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Oral Cancer PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "ORAL CANCER” by Dr. Neha Agrawal.

This medical PowerPoint presentation is about oral cancer, a type of cancer that develops in the tissues of the mouth or throat. It is also known as mouth cancer or oral cavity cancer. The most common type of oral cancer is squamous cell carcinoma, which is a cancer that starts in the squamous cells, the thin, flat cells that line the inside of the mouth and throat.

Oral cancer can occur in various parts of the mouth, including the lips, tongue, gums, floor of the mouth, roof of the mouth, and the inner lining of the cheeks and throat. The exact cause of oral cancer is not clear, but some risk factors that can increase the likelihood of developing the disease include tobacco use, excessive alcohol consumption, poor oral hygiene, exposure to certain viruses (such as human papillomavirus or HPV), and a family history of oral cancer.

Symptoms of oral cancer can include persistent sores or ulcers in the mouth, difficulty chewing or swallowing, a persistent sore throat, white or red patches in the mouth, and a lump or thickening in the cheek or neck. If you experience any of these symptoms, it is important to see your doctor or dentist for an evaluation.

Treatment for oral cancer may include surgery, radiation therapy, and chemotherapy, depending on the stage and location of the cancer. Early detection and treatment can improve the chances of a successful outcome, so it is important to be aware of the signs and symptoms of oral cancer and to seek medical attention if you have any concerns.

Tags : oral cancer, mouth cancer, oral cavity cancer, squamous cell carcinoma, Dentistry, dental medicine, oral medicine, dental medicine PowerPoint presentation

Published on : Jun 20, 2023 | Views : 2315 | Downloads : 6

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ORAL CANCER Presented by Dr. Neha Agrawal
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Introduction. The oral cavity extends from the vermilion border of lips to the junction of the hard and soft palates superiorly and inferiorly to the circumvallate papilla. Any malignancy that arises from oral tissues. The area is divided into distinct anatomic regions, including the lips, the buccal mucosa the alveolar ridge, the hard palate, and the anterior two thirds of the tongue.
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Remarkably common Major Public health importance 10 million new cancer cases Half of patients die
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Basics concepts A premalignant condition is defined as generalized disturbance or a disease state which predisposes to the development of neoplasm at a particular site. A premalignant lesion is defined as morphologically altered tissue in which cancer is more likely to develop than in its apparently normal counterpart. – WHO.
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Anaplasia: There is a lack of normal coordinated cell differentiation. Metastasis: Cancer cells develop the capacity for discontinuous growth and dissemination to other parts of the body.
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Clonality: Cancer originates from genetic changes in a single cell which proliferates to form a clone of malignant cells. Autonomy: Growth is not properly regulated by the normal biochemical and physical influences in the environment.
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PREVALENCE AND INCIDENCE: Oral cancer is one of the ten leading, cancers. In highly industrialized countries 3-5 % Developing countries it is up to 40 %. About 2.5 lakh new cases of oral cancer occur each year with countries like India, Pakistan, Bangladesh, Afghanistan, Srilanka and some countries in the South East Asia region.
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In India, the age standardized incidence rate of oral cancer is 12.6 per 100 000 population. Strengthening the prevention of oral cancer: the WHO perspective. Community Dent Oral Epidemiol 2005; 33: 397–9
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Age distribution... Prolonged exposure Decreased immunity Cellular ageing
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Gender.... SE Asia Leading Third As compared to developed countries 2.5X 4 X Tongue BM Palate BM
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SITE DISTRIBUTION
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Age, gender and site distribution: Oral cancer is predominantly seen in the older age group. Studies have reported maximum prevalence in the 5th and 6th decade of life. In South-East Asia, oral cancer is the leading cancer in males and the 3rd leading in females. In developing countries, for males it is 2.5 times as many as industrialized countries.
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Site distribution. Cancer of tongue and buccal mucosa constitute the bulk of the oral cancers in India. The predominant subsites affected in females in most of the registries are the buccal mucosa and palate.
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The most common subsite affected is the tongue in Bombay and the buccal mucosa in Madras . Bombay has almost twice the incidence of cancer tongue compared to the other registries in the country (9.4 per lakh vs 4.3-5 per lakh).
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In India the site of occurrence of oral squamous cell carcinoma has been reported to vary depending on the regions studied. The lateral border and undersurface of tongue, labial commissure and buccal mucosa are sites particularly associated with betel-tobacco chewers.
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It has been remarked that buccal mucosa (65%), lower alveolus (30%), retro molar trigone (5%) grouped together as the gingivo-buccal complex can be called "Indian oral cancer" as they constitute more than 60% of all cancers.
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CLINICAL APPEARANCE
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CARCINOMA OF TONGUE
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CARCINOMA OF GINGIVA Chronic irritation and inflammation of gingiva over a period of several years due to calculus formation and collection of micro organisms
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CARCINOMA OF FLOOR OF MOUTH Smoking pipes or cigars Alcohol consumption Leukoplakia Poor oral hygiene
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CARCINOMA OF LIP Pipe smoking Syphilis Sunlight Poor oral hygiene
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Etiology of oral cancer can be studied under 3 subheads, forming a triad Agent Host Environment
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1. TOBACCO According to WHO (1984) as much as 90% of oral cancer in developing countries like India and other South East Asian countries is directly attributable to chewing and tobacco smoking. Tobacco may be chewed, smoked, sucked .
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The carcinogenic role of tobacco is related to The way in which it is used The type of tobacco product. Its use in combination with other substances.
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Tobacco smoking smokeless tobacco 1. Bidis 7. Zarda 2. Chillum 8. Khaini 3. Chutta 9. Manipuri tobacco 4. Cigarettes 10. Mawa 5. Dhumti 11. Mishri/Masheri 6. Hookha 12. Paan 13. Snuff 14.Gutkha
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Cigarette Bidi Pipe Hookah Cigar
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Gutkha Paan Khaini Chewed tobacco Snuff Zarda
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BEEDI Most popular form of tobacco in India About 0.2 to 0.3 gms of sundried tobacco flakes are hand rolled in a rectangular piece of temburni (Diospyros ebenum) or tender (Diospyros melanoxylon) leaf and tied with a thread.
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2. CHILLUM : It is a straight 10-14cm long conical clay pipe used for smoking tobacco. It is filled with coarsely cut tobacco pieces and a glowing charcoal is kept on the top of the tobacco. 3. CHUTTA : A somewhat cylindrical coarsely prepared cheroot curved tobacco is wrapped in a dried tobacco leaf. it is also called as ‘Cigar” or “Cheroor” and is a popular form of tobacco in certain parts of India. Cheroors are small cigars made of heavily bodied tobacco.. 4. CIGARETTES : They are estimated to contain 1-1.4mg of nicotine and 19-27mg of tar. It is the most common form of tobacco used in modern societies.
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5. DHUMTI : They are conical cheroote. Rolled leaf tobacco is used inside a leaf of jack fruit tree. This form of tobacco is occasionally used for reverse smoking especially among “women”. 6. GUDAKHU: Is a paste of powdered tobacco, molasses (brown sugar) and other ingredient. Primarily used to clean tooth. It is used predominantly by women in Bihar.
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7. HOOKAH : It is also called “WATER PIPE” or “HUBBLE-BUBBLE”. It is used in place with strong mughal culture influence. It is purely of Indian origin, which corresponds with the introduction of tobacco in India. 8. HOOKLI : It is a clay pipe of rather short stem varying from about 7 to 10cm, with a mouth piece and a bowl. It is commonly used in Bhavnagar district of Gujarat.
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9. KHAINI : It is powdered sundried tobacco, shalked lime (calcium hydroxide) paste mixture occasionally used with arecanut. It is simply placed in the mouth / chewed. This form of smokeless tobacco is widespread in Maharashtra and North India. The ingredients are vigorously mixed with thumb to make the mixture alkaline and is placed in the premolar region of the mandibular groove.
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10.MANIPURI TOBACCO : Ingredients are tobacco, slaked lime, finely cut arecanut, camphor, cloves. It is used in rural areas of Uttar Pradesh. 11.MAWA : Is a preparation containing thin shavings of arecanut with the addition of some tobacco and shaked lime
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12.MISHRI/MASHERI : It is prepared by roasting tobacco on a hot metal plate until it is uniformly black. It is primarily to clean teeth. 13.PAAN : Paan chewing is the most common habit of smokeless tobacco usage in India, which has its origins dating back to more than 2000 years.
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14.SNUFF : Finely powdered air cured and fire cured tobacco leaves. It may be clay or moist, used plain or with other ingredients or may be used orally/nasally. Bajjar is a dry snuff used by about 14% of women in Gujarat. It is carried in a metal container, a twig is dipped into it and applied over the tooth and gingiva. 15.ZARDA : Tobacco leaf is boiled in water along with lime and spices until evaporation. The residual tobacco is then dried and coloured with dyes. It is chewed
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CONSTITUENTS Raw and processed tobacco has been shown to contain more than 2500 different chemical constituents. 1. Polycyclic Aromatic Hydrocarbon : It causes carcinogenesis. 2. Nicotine : Potential carcinogenic agents. 3. Phenol : It produces ganglionic stimulations and depressions and tumour promotion. 4. Benzopyrene : It plays an important role in tumour promotion and irritation.
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5. Carbon Monoxide: It produces impaired oxygen transport and repair. 6. Formaldehyde & Oxides of Nitrogen : Toxicity to cilia and irritation. 7. Nitrosamine:It is also a potential carcinogenic agent.
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Tobacco use in India : The mean age of commencement of this habit was found to be 22 - 27 years in males with oral cancer. It is 29 -35 year for controls. However in some fisherman communities of Southern India, the habit begins in early childhood. The habit usually starts as recreational compulsion in teens. Some other reasons include to relieve hunger, overcome boredom and anxiety, strengthens gums, induces euphoria, for concentration etc.
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The high incidence of oral cancers in India due to: Processing of tobacco in India is done by farmers and small companies with little control over fermentation and curing. In India, tobacco is used along with betel leaf [Piper betel], sliced areca nut [Areca catechu] and powdered slaked line which enhance the effect. Indian users often smoke\consume alcohol concurrently, thus increasing the effect.
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Reverse smoking: where the lightened end is inside the mouth. It is common in Vishakapattanam and Srikakulam district of Andra Pradesh. The temperature of the palatal mucosa may go up to 58 degree centigrade.
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II. ALCOHOL : The reported risk for Alcohol consumers vary from 2 - 100 fold depending on amount consumed, type of alcohol, concomitant smoking etc. Alcohol may also act as solvent and enhance penetration of carcinogens into target tissue.
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Alcohol may also act as solvent and enhance penetration of carcinogens into target tissue.
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III. Viruses The two viruses associated with oral cancer as well as premalignant oral lesions are - Epstein - Bass virus [EBV] and Human Papilloma Virus [HPV]. Other causes Sunlight (Actinic Radiation): The incidence of lower lip cancer is common in Caucasians in sunnier climates and fair skinned people are advised to wear sunscreen to prevent actinic damage.
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Diet and Nutritional status Studies have shown the relationship between low vit A or B carotene and oral cancer. Studies also suggest micronutrients like selenium protect again cancer. Dietry iron may play a role in maintaining epithelial thickness. Deficiency of iron may lead to Cancer of upper GIT Plummer – vinson syndrome. Some studies have shown that eating fresh fruit and vegetables lowers the risk of cancer.
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3. Immune deficiency A defective immune response may predispose to carcinogenesis. However HIV infections does not appear to risk of Cancer.
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4. Chronic irritation. Faulty restoration. Ill fitting denture.
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5. Use of alcohol containing Mouthwashes [More than 27%] may increase the risk, but recent evidence is contradicting. 6. Stress may impair immune system and hence may have an adverse effect.
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Types of Oral cancers : 98.72% of oral cancers are squamous cell carcinomas. The intraoral distribution revealed buccal mucosa to be the most common site [50% of all caners] followed by anterior 2/3 of tongue (24%) lower gum (12.5%), lip (4%), hard palate (3.2%), floor of mouth (3%) and the upper gum (2.8).
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Prevention of oral cancer
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Primary Prevention: Primary Prevention focuses on avoidance of known aetiological factors and alterations in lifestyle to prevent cancer development in the first place. This is particularly important because oral cancer is one of the few cancers with a high potential for prevention. It has been estimated that 65-80% of oral cancer is environmental, attributable to lifestyle and thus may be prevented.
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Approches: 1. Educational approach 2. Regulatory approach 3. Service approach
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Tobacco Cessation Clinic
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Patient counseling stop smoking. Be moderate in alcohol. Eat five or more portion of fresh fruit an vegetable a day. National Institute of Nutrition (NIN), Hyberabad: a diet that includes high intake of fresh vegetables and fruits, with spices such as turmeric, in adequate amounts. Sinha R, Anderson DE, McDonald SS, Greenwald P.Cancer Risk and Diet. IndiaJ Postgrad Med 2003;49:222-228
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THE 5 ‘A’ EDUCATIONAL APPROACH
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Formal assistance 5 A ASSESS
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5 A ADVICE ASSIST
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ARRANGE Follow-up within 1 week Refer Counseling and nicotine replacement therapy
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1. Educational approach: The process of becoming a smoker, involves 4 stages Awareness Initiation / experimentation Habituation Maintenance / dependence. Hence education plays an important role in discouraging people from starting/continuing tobacco consumption
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Educational approach: Health education encompasses the following aspects: (a) Programmes to educate adolescents including school children against tobacco use with the aim of preventing them from acquiring any tobacco taking in any form of habits. (b) Educational programmes for current tobacco users to stop or decrease their use of tobacco including their family members.
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(c) People should be educated about warning signals of oral cancer so that they can do the self-examination and report at the earliest for necessary investigation and required treatment. (d) The importance of regular oral check-up by a qualified dental surgeon should be emphasized.
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(e) Importance of good oral hygiene and role of diet and nutrition in oral cancer prevention should be emphasized. (f) Importance of various sources of protein, vitamins, minerals, and trace elements, balanced diet, as well as the right method of cooking and preserving the nutrient of food items is not well understood by people, hence these aspects should be stressed.
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2. Regulatory approach: The earliest regulatory acts were passed by King James of England who increased tax on tobacco by 4000%. In 1965, in USA, legislation was passed requiring cigarette packages to carry a health hazard warning. It was extended to smokeless tobacco products in 1986. In India, the cigarette Act 1975 has made it necessary to print warnings on cigarette packets
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LEGISLATION Prohibit sale of tobacco to minors Place health warning signs wherever tobacco products are sold
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LEGISLATION PROHIBIT ADVERTISING OF TOBACCO PRODUCTS ( 1975-2001)
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Smoking stars in India 76% of Bollywood films show smoking scenes
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Service approach The active search for disease among apparently healthy people is a fundamental aspect for prevention. In order to be suitable for screening, certain criteria should be met. The screening tool is inexpensive and safe screening for oral cancer is feasible because. oral cavity is easily accessible and its examination poses relatively little discomfort to the patient. It provides an opportunity to identify and counsel patients about habit that increase the risks of cancer.
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Secondary Prevention : Involves early recognizing of abnormalities and treating then appropriately.
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BIOPSY
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The screening techniques Toluidine Blue Vital Staining
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The screening techniques available are; I. Exfoliative Cytology : It is a quick, simple, painless and bloodless procedure. The surface from where the specimen has to be taken must first be cleared to all debris. The edge of a moistened tongue blade is then use to scrape the suspected area. An adequate number of representative cells are usually picked up and transferred to a glass slide and placed in 95% alcohol for 30 minutes. After this period of fixation, the slides are removed, air dried and examined microscopically. However this technique is ineffective with lesions that have a heavy Keratin layer or in lesions where the abnormal cells are below the surface layer.
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The smear obtained through exfoliative cytology is reported by cytologist in one of the following five classes: Class I : Normal Class II: Presence of minor atypia but no evidence of malignancy. Class III: Cells display wider atypia that may be suggestive of cancer. Class IV: A few cells with malignant characteristic. Biopsy is mandatory. Class V: Cells are malignant. Biopsy is mandatory.
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II. Toluidine Blue Vital Staining : Toluidene blue, a Basophilic vital nuclear dye can guide biopsy procedure by localizing small foci of tumour cells within large areas of inflammation. It stains malignant lesions but not normal tissue. A 1% solution of Toluidene blue is used as a mouthwash and retained over the area of the defuse lesion for 1 min. The area is then irrigated with 1% acetic acid. Pt may rinse their mouth with 1% acetic acid prior to application of Toluidene blue to clear the necrotic debris.
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III. Biopsy: Is absolutely required before cancer therapy can be initiated. Adequate depth of the lesion is necessary to determine the integrity of basement membrane and to search for malignant cells. When ulceration is present, the biopsy may reveal a non - diagnostic necrosis. Intentional excisional biopsy has little role in oral cancer and if done requires at least 1.5cm margin of clinically uninvolved tissue. Use of anesthesia for incisional biopsy is minimal and usually infiltrated around the lesion. Recently use of biopsy forceps rather than a scalpel may offer certain advantages, especially in the oral cavity posteriorly or in relatively inaccessible areas such as uvula and retro molar trigone. After the specimen is removed it should be placed into 10% formalin, atleast 10 times in volume of the tissue mass. This prevents autolysis of the specimen.
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Chemoprevention : Chemoprevention is a method of cancer control in which the occurrence of disease is prevented by administration of one or several chemical compounds. Wattenberg classified chemopreventive agents into three broad categories: A > Compounds those are effective against a complete carcinogen.
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B. Compounds those are effective against tumor promoter. C. Compounds that inhibit neoplasm when administered shortly before exposure to a carcinogenic compound. Eg : - Vit A is considered to have A - III, B and C activities. - Selenium(Se) has A - III activities - Phenols such as butylated hydroxytoluene have A-III and B activities.
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TERTIARY PREVENTION
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Cancer cures smoking…… Sooner or later everyone quits smoking 5 year survival rate : 34-56%
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Treatment for cancers: The main treatment modalities of oral cancer are surgery and radiotherapy. chemotherapy, which is currently used for advanced or recurrent cancers, is not curative. High cure rate can be achieved in stage I and early stage II cases with 5 year survival rate varying from 75 - 60%. However, patients with advanced disease [stage III, Stage iv] 5 - year survival rate drops to about 10%.
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Radiotherapy : Is the treatment of disease with x - rays or other forms of radiation. The general aim is to deliver uniform dose of radiation as possible to all parts tumor bearing zone. Outside this zone as low as dose as possible. The most sensitive to radiation are - Bone marrow, breast and thyroid
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Types of radiotherapy are used in oral cancer treatment. a) External irradiation b) Perioral irradiation c) Interstitial irradiation d) Surface irradiation
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Principles of Radiotherapy : 1.Physician should be familiar with outline of procedure. 2.Treatment planning consists of accurate of multiple daily fractions of irradiation for a period of time. 3.The biological effect of radiation depends on the amount of energy absorbed / unit mass. 4.Before starting radiotherapy, adequate dental treatment should be done. 5.Radiotherapy planning must take into account the exact anatomical distribution of tumor in order to minimize the exposure of normal tissues.
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Supportive services during radiotherapy Maintenance of nutrition - orally or by nasogastric tube Attention to oral hygiene especially to prevent – osteoradionecrosis. Appropriate use of vitamins, proteins, antibiotics and mouthwashes will prevent infection. Recent trials reporting the use of chemotherapy combined with radiotherapy and surgery in patients with advanced disease have shown encouraging early results.
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Tertiary Prevention : Usually concentrates on prevention of recurrence. This involves Importance of routine extraoral and intraoral examination. Regular review Dietary advice Chemoprevention
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Challenge in oral cancer prevention: Population group at the highest risk to oral cancer are those most refractory in accepting and acting on preventive advice. Many are misinformed and may be unaware that cancer can affect mouth. Because of low prevalence of precancer – high frequency of false positive registration. client self selection bias.
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Programs for prevention of oral cancer
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Smile Foundation has initiated the Oral Health Education Programme with the aim of covering 10,000 children and youth through its various projects in 8 states in an effort to inculcate self-care habits among children. The program will address problems like dental decay, gum disease and oral cancer.
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Oral Cancer Among Young “Oral Cancer Among Young” (OCAY) grant proposal is to bring together a group of international researchers from the U.S., Europe, and Asia through collaborative partnerships to conduct research according to a common protocol to address the rising incidence of cancer of the tongue and mouth among youth in different parts of the world.
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Conclusion: Much has been learned in the past 50 years about oral SCC, and new and ingenious strategies are being developed to combat the disease. However, despite this Increase in knowledge, survival rates for patients presenting with advanced disease have not improved significantly. Early diagnosis is still the most important factor in improving the prognosis. It is therefore the responsibility of the dental profession to increase and Maintain its high level of its awareness and to actively pursue the understanding of this disease to enable earlier diagnosis, and hence improved outcomes
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Sober Peter, Essentials of Preventive and community Dentistry, 1st ed Arya Publishing House. Hiremath SS. Text book of preventive and community dentistry. Elsevier publication. Spencer KR, Ferguson JW, Wiesenfeld D. Current concepts in the management of oral squamous cell carcinoma. Aust Dental J 2002;47: 284-289. Daily Blanaid, Watt Richard, Batchelor Paul, Treasure Elizabeth. Essential public dental public health.1st ed. 2002 Oxford university press, New Delhi. Pine CM. community oral health. 1997. ed. Mumbai. KM Varghese company. 91-92.
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References: Burt BA. Dentistry, dental practice and community. 2005. 6th ed. 294-296. Sunny et al. Oral cancers in Mumbai, India: a fifteen years perspective with respect to incidence trend and cumulative risk. Asian Pac J Cancer Prev. 2004 Jul-Sep;5(3):294-300. http://smilefoundationindia.org/oralhealth.htm http://www.med.nyu.edu/cih/cancer/prevention_6stoppaan.htm
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Gupta PC. Mouth cancer in India: a new epidemic? J Indian Med Assoc. 1999 Sep;97(9):370-3. Sinha R, Anderson DE, McDonald SS, Greenwald P.Cancer Risk and Diet in India. J Postgrad Med 2003;49:222-228.
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THANK YOU