Sunday, September 16, 2018

Tumors Oral Cavity : How to Diagnosis, Treatment and Prevent

Oral Cavity Cancer

Tumors Oral Cavity

Carcinoma of the oral cavity is a group of cancers called head and neck cancer. Cancer of the oral cavity can develop in various places in the oral cavity or oropharynx. Most carcinomas of the oral cavity start from the base of the tongue and mouth. Almost all carcinomas of the oral cavity start of flat cells (cell squamous) that coat the surface of the mouth, tongue and lips. This cancer called squamous cell carcinoma.

Carcinoma of the oral cavity is usually spread through the lymphatic system. Cancer cells usually appear initially in the lymph nodes of the neck. Cancer cells can also spread to other places on the neck, lungs, and other places throughout the body. When this happens, the new tumor is the same type of abnormal cells such as in the primary tumor.

Carcinoma of the oral cavity is one of the diseases can be detected early. It is caused by its own can be seen every day as well as by others, either intentionally or unintentionally, for example when doing a toothbrush will spontaneously can be seen the presence of abnormalities in the cavity the mouth. Abnormalities in the oral cavity can also be viewed by others while it is performing a dental examination nor was talking with other people. Other things that can potentially find the presence of tumors in the oral cavity can be seen from a disorder of movement of the tongue when speaking and so forth.

It is important to find a carcinoma of the oral cavity is premature, because thus more treatment success is assured. Researchers are trying to probe these further diseases to share information so that the public knows about Carcinoma of the oral cavity. With the examination-an examination of the simple as screening for Carcinoma of the oral cavity to find then it should have been the genesis of the oral cavity Carcinoma can be reduced and its treatment can be more successful.


Carcinoma of the oral cavity was found roughly around ⅔ occurs in the mouth and pharynx ⅓ found in. In the United States each year, about 29,000 people realize it has contracted cancer of the oral cavity (the mouth and lips) or oropharynx. This cancer is diagnosed in approximately 30,000 Americans (this year) and caused more than 8,000 deaths. The disease has killed nearly 1 person every hour. Cancer of the oral cavity ranks 6th for types of cancer that is often inflicted on men and no. 14 on the woman. Carcinoma of the oral cavity is spreading quickly. On average, only half (59%) are diagnosed with this disease can survive more than 5 years. Oral cavity cancers often occur at the age above 40 years old and affect more men than women. Vaamonde (2004) found that of 636 people patients suffering from head and neck cancer, 48 people or 7.5% develop secondary lesions.

Risk Factors

Tobacco/Alcohol Consumption; The use of tobacco and excessive Alcohol will increase the risk of cancer of the oral cavity. Cigarette smokers, cigars, pipe tobacco, snuff tobacco, tobacco chewers are those associated with the risk of Carcinoma of the oral cavity. In some tribes, tobacco is the need to run a cultural ritual or habit. For example on Indian tribes who perform the ritual of Sucking Pipe of peace to relieve tribal warfare. Likewise there are tribes in Indonesia Batak (Toba, Batak Simalungun, Nias) chewing tobacco (menyirih or suntil) has become a habit. For people who consume alcohol will increase the risk of developing cancer is with increasing amounts of alcohol consumed. The use of tobacco and alcohol at the same time increases the risk of more than one usage; even three of the four incidents of cancer of the oral cavity appear in people who consume tobacco, alcohol, or both.

Light From the Sun; Sun exposure is a risk factor for cancer of the lips, and even a smoker would be more prone to carcinomas. Using CAP, lip balm or lotion containing ultra violet protective will reduce or protect the lips from the risk of cancer of the lip.

Age; Carcinoma of the oral cavity is a disease typical in people with older age, usually because of the length of exposure to risk factors affected. Figures for the incidence of Carcinoma of the oral cavity increases with age, reaching the largest number at the age of 65-74 years. In Africa-American people, most events numbers at the age of about 10 years younger.

Gender; Carcinoma of the oral cavity about male 2 times more often than women.

Research shows that people who have risk factors such as above have greater possibilities to develop into Carcinoma of the oral cavity. Most cancers of the oral cavity can be prevented. 75% of this cancer is associated with use of tobacco, alcohol, or both simultaneously. Avoiding risk factors and factors coupled with eating more healthy foods like vegetables, fruits containing high in fiber will reduce the risk of cancer.

The table below is a risk factor data against cancer:

Risk Factor Percentage
Tobacco 30%
Diet / Obesity 30%
Habits/Patterns of life 5%
Factor obtained 5%
Family Cancer History 5%
Viruses/biological 5%
Perinatal Factor 5%
Reproductive 3%
Alcohol 3%
Socioeconomic Status 3%
Environmental pollution 2%
Ionizing/UV radiation 2%
Other 2%


The symptoms that often appear on cancer of the oral cavity is the membranes in the mouth or lips are colored white, red or both (color change on the network of the mouth); Pain in the lips or mouth which bleeds easily and does not heal; teeth date; Difficulty or pain when chewing or swallowing; Trouble talking or moving the jaw or tongue; Difficulty or discomfort when Moor teeth (wearing false teeth); Swelling in the neck; pain in the ear, and so forth.


Macroscopic. Note the presence of the preliminary signs that usually initiate the occurrence of cancer of the oral cavity that can look out for. Oral cancer is often preceded by a form of lesions are small, white or red spots that are often not aware of its existence or stung in the mouth. Such circumstances may occur throughout the area of the oral cavity including the lips, gums, cheek, tongue, inside and the ceiling (palate). Lesions that maybe a sign of cancer of the oral cavity. There are two lesions that can be precursors to cancer of the oral cavity, i.e. Leukoplakia (white lesions) and erythroplakia (red lesions). Although more rare lesions erythroplakia than leukoplakia, erythroplakia component containing the lesion has a greater potential for continued into cancer. All lesions, either white or red that does not improve within two weeks should be re-evaluated and considered for action biopsy to determine the Diagnosis of definitive. Other lesions may be the signs and symptoms. Signs and symptoms of Carcinoma of the oral cavity which usually includes: patient complained of the presence of a lump or thickening of the tissues of the mouth, pain or feeling like something stuck in throat, difficulty chewing or swallowing, ear pain, It's hard moving the jaw or tongue, hoarse, numbing on tongue or other parts of the mouth. If problems like this settled more than two weeks, then the necessary clinical and laboratory examination. If a diagnosis cannot be enforced, should patients referred to a specialist who is more appropriate.

Microscopic / Histopathology. The description of the histopathology varies greatly, ranging from hyperkeratosis and hyperplasia up on the State of atrophy and severe dysplasia. Patients with idiopathic leukoplakia have a higher risk to develop into cancer. From the research that there is a 4-17% of patients such as the malignant transformation of the incident found the lesion leukoplakia in less than 20 years later. Lesions in the oral cavity will develop into malignant lesions on areas likely 5 times greater in patients with leukoplakia than in patients without leukoplakia. Atrophic Mucosa is the initial conditions of pre Cancer lesions in the oral cavity where the epithelial cells and mucous tissue undergoes atrophy. Hiperplastik: mucosa epithelial cells in the mucosa of the oral cavity are having hyperplasia. Leukoplakia, usually asymptomatic and are discovered by accident while performing a routine dental examination. Leukoplakia can occur throughout the area of the oral cavity, though most often is in the buccal mucosa, the base of the mouth, tongue and palate the ventral part of the gingival. The appearance of leukoplakia is whitish plaques are solitary or multiple with an assertive edge. Leukoplakia can be slightly thickened and slippery or frown-shaped and fisur, may also appear with such plaques form veruka. Leukoplakia cannot be removed by using a swab. Eritroplakia, picture histologik Erythroplakia is epidermal thickening; almost 90% of the epidermal surface erosion is with dysplasia, carcinoma in situ, or already happened around the carcinoma growth margins of erythroplakia. Redness in lesions is a result of the reaction of subepitel with inflammation in the vascular dilation. The size of the lesion does not seem to be a relevance, i.e. even a very small dysplasia lesions can be a multiple carcinomas and fatal.

Dysplasia. Displastik lesions are not showing the specific clinical picture, however if accompanied by a erythroplakia, then the picture is like a dysplasia. 17-25% biopsy sample of leukoplakia is a proven dysplasia. Verrucous Leukoplakia, Erythroplakia, Leukoplakia and Nodular showed an increase in the frequency of changes of histology dysplasia. Leukoplakia as above, or a erythroplakia, is usually a displastik or carcinoma. Most idiopathic Leukoplakia is homogeneous and very little that shows berubahan histology dysplasia. Nodular Leukoplakia or Verrucous lesions is not homogeneous, but homogeneous leukoplakia doesn't show potential malignant. However, the study found heavy dysplasia or carcinoma shows of leukoplakia specimens originating from excision almost 5% when diagnosis specimens originating from the biopsy showed an absence of dysplasia. In Situ Carcinoma is a term used in the controversial if a severe Dysplasia in which abnormal area extending past the thickness of the epithelium. The entire abnormal cellular characteristics of the malignant state can appear; It's just an invasion of connective tissue is not found. Starting from top to bottom, as in dysplasia epithel lesions-lesions Dysplasia of the other, did not have a characteristic clinical picture, although erythroplakia Carcinoma proved to be in Situ or an Early Invasion Carcinoma. Squamous Cell Carcinoma is 95% type of carcinoma in HNSCC (Head and Neck Squamous Cell Carcinoma). Tumor Odontogenic, is a group of complex lesions by clinical and histological picture is very different. Some indeed a neoplasm (benign and malignant), but partly resembles the hematoma. Odontogenic tumor derived from epithelial odontogenic, ectomesnchyme, or from both. This type of tumor odontogenic the most frequently encountered is Ameloblastoma: derived from the epithelium of the odontogenik; Odontoma, derived from the epithelium but occupying positions in email and dentin. Odontomas hematoma is more of a than a neoplasm and can be cured by local excision.


Diagnosis is done by doing a physical examination that is seeing signs in the mouth or throat leukoplakia or erythroplakia existence, bumps, or other problems. The examination started from the base of the back of the throat, mouth and the inside of the cheeks and lips. Then conducted an examination of the tongue with interesting tongue carefully and proceed with an examination of the lymph nodes in the neck. On examination of the abnormal area is found, and then the Biopsy is done to ensure that suspected area. Determination of the structure and cytology is the Gold Standard in finding the presence of abnormality in the oral cavity. Endoscopy is also done to browse there whether or not the spread of cancer to other place.

Scanning can be done are: dental x-ray and chest CT scan, MRI, The examination conducted under this is an abstract of a standard inspection method which is already recommended by the WHO. Method of inspection is also done by the Center for disease control and prevention's National Health Agency. The tools used are: adequate light (a flashlight), the glass mouth, 2 pieces size gauze 2 x 2 ", and gloves. This examination is not more than 5 minutes. The patient is prepared by releasing first if any protease on the mouth (e.g., false teeth, braces, and so on), and then the patient is seated in a comfortable position.

Examination of Intra Oral and Perioral Tissues

The procedure is done is a systematic assessment of the 7 steps of the labial mucosa, lip and sulcus, mucosa and buccal commissural, sulcus, the alveolar and ginggiva, the base of the tongue, mouth, and palate. Lips: examination begins by observing the patient's mouth with lips open and closed. Check the colors, textures and surfaces that are abnormal in the boundaries of the upper and lower lips. Labial Mucosa: a patient's mouth half open, the assessment performed on the labial mucosa and sulcus of vestibula maxillary and frenum and vestibular mandibular. Observe the color, texture, and the presence of abnormal swelling or other circumstances of the vestibular gingival and mucosa. The buccal mucosa: stretch the buccal mucosa. The value of the right side first and then the left side of the buccal mucosa is then shifted to the commissural labial anterior tonsillar fails and returns. Make a note of any changes of pigmentation, color, texture, mobility and other abnormal circumstances. It must be ensured that the komisura are not covered by the retractor when doing stretching from the cheek. The first carried out the examination of the buccal and labial gingival and bordering the alveolar gingival starts from the posterior maxillary alveolar and right on, then moves to the left around the corner of the posterior region. Proceed to the area posterior to the mandibular gingival and alveolar left and move around the corner of the right posterior.

Tongue: the tongue of the patient in a State of rest, and the mouth a little open in the State, observe the tongue dorsum part are encountered swelling, ulceration, membranes, or variations of size, color, or texture. Also given notes if there is a change in the shape of the surface of the tongue wraps papilla and do also checks the tip of the tongue. Then the patient is asked to stick his tongue out and carried out assessment of mobility and his position with the glass mouth, notice the area of the lateral edge of the right and left sides of the tongue. Hold the tip of the tongue with gauze and pulling the tongue out carefully and optimized, then do the inspection on the lateral edge of the posterior region of the tongue. The ventral surface of the examination then does. Palpation of the tongue to detect any abnormal state of things.

The base of the Mouth: the tongue is still in a State of raised, inspection of the ground state of the mouth with the notice a color change, texture, swelling, or other abnormal condition.

Palate: a mouth wide open in a State of patients and patient's head leaning forward, carefully press the base of the tongue with the glass mouth. First observe the ceiling hard then soft palate. Second, check your palate and lingual area as it has been done at the time of the inspection the face, starting from right to left of the palate (maxillary) and from left to right lingual (mandible). Perform checks on the whole palate and network oropharingeal. Palpation in bimanual basic areas of the mouth and the detection of the presence of the abnormal circumstances. The entire mucosal or facial tissue that seems abnormal must be dipalpasi.

Early Detection of Carcinomas of the Oral Cavity. It is very important to find cancers of the oral cavity as early as possible so that treatment can be done more successfully. Carcinoma of the oral cavity examination is conducted to find signs of cancer. Carcinoma of the oral cavity examination is painless and quick, just spend a few minutes. At the time of examination is the right opportunity to do an examination of Carcinoma of the oral cavity. Early detection of Carcinomas of the oral cavity is important due to the early detection can save lives. With the discovery of the oral cavity carcinoma in early and regular therapy, death due to carcinoma can be reduced drastically. As was mentioned above that the determination of the structure and cytology is the "Gold Standard" in finding the presence of abnormality in the oral cavity, then the role of Biopsy in early detection of a carcinoma of the oral cavity is very important, due to the ability of aspiration biopsy cytology in addition to distinguish benign tumor with malignant tumor, can also specify subtype in most tumors. Biopsy for the lesions-lesions on the oral cavity can be done in a way "Aspirasi Biospi Jarum Halus (SiBajah)" or by means of a biopsy using a Stiff-bristled Brush, a Punch Biopsy and also Pan Endoscopy. Do SiBajah very profitable from various aspects be it from the side of the patient and the clinical management, among others, the inspection is fast, simple, inexpensive, rapid diagnosis can prevent delays in treatment and also the opportunity find cancer as early as possible. In terms of clinical management action SiBajah greatly help clinicians in providing the treatment immediately and more accurate, for the surgeon can help in determining the schedule and choose the method of operation resulting in more effective and efficient.


Some of Leukoplakia is potentially to be Malignant. Dysplasia often appears as the best predictor of a potential for violence. As much as approximately 25% of leukoplakia on the first meeting is dysplastic.


Estimated incidence of violence varies from transformation of 3-33% over a period of 10 years. Chance of living 5 years in people with oral cancer that is localized is 81% compared to sufferers of metastatic cancer of the mouth that is already about 30% only. Preparation for early detection is started by communicating with patients concerning the use of tobacco or alcohol history; at once inform patients of the existence of a link between the use of tobacco and alcohol as a cancer risk factor the oral cavity. As much as approximately 30% of Leukoplakia may be regressive if bad habits are discontinued.


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