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Oral Malignancy - Coggle Diagram
Oral Malignancy
Steps to cancer
Mutation escapes DNA repair
Mutation is not lethal to cell
Mutation
Cell escapes apoptosis (by tumour suppressor genes)
Mutagenic agent acts on basal cells
Escapes immune system
Oral malignant neoplasms
Malignant melanoma
Lymphomas
Malignant salivary gland tumour
Neoplasms of bone and connective tissue (sarcomas)
SSC (90%)
Men over middle age
Tobacco use and alcohol
Carcinogens
Genotoxins
Nongenotoxins
IARC classification: group 1 (definitely carcinogenic) to group 4 (probably not carinogenic)
Microbiome and cancer
Genotoxicity
Metabolic by-products
Inflammation
HPV, EBV, H. pylori, chronic candida
Potentially malignant chronic mucosal inflammatory diseases/lesions
Lichenoid reaction
Erythroplakia
Lichen planus
Leukoplakia
Genetics
Defects in DNA repair
Defects in immune system
Clearance of altered autologous cells
Malignancy
Tolerance
Autoimmunity
Infection control
Susceptibility to infections
Chronic inflammatory mucosal diseases
TNM
T - size or extend of primary tumour
N - Degree of spread to regional lymph nodes
M - presence of metastasis to distant organs
Treatment
Radiotherapy if evidence of metastasis
Xerostomia
Osteoradionecrosis
Candidosis
C. albicans (70%)
Non-albicans candida
C. glabrata
C. krusei
Risk of candidemias (high mortality)
Treatment
Clearance of infection foci (oral hygiene, denture hygiene)
Antifungals
Control of predisposing factors
Clearance of infection foci before radiotherapy
Surgery +- neck dissection
Increased acetyaldehyde (ACH) levels in saliva
Alcohol
Tobacco
Poor oral hygiene
Candida can produce ACH from glucose and ethanol
Inflammation aids tumour progression
