Introduction to malignant tumor pathology
Introduction
The odontostomatologist plays an important role in the field of malignant tumor pathology:
- Screening for cancerous lesions of the oral cavity;
- Care for patients who are candidates for, or have undergone, anticancer treatment.
- Definitions
- Neoplastic tumor
Pathological growth due to a proliferation of cells resulting in a newly formed or neoplastic tissue resembling the normal tissue at the expense of which it developed:
- Benign tumor
Tissue outgrowth with architectural reproduction of the same tissue
- It is well limited, often encapsulated
- It pushes back neighboring tissues without invading them
- Slow evolution
- Absence of pain
- Absence of lymphadenopathy
- Preservation of the general condition
- Complete recovery after treatment
- No recurrence after treatment
- Favorable prognosis
- Malignant transformation is rare
- Malignant tumor
Anarchic proliferation of abnormal cells called “malignant” from a primary focus which can recur locally after ablation and spread to distant locations, giving rise to metastases.
- It is poorly limited
- It infiltrates neighboring tissues
- Alteration of general condition
- Fixed and hard lymphadenopathy
- Rapid evolution
- Recurrence after treatment
- Metastasis
Migration of cancer cells via the blood or lymphatic system from a primary site to another organ.
- Local extension of the tumor
- Spread to nearby lymph nodes
- Dissemination through the bloodstream proliferation in another organ
- Etiology
- Tobacco
- Alcohol
- Professional factor
- Nutritional factor
- Viral infections
- Potentially malignant conditions
- Genetic factor
- Poor oral hygiene
- Classification
TNM classification
T: primary tumor
N: regional lymph node metastases M: metastases
- T: primary tumor
- Tx: primary tumor cannot be assessed
- T0: no detectable tumor
- Tis: carcinoma in situ
- T1: T ≤ 2cm in its largest dimension
- T2: 2 ≤T≤ 4cm in its largest dimension
- T3: T˃4 cm in its largest dimension
- T4: Oral cavity extension to muscles and bone
- N: lymph node extension
- N0: Non-palpable GGs
- T1: Mobile homolateral GGs with a diameter of ≤3 cm
- N2a: ipsilateral single GG 3≤ N≤ 6cm
- N2b: Multiple homolateral GGs <6 cm
- N2c: Bilateral or contralateral GGs ˃ 6 cm
- N3: Fixed GG ˃6 cm
- Nx: unspecifiable extension
- M0: no detectable metastasis
- M1: certain metastasis
- Mx: unspecified metastasis
- Stage 0: T0N0M0: cancer in situ
- Stage I: T1N0M0: small tumor without lymph node invasion
- Stage II: T2N0M0: large tumor + lymph node invasion
- Stage III: T3N0M0: tumor developed beyond the organ + significant T1N1M0 lymph node invasion
T2N1M0 T3N1M0
- Stage IV: T4N0/N1M0: extensive tumor with ADP and TN2/N3M0 metastases
TNM1
Histopathological classification
- Epithelial lining carcinomas
- Basal cell E .: minimally invasive, no metastasis and recurrence rate is low
- E. spinocellular : +++ CB differentiated cells lymph node invasion
- E. metaplastic : in case of difficulty in DGC between basal and spinocellular
- Sarcomas : connective tissue
- Clinical examination
- Examination
- Age
- Profession and lifestyle
- Duration and quantity of tobacco and alcohol
- Medical-surgical history
- General condition and possibility of weight loss
- Functional signs
- Earache, dysphonia, nasal obstruction, epistaxis
- Reason for consultation
- Pain
- Swelling
- Mouth ulcer – white or red patch
- Unexplained bleeding
- Hyper drooling with blood
- Unexplained tooth mobility
- Loss of sensitivity in a territory of the V nerve
- Earache, dysphonia, dysphagia or nasal obstruction and epistaxis
- Limitation of mouth opening
- Oral exo-examination
- Facial symmetry examination
- Mouth opening width
- Examination of the sensory and motor innervation of the face
- ADPs: seat number size mobility or fixity and consistency
- Endo-oral examination
- HBD Assessment
- Denture: unexplained tooth mobility
- Periodontium
- Salivary duct orifices
- Appearance of the oral mucosa
- Ulceration nodule budding
- Sensitivity disorder
- Examination of the lesion :
- Color
- Appearance
- Shape
- Dimension
- Location
- Number
- Consistency
- Mobility and sensitivity
Vegetative or budding form
Ulcerative form Ulcer-vegetative form
- Diagnosis
- Histological sampling methods
- Biopsies
- Cytological sampling methods
- Exfoliative cytology
- Fine needle aspiration
- Cytodiagnostic elements
- The biopsy brush
- Paraclinical examinations and extension assessment
- Local extension (T)
- Intraoral clinical examination (palpation)
- TDM
- MRI
- Lymphatic extension (N)
- Cervicofacial palpation
- Cervical MRI
- Cervical ultrasound
- Remote Extension (M)
- Chest x-ray
- Thoracic and abdominal CT scans
- Liver ultrasound
- Additional examinations
- Panoramic x-ray – RRA: bone lysis or condensation
- CT scan: appearance of bone structures and possible extension of neighboring tissues
- MRI: soft tissue and lymph node areas
- Scintigraphy: bone metastases
Conclusion
The role of the dental practitioner:
- Prevention of risk factors
- Diagnosis; treatment and monitoring of potentially malignant lesions
- Screening for cancerous lesions
- Oral care before, during and after cancer treatment
Introduction to malignant tumor pathology
Wisdom teeth can cause infections if not removed in time.
Dental crowns protect teeth weakened by cavities or fractures.
Inflamed gums can be a sign of gingivitis or periodontitis.
Clear aligners discreetly and comfortably correct teeth.
Modern dental fillings use biocompatible and aesthetic materials.
Interdental brushes remove food debris between teeth.
Adequate hydration helps maintain healthy saliva, which is essential for dental health.