Mark Bride,
DDS, ViziLite, Zila Pharmaceuticals 2004
20
Oral Candidiasis - Soft Palate
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
2003119.
21
Location of Oral Cancer
Relative Locations of Intraoral Cancers by Percentage Relative Locations of Intraoral Cancers by Percentage
Tongue 50
Floor of the mouth 25
Soft palate and oropharynx 15
Gingiva 5
Buccal mucosa 5
22
Common Oral Cancer Locations
Areas highlighted in yellow are the most frequent
locations for oral cancers to occur.
Image used with permission from Sapp, Eversole,
Wysocki (2004) Mosby, 190.
23
Tongue Carcinoma
The tongue is increasingly a site for oral cancer
in young individuals with no apparent risk
factors.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200336.
24
Tongue Carcinoma
Carcinomas of the tongue account for 25 of all
oral squamous cell carcinomas and half of
intraoral lesions.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200337.
25
Floor of the Mouth
Approximately 25 of oral carcinomas occur in the
floor of the mouth region.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200337.
26
Floor of the Mouth
Erythroplasia on the floor of the mouth adjacent
to the lingual frenum.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200350.
27
Floor of the Mouth
Carcinoma appearing as a non-healing, ulcerated
area.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200350.
28
Carcinoma of the Soft Palate
Due to their posterior location, patients are
often unaware of the presence of these lesions
and diagnosis may be delayed.
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200352.
29
Carcinoma of the Oropharynx
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200352.
30
Gingival Squamous Cell Carcinoma
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200334.
31
Squamous Cell Carcinoma in the Buccal Mucosa
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200334.
32
Carcinoma of Buccal Mucosa/Oropharynx
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200352.
33
Squamous Cell Carcinoma
Lip carcinoma caused by pipe smoking
Image used with permission from Dr. Sol Silverman
and the American Cancer Society Silverman,
200311.
34
Lymph Node Locations
Preauricular
Parotid
Occipital
Retropharyngeal (tonsillar)
Submandibular (submaxillary)
Postauricular
Submental
Posterior Cervical
Anterior Cervical
Supraclavicular
Retrieved July 30, 2004 from http//www.med.usf.e
du/FAMILY/cough_and_congestion/lymph.nodes_head_an
d_neck.jpg
35
Signs and Symptoms

• A sore or area in the mouth that does not heal
  after two weeks
• Persistent pain in the mouth
• Persistent lump or thickening in the cheek
• Sore throat or feeling that something is caught
  in the throat
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Voice changes

36
Signs and Symptoms

• Numbness in the tongue or other area of the mouth
• Swelling in the jaw that causes dentures to fit
  poorly or become uncomfortable
• Loosening of teeth or pain around the teeth or
  jaw
• Lump or mass in the neck
• Weight loss (unexplained)
• Persistent bad breath

37
Summary

• Oral cancer may appear as erythroplakia,
  leukoplakia, or erythroleukoplakia.
• Common locations include the tongue (50), floor
  of the mouth (25), soft palate/oropharynx (15),
  and gingiva (5) or buccal mucosa (5)
• Lesions that may mimic oral cancer include
  candidiasis, oral lichen planus or physical
  trauma.