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GP2 Ch4 Neoplasms腫瘤 (Definition (tumor (abnormal growth of tissue, benign…
GP2 Ch4 Neoplasms腫瘤
Definition
tumor
abnormal growth of tissue
benign or malignant
swelling of a part of the body
Neoplasm
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).
Different diagnosis between leukoplakia白斑病and pseumembranous candidiasis假性念珠菌病
Different diagnosis:particular disease or condition from others that present similar clinical features
In fungal infection you can remove the white spots
Origin of the manifestation 表現的起源
Neoplasms
head and neck tumors
benign
epithelial
melanotic macule黑色斑
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
papilloma乳頭狀瘤
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
nevus痣
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
connective
fibroma纖維瘤
• 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
gingival hyperplasia 牙齦增生
Common in
mouthbreathers口腔呼吸器
poor oral hygiene
some drugs (phenytoin苯妥英)
Thickening of the epithelium上皮增厚
Papillae are firm, pale and enlarged
pyogenic granuloma化膿性肉芽腫
Exaggerated response誇大反應 to minor trauma
uccommon
except in
pregnancy
inmunocompromised people.
seen most commonly on the gingiva.
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
malignant
• Oral squamous cell carcinoma(OSCC)口腔鱗狀細胞癌
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
HPV (HPV-16)
most common oral cancer (全球10種最常見的癌症)
most commonly in the tongue
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
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
Adenocarcinoma腺癌
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
• Lymphoma淋巴瘤
• Sarcoma肉瘤
• Metastasis
Origin of the manifestation 表現的起源
Treatment
radiotherapy
external beam radiotherapy外照射放療
brachytherapy 近距離放射治療
Type
Mucositis
irritation
Redness
sores in the mouth
Salivary gland dysfunction
Dry mouth or thickened saliva
Difficulty in swallowing
Neurotoxicity
Changes in or lost of taste:May decrease appetite and affect nutrition
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
chemotherapy
Direct effects (cell destruction)
• Oral mucositis口腔粘膜炎
• Xerostomia口腔乾燥症
• Taste dysfunction
• Neuropathies
• Graft vs host disease
• Osteoquimionecrosis
Bisphosphonates雙膦酸鹽
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
• Zoledronate
• Alendronate
• Pamidronate
• Risedronate
• Ibandronate
• Non bisphosphonates: denosumab
Indirect effects (myelosuppression骨髓抑制)
Infection
Bacterial
fungal
Mucositis粘膜炎
Hemorrhage
surgery
Swelling
Initial
Long lasting in lymph node removal
Chewing, swallowing or talking impairment
tongue
larynx resections喉部切除術
Jaw
Nerve injury
Origin of the manifestation 表現的起源
paraneoplastic syndromes 副腫瘤綜合徵
Types
Endocrine
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
Neurological
Encephalitis腦炎
polymyositis多發性肌炎
myasthenia肌無力
cerebellar degeneration小腦變性
Mucocutaneous
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
Hematological
Anemia
polycythemia紅細胞增多症
nonbacterial thrombotic endocarditis非細菌性血栓性心內膜炎
others
Glomerulonephritis腎小球腎炎
osteomalacia骨軟化症
fever
indirect effects of a tumor that occur distant to遠端 the tumor or metastatic site轉移部位