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