Mehdi masoud 200910759 ali mohammad 200810781

Case: 50years old lady, seeking full denture, during examination you noted a palpable, fixed, indurated supraclavicular lymph node. Her past medical history was heavy drinker and smoker

 Supraclvicular node: function: The function of the supra clavicular lymph nodes and other lymph nodes is to filter lymph fluid in the body. The right supraclavicular lymph node is responsible for lymphatic drainage of mediastinum, lungs, and esophagus. The left supraclavicular lymph node is responsible for lymphatic drainage of the thorax and abdomen.

Causes of enlargement of supraclavicular L.N:

Bacterial infection Fungal infection Lymphoma Thoracic cancer Retroperitoneal cancer

Effect of alcohol and somking:

Alcohol use clearly rasies the the risk of these cancers. Drinking and smoking toghether raise the risk of these cancer than effect of each one individually. This is because alcohol can act as solvent, helping harmful chemicals in tobacco to get into the cell lining the digistive tract. Alcohol may also slow down these cells ability to repair DNA damage caused by chemicals in tobacco

 Differntial diagnosis:
Lymphoma(hodgkin and non-hodgkin) Metastas from lung cancer

Metastas from abdominal cancer (insetine, gastric)

Lymphoma:
Lymphoma is a type of blood cancer that occurs when B or T lymphocytes divide faster than normal cells or live longer than they are supposed to. Hodgkin's lymphoma is one of the most well-known types of lymphoma, is marked by the presence of a type of cell called the Reed-Sternberg cell. The non-Hodgkin lymphomas any kind of lymphoma except Hodgkin's lymphomas. They vary significantly in their severity, from indolent to very aggressive.

Investigation:
Past medical history Physical and clinical examination FBC:to exclude leukaemia, mononucleosis and other causes of lymphadenopathy ESR: an ESR of greater than 70 carries an unfavourable prognosis CT scans of the thorax and abdomen are required for staging Hodgkin's lymphoma. Lymph node biopsy: to provide sufficiently large specimen for fresh frozen and formalin-fixed samples. Bone marrow biopsy is indicated for staging purposes

 Gallium scans Liver function and serum protein tests Fine needle aspiration: a diagnostic procedure used to investigate superficial lumps or masses

Treatment:
Chemotherapy Radiation Stem cell transplant Surgery combination

Prognosis:
new types of chemotherapy increased the survival rate than pervious. 5 years survival is seen in 98% of patients with favorable prognosis.

The adverse prognostic factors: Age 45 years Stage IV disease Hemoglobin < 10.5 g/dl Lymphocyte count < 600/l or < 8% Male Albumin < 4.0 g/dl White blood count 15,000/l

Oral Complication of chemotherapy and radiotherapy

Mucositis Infection taste change dry mouth Pain Dehydration Malnutrition tooth decay and gum disease

Preventive mesaure:
Balanced diet Good oral hygiene Prevent invasive dental procedure Oral health examination by dentist