Module 3
Clinical
Manifestations
Introduction
 Intraoral cancers occur most frequently on
the:
-
Tongue
Floor of the mouth
Soft palate and
Oropharynx
 Squamous cell carcinoma is the most
common type, accounting for 90% of oral
cancers.
Types of Tumors
Squamous Cell Carcinoma
 The most common presentations of
intraoral squamous cell carcinoma are:
– exophytic (mass-forming)
– endophytic (ulcerated)
– leukoplakic (white patches)
– erythroplakic (red patches) and
– erythroleukoplakic (combined white and red
patches)
Leukoplakia
Leukoplakia describes a white patch or plaque on
the oral mucosa that cannot be wiped off and cannot
be classified as another disease condition.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:29.
Leukoplakia
Leukoplakias are considered precancerous—the longer
the lesion is present, the greater the chance of
transformation to cancer.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:30.
Leukoplakia – Snuff-related
Used with permission from Dr. Joel Schwartz, University of Illinois at Chicago
Leukoplakia – Snuff-related
Used with permission from Dr. Joel Schwartz, University of Illinois at Chicago
Leukoplakia
Used with permission from Dr. Joel Schwartz, University of Illinois at Chicago
Plaque Form of Candidiasis
Candidiasis can be wiped off with gauze or
an instrument.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:41.
Verrucous Leukoplakia
Verrucous leukoplakia should be treated
aggressively.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:39.
Leukoplakia
Recurrences of white and/or red lesions are
common, so frequent follow-up is necessary.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:39.
Proliferative Verrucous
Leukoplakia
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:39.
Hairy Leukoplakia
Hairy leukoplakia is a benign condition that
signals HIV infection.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:42.
Leukoplakia
All chronic white and/or red lesions should be
carefully monitored and biopsied.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:31.
Erythroplakia
Erythroplakia
appears as a
red lesion
that may
demonstrate
an erosive
component.
Image used with permission from Dr. Mark Bride, DDS, and ViziLite, Zila Pharmaceuticals, 2004
Erythroleukoplakia
Erythroleukoplakia has both white and red
components.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:36.
Erythroleukoplakia
These lesions are 4 times more likely to undergo
a malignant transformation than other types.
Image used with permission from Dr. John L. Giunta, BS, DMD, MS, 1998, http://www.forsyth.org/oralpathology
Erythroleukoplakia
Red lesions present after 14 days should be
biopsied or referred to a specialist.
Image used with permission from Dr. Mark Bride, DDS, ViziLite, Zila Pharmaceuticals 2004
Oral Candidiasis - Soft Palate
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:119.
Location of Oral Cancer
Relative Locations of Intraoral
Cancers by Percentage
Tongue
Floor of the mouth
Soft palate and oropharynx
Gingiva
Buccal mucosa
50%
25%
15%
5%
5%
Common Oral Cancer Locations
Areas
highlighted in
yellow are
the most
frequent
locations for
oral cancers
to occur.
Image used with permission from Sapp, Eversole, & Wysocki (2004) Mosby, 190.
Tongue Carcinoma
The tongue is increasingly a site for oral cancer in
young individuals with no apparent risk factors.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:36.
Tongue Carcinoma
Carcinomas of the tongue account for 25% of all oral
squamous cell carcinomas and half of intraoral lesions.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:37.
Floor of the Mouth
Approximately 25% of oral carcinomas occur in
the floor of the mouth region.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:37.
Floor of the Mouth
Erythroplasia on the floor of the mouth
adjacent to the lingual frenum.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:50.
Floor of the Mouth
Carcinoma appearing as a non-healing,
ulcerated area.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:50.
Carcinoma of the Soft Palate
Due to their posterior location, patients are
often unaware of the presence of these lesions
and diagnosis may be delayed.
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:52.
Carcinoma of the Oropharynx
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:52.
Gingival Squamous Cell
Carcinoma
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:34.
Squamous Cell Carcinoma
in the Buccal Mucosa
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:34.
Carcinoma of Buccal
Mucosa/Oropharynx
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:52.
Squamous Cell
Carcinoma
Lip
carcinoma
caused by
pipe
smoking
Image used with permission from Dr. Sol Silverman and the American Cancer Society; Silverman, 2003:11.
Lymph Node Locations
Preauricular
Parotid
Retropharyngeal
(tonsillar)
Submandibular
(submaxillary)
Submental
Occipital
Postauricular
Posterior
Cervical
Anterior Cervical
Supraclavicular
Retrieved July 30, 2004 from:
http://www.med.usf.edu/FAMILY/cough_and_congestion/lymph.nodes_head_and_neck.jpg
Signs and Symptoms
 A sore or area in the mouth that does not
heal after two weeks
 Persistent pain in the mouth
 Persistent lump or thickening in the cheek
 Sore throat or feeling that something is
caught in the throat
 Difficulty chewing or swallowing
 Difficulty moving the jaw or tongue
 Voice changes
Signs and Symptoms
 Numbness in the tongue or other area of the mouth
 Swelling in the jaw that causes dentures to fit poorly
or become uncomfortable
 Loosening of teeth or pain around the teeth or jaw
 Lump or mass in the neck
 Weight loss (unexplained)
 Persistent bad breath
Summary
• Oral cancer may appear as erythroplakia,
leukoplakia, or erythroleukoplakia.
• Common locations include the tongue
(50%), floor of the mouth (25%), soft
palate/oropharynx (15%), and gingiva
(5%) or buccal mucosa (5%)
• Lesions that may mimic oral cancer
include candidiasis, oral lichen planus or
physical trauma.