GP2 Ch4 Neoplasms腫瘤
Origin of the manifestation 表現的起源
Different diagnosis between leukoplakia白斑病and pseumembranous candidiasis假性念珠菌病
Definition
tumor
Neoplasm
abnormal growth of tissue
benign or malignant
swelling of a part of the body
any new and abnormal growth
specifically in which cell multiplication is uncontrolled and progressive
benign or malignant
mode of growth
benign : expansion
malignant : expansion +infiltration
Cancer
abnormal growth of cells
tend to proliferate in an uncontrolled way以不受控制的方式增殖
metastasize轉移 (spread).
Neoplasms
Origin of the manifestation 表現的起源
head and neck tumors
Origin of the manifestation 表現的起源
Treatment
radiotherapy
chemotherapy
external beam radiotherapy外照射放療
brachytherapy 近距離放射治療
benign
malignant
epithelial
connective
melanotic macule黑色斑
papilloma乳頭狀瘤
nevus痣
fibroma纖維瘤
gingival hyperplasia 牙齦增生
pyogenic granuloma化膿性肉芽腫
1/3 are blue naevi (deeper).
1/2 ot the naevi are histollogically of the intramucosal type膜內型
Circumscribed, small, greyish or brownish macules
congenital
Palate and buccal mucosa
Acquired, small, flat, brown to brown-black
Usually seen in isolation
occur on the vermilion border下唇的唇緣 of the lower lip as solitary lesions孤立的病變
Human Papilloma Virus
Charateristic
exophitic外生性
keratinized角質化
sessile papules無梗性丘疹
nodules結節 cauliflowe-like 2-5 mm
• Fibrous hyperplasia纖維增生
• 20% of lesions in oral cavity口腔中20％的病變
• Caused by trauma or suction
• Tumorous lesion up to 2 cm, elastic, pain
Common in
some drugs (phenytoin苯妥英)
Thickening of the epithelium上皮增厚
Papillae are firm, pale and enlarged
mouthbreathers口腔呼吸器
poor oral hygiene
Exaggerated response誇大反應 to minor trauma
uccommon
except in
seen most commonly on the gingiva.
pregnancy
inmunocompromised people.
Appearance
soft
fleshy肉質
rough-surfaced vascular lesions粗糙表面的血管病變 that bleed readily
Slight maloclusion錯牙合畸形 leading to plaque accumulation
• Oral squamous cell carcinoma(OSCC)口腔鱗狀細胞癌
Adenocarcinoma腺癌
• Lymphoma淋巴瘤
• Sarcoma肉瘤
• Metastasis
Cause
Tabaco and alcohol 75%
Others
– Betel檳榔 quid & mate (cold)
– Preserved & salted food
– Oral health (alcohol)
– Occupational & radiation exposures
– Ancestry
– Epstein-Barr Virus
most common oral cancer (全球10種最常見的癌症)
most commonly in the tongue
HPV (HPV-16)
consequence of multiple molecular events causing genetic damage-->leads to DNA changes-->onset of malignancy(Epithelial displasya)
Epithelial displasya上皮發育不良
disorder of differentiation of epithelial cells which 上皮細胞分化紊亂
may regress remain stable, or progress to invasive carcinoma
Potencially malignant (precancerous lesions癌前病變) which can progress to OSCC
– Erythroplakia紅癬 (most likely)
– Actinic cheilitis光化性唇炎
– Lichenoid lesions
– Discoid lupus erythematosus 盤狀紅斑狼瘡
– Leukoplakia
Different diagnosis:particular disease or condition from others that present similar clinical features
In fungal infection you can remove the white spots
Clinical manifestation
– Granular ulcer with fissuring or raised rolled everted margins
– Red lesion
– White lesion
– Mixed white and red lesion
– Lump, sometimes with abnormal supplying of blood vessels
– Lump / ulcer which is indurated潰瘍
Advanced stage
sore throat
Swallowing impairment
Lymph node enlargement
Salivary gland cancer
Salivary gland neoplasms are uncommon and most are benign and affect the parotid
Associated to radiation
Clinical manifestation
• Painless lump.
• Fluid leaking from the ear.
• Trouble swallowing or opening the mouth widely
• Numbness or weakness in the face.
• Long lasting pain in the face.
Adenoid cystic tumor腺樣囊性癌
most often occurs in the salivary glands
survive for years with metastases because this tumor is generally well-differentiated分化良好and slow growing
Rare type of cancer that can exist in many different body sites
Rare in parotid gland
paraneoplastic syndromes 副腫瘤綜合徵
Types
Endocrine
Neurological
Mucocutaneous
Hematological
others
Hyperaldosteronism醛固酮增多症
Cushing syndrome庫欣綜合徵
hypercalcemia高鈣血症
SIADH不適當的抗利尿激素綜合徵
hypoglycemia低血糖
carcinoid syndrome類癌綜合徵
Encephalitis腦炎
polymyositis多發性肌炎
myasthenia肌無力
cerebellar degeneration小腦變性
Acanthosis nigricans黑棘皮病
dermatomyositis皮肌炎
necrolytic migratory erythema壞死性遷移性紅斑
pyoderma gangrenosum壞疽性膿皮病
hypertrichosis多毛症
Sweet syndrome
Anemia
polycythemia紅細胞增多症
nonbacterial thrombotic endocarditis非細菌性血栓性心內膜炎
Glomerulonephritis腎小球腎炎
osteomalacia骨軟化症
fever
surgery
Swelling
Chewing, swallowing or talking impairment
tongue
larynx resections喉部切除術
Jaw
Initial
Long lasting in lymph node removal
Type
Mucositis
Salivary gland dysfunction
Neurotoxicity
Nausea噁心
Earache
Swelling or drooping of the skin under the chin
Changes in the texture of the skin
Stiffness in the mouth: Might limit the opening of the mouth
Osteorradionecrosis放射性骨壞死
irritation
Redness
sores in the mouth
Dry mouth or thickened saliva
Difficulty in swallowing
Changes in or lost of taste:May decrease appetite and affect nutrition
Direct effects (cell destruction)
Indirect effects (myelosuppression骨髓抑制)
• Oral mucositis口腔粘膜炎
• Xerostomia口腔乾燥症
• Taste dysfunction
• Neuropathies
• Graft vs host disease
• Osteoquimionecrosis
Infection
Mucositis粘膜炎
Hemorrhage
Bacterial
fungal
Bisphosphonates雙膦酸鹽
• Zoledronate
• Alendronate
• Pamidronate
• Risedronate
• Ibandronate
• Non bisphosphonates: denosumab
More frequent with intravenous
Bone exposure that does not heal
Type of chronic osteomyelitis that appears in patients who have taken o are taking oral or intravenous bisphosphonates.
Extraction
Nerve injury
indirect effects of a tumor that occur distant to遠端 the tumor or metastatic site轉移部位