ORAL CAVITY CANCER

Oral cavity cancer is cancer originating from both

epithelial mucosa or salivary glands in the walls of
the oral cavity and organs in the mouth. Oral cavity
cancer is more prevalent in males than females with
a ratio of 3/2 - 2/1. It mostly occurs in the age
above 40 years (70%) and it spread all over the
world. The highest incidence are in France and
India, while the lowest is in Japan.
The etiology of oral cavity cancer is exposure to
carcinogens, which are widely found in cigarettes or
tobacco. High risk of oral cavity cancer gets there in
the smoker, nginang / fringe, alcohol, dental caries,
poor oral hygiene
Goal
1. To know the definition of carcinoma of the oral cavity
2. Can explain the pathophysiology of carcinoma of the
oral cavity
3. To determine the risk factors for oral squamous
4. To find a variety of carcinomas of the oral cavity
5. To determine the clinical symptoms of oral carcinoma
6. To find out how to diagnose carcinoma of the oral
cavity
7. To determine the treatment of carcinoma of the oral
cavity

Oral Cavity Carcinoma
A. Definition
Oral cavity cancer is cancer originating from both
epithelial mucosa or salivary glands in the walls of the
oral cavity and organs in the mouth
The boundaries of the oral cavity is:
Front : the edge of the upper lip vermilion and lower lip
Above: the hard palate and molle
Lateral: right and left buccal
Bottom: floor of the mouth and tongue
Rear: left and right anterior arch pharyngeus and uvula,
left and right arch glossopalatinus, the lateral edge of the
tongue, the tongue circumvallate papillae
B. Pathophysiology
DNA is a chemical in every cell of the body that will form the gene,
showed that the cells in the body to function properly. Some genes
have instructions for controlling when cells grow and divide. Genes
that stimulate cell division are called oncogenes. Genes that slow
down cell division or cause cells to die at the right time are called
tumor suppressor genes.
When tobacco and alcohol damage the cells that line the mouth
and throat, the cells should grow more rapidly to repair this damage.
In this case there is an opportunity to make a mistake when copying a
gene so that DNA into cancer cells. Many of the chemicals found in
tobacco can damage DNA directly. This damage can lead to oncogenes
and tumor suppressor genes were damaged, DNA changes that
activate oncogenes or deactivate tumor gensupresor produce
abnormal cells to form tumors.
With the additional damage, Human Papilloma Virus infection,
causing the cells to make 2 protein, the E6 and E7. This protein kills
several genes that keep cell growth under control, so that the cell
growth becomes uncontrolled and become cancerous. HPV DNA was
found in the tumor cells, especially in cells of patients with non-
smokers who drank little or no alcohol consumption alcohol. HPV is
estimated to be the likely cause of cancer


C. Risk factor
Smoke
Consumption of alcohol
Infection of Human Papilloma Virus (HPV)
Sex
Age
Ultraviolet (UV)
Malnutrition
Weak Immune System
Genetic


D. Clinical diagnosis
Anamnesis.
Patient complaints, grievances previous dental, general
medical history past and present, lifestyle habits, family
history, socioeconomic status and occupation. While doing
anamnesis physician can also see the state of the patient oral
extras, such as lip and facial asymmetry.
Clinical examination
1. Change the color, whether oral mucosal abnormal color,
such as white, red or black.
2. Consistency, whether hard tissue, chewy, soft, fIuktuan or
nodular.
3. Contour, whether mucosal surface rough, ulceration,
asymmetry or swelling.
4. Temperature.
5. Function, whether the patient can open the mouth
perfectly.
6. Lymphnode cervical






Characteristic
Generally, early stage oral cancer does not cause
symptoms, less than 2 cm in diameter, mostly red with or
without white components, slick, smooth and showed minimal
elevation. Often beginning of malignancy characterized by the
presence of ulcers. If there are ulcers that do not heal within 2
weeks, then the situation can already be suspected as early in
the process of malignancy.
Other signs of malignancy include ulcers process painless
ulcer, rolled edge, higher than the surrounding area and
induration (harder), can essentially bumps and peeling.
Growth carcinoma ulcer forms are referred to as growth
endofitik. Besides oral carcinoma is also seen as a growth
eksofitik (superficial lesions) that can be shaped or papillary
cauliflower, bleeds easily. Eksofitik lesions are more easily
recognized its existence and has a better prognosis.
E. Histopathology classification
Type of histology






The majority ( 90%) cancers originate from the mucosa of
the oral cavity in the form of epidermoid carcinoma or
squamous cell carcinoma with well differentiation, but can also
moderate, bad or anaplastic. When the pathological picture
showed a rhabdomyosarcoma, fibrosarcoma, malignant or
malignant tumors fibrohistiocytoma other soft tissue, should
be carefully examined whether the tumor was actually a
malignant tumor of the oral cavity (C00-C06) or a malignant
tumor of the soft tissues of the cheek, skin or bone invasion
held into the oral cavity.


NO HISTOLOGY TYPE ICD.M
1 Squamous cell carc. 5070/3
2 Adenocarcinoma 8140/3
3 Adenoid cyst.carc 8200/3
4 Ameloblastic carc 9270/2
5 Adenolymphoma 8561/3
6 Mal. mixed tumor 8940/3
7 Pleomorphic carc 8941/3
8 Melanoma maligna 8720/3
9 Lymphoma maligna 9590/3-9711/3
Degree of Differentiation
Standard Pathology Reports
To report on the results of the pathological examination of
the specimen operations include:
1. Histologic type of tumor
2. The degree of differentiation (grade)
3. Examination to determine the stage of pathological
TNM (pTNM)
T = primary tumor
Size of tumor
The invasion into the blood
vessels / lymph
Operating radicalism
N = regional nodes
number KGB found
Level KGB positive
The number of positive
nodes
Invasion of the tumor out
kapsel KGB
The extra-nodal metastases
M = distant metastasis
Degree of Diffeentiation
GRADE KETERANGAN
G1 Differensiasi baik
G2 Differensiasi sedang
G3 Differensiasi jelek
G4 Tanpa differensiasi = anaplastik
F. Clinical stadium classification
Determining the stage of cancer of the oral cavity is recommended using TNM
system of UICC, 2002. Treatment depends on the stage of therapy. Instead of staging to
delineate the severity of cancer can also be widely used extension of disease.
ST T N M TNM KETERANGAN
0 TIS N0 M0 T0 Tidak ditemukan tumor
TIS Tumor in situ
I T1 N0 M0 T1 2 cm
T2 >2 cm - 4 cm
II T2 N0 M0 T3 > 4 cm
T4a


T4b
Bibir :infiltrasi tulang, n.alveolaris inferior, dasar mulut, kulit
Rongga mulut : infiltrasi tulang, otot lidah (ekstrinsik /deep), sinus maksilaris,
kulit
Infiltrasi masticator space, pterygoid plates, dasar tengkorak, a.karotis interna
III T3 N0 M0
T1 N1 M0 N0 Tidak terdapat metastase regional
T2 N1 M0 N1 KGB Ipsilateral singel, 3 cm
T3 N1 M0 N2a KGB Ipsilateral singel, >3 - 6 cm
N2b KGB Ipsilateral multipel, < 6 cm
IVA T4
Tiap
T
N0,N
1
N2
M0
M0
N2c KGB Bilateral /kontralateral, < 6 cm
N3 KGB > 6 cm
IVB Tiap
T
N3 M0
IVC Tiap
T
Tiap
N
M1 M0 Tidak ditemukan metastase jauh
M1 Metastase jauh
G. DIAGNOSTIC PROCEDURE
Clinical examination
anamnesa
Anamnesa kwesioner by the patient or family.
1) Complaints
2) Course
3) the etiology and risk factors
4) What treatment has been given
5) How do the results of treatment
6) How long delays
physical examination
general status
General examination from head to toe
Determine:
a. Appearance
b. General condition
c. Distant metastases
the local
inspection

bimanual palpation
Abnormalities in the oral cavity checked by inspection and palpation
with the help spatel tongue and illumination using a flashlight or head
lamp. The entire oral cavity seen, from the lips to the posterior
oropharynx. Palpability of lesions of the oral cavity is done by inserting
one or two fingers into the mouth. To determine which lesions are
performed by touching bimanuil. One or two fingers left or right hand is
inserted into the cavity of the mouth and the fingers of his other hand
fingered lesions outside the mouth.
For the inspection of the tongue and oropharynx can the tip of the
tongue that has been wrapped with a 2x2 inch gauze is held with the
examiner's left hand and pulled out the mouth and directed right and left
to see the surface of the dorsal, ventral and lateral tongue, floor of the
mouth and oropharynx. Inspections can be better when using the help of
a mirror examiner.
Determine where the primary tumor site, how it would look, how
much in cm, how much infiltration, how operabilitasnya.
regional status
Palpation is there any enlargement of cervical lymph nodes
ipsilateral and contralateral neck. If there is enlargement specify the
location, number, size (the largest), and mobility.
Radiography Examination
a. X-plain
X-mandibular photo AP, lateral, Eisler, panoramic, occlusal,
mandibular gingiva done on the tumor or tumors attached to the
mandible
Lateral head X-photo, Waters, occlusal, gingival done on the
tumor, maxillary or maxillary tumor attached to
X-Hap photo done on the hard palate tumor
X-thorax photo, for the presence of pulmonary metastases
B. Imaging (made only on indication)
Liver ultrasound to look at the liver metastases
CT-scan or MRI to assess tumor extension vast lokoregional
A bone scan, if suspected metastasis to bone

Laboratory
Routine laboratory examinations, such as blood, urine,
SGOT / SGPT, alkaline phosphatase, BUN / creatinine, albumin,
globulin, serum electrolytes, physiological hemostasis, to
assess the general condition and preparation of the operation.





Pathology examination
All patients with oral cancer or suspected cancer of the oral cavity
should be carefully examined pathologically.
Specimens taken from tumor biopsies
Fine-needle biopsy (FNA) for cytological examination can be
performed on the primary tumor or metastatic cervical lymph nodes.
excision biopsy : when small tumors, excision of 1 cm or less extensive
excision is undertaken as definitive surgery (1 cm from the edge of the
tumor)
Biopsy cakot incision or biopsy (punch biopsy) using alligator forceps:
if the tumor is large or inoperable
What should be examined is in preparation histopathologic type,
differentiation and extensive invasion of the tumor.
large tumors predicted operabel:
A biopsy should be performed under general anesthesia and can be
done at the same time bimanuil exploration to determine the extent of
tumor infiltration (staging)
the expected large inoperable tumor:
A biopsy is done with local anesthetic block in normal tissue around
the tumor. (Anesthetic infiltration of the tumor should not be done to
prevent the spread of cancer cells).
H. DIAGNOSIS upheld
primary diagnosis
macroscopic description of the cancer disease itself,
which is a clinical diagnosis
Diagnosis of complications
Other disease that is caused by cancer
Secondary Diagnosis
Another disease that has nothing to do with cancer
suffered, but it may affect treatment or prognosenya.
diagnosis pathology
A microscopic picture of the cancer

I. TREATMENT PROCEDURES
Oral cavity cancer treatment should be multidisciplinary involving several specialist
areas, namely :
Oncologic Surgeon
Plastic & Reconstructive Surgeon
Radiation oncologist
Medical oncologist
Dentists
Rehabilitation specialists
Some things to consider in the treatment of oral cancer is the eradication of the
tumor, restoring the function of the oral cavity, as well as the cosmetic aspect or
appearance of the patient. Some factors to consider in determining the kinds of therapy
are:
Age of the patient
The general state of the patient
Facilities available
Ability doctor
The choice of the patient.
For small lesions (T1 and T2), surgery or radiotherapy alone can provide a high cure
rate, with a note that radiotherapy alone on T2 gives a higher recurrence rate than surgery.
For T3 and T4, the combination of surgery and radiotherapy treatment gives the best
results. Giving neo-adjuvant radiotherapy and or chemotherapy prior to surgery may be
given to the cavity cancer locally advanced (T3, T4).
Radiotherapy can be given as interstitial or external tumors eksofitik with small size
will be more successful than endofitik tumors with large size. The role of chemotherapy in
the treatment of oral cancer is still not much in the research phase of chemotherapy is only
used as neo-adjuvant pre-operative or post-operative adjuvant for sterilization possibility of
micro-metastasis.
ST T.N.M. OPERASI RADIOTERAPI KHEMOTERAPI
I T1.N0.M0 Eksisi radikal atau Kuratif, 50-70 Gy Tidak dianjurkan

II T2.N0.M0 Eksisi radikal atau Kuratif, 50-70 Gy Tidak dianjurkan

III T3.N0.M0
T1,2,3.N1.M0
Eksisi radikal dan Post op. 30-40 Gy

(dan) CT

IVA T4N0,1.M0
Tiap T.N2.M0
Eksisi radikal dan Post.op 30-40 Gy
IVB Tiap T.N3.M0
-operabel

-inoperabel

Eksisi radikal

-

dan
Post.op 30-40 Gy
Paliatif, 50-70 Gy

(dan)
CT
IVC TiapT.tiapN.M1 Paliatif Paliatif Paliatif

Residif local Operasi untuk
residif post RT
RT untuk residif
post op
dan CT
Metastase Tidak dianjurkan Tidak dianjurkan CT
carcinoma of the lip
T1: wide excision or radiotherapy
T2: wide excision. When the commissure, radiotherapy will provide relief to the function and
better cosmetic
T3, 4: wide excision + + deseksi suprahioid postoperative radiotherapy
Carcinoma of the mouth
T1: wide excision or radiotherapy
T2: not attached periosteum wide excision, wide excision periosteum Sticking with
marginal mandibulektomi
T3, 4: wide excision with marginal mandibulektomi dissection supraomohioid + +
postoperative radiotherapy
carcinoma of tongue
T1, 2: wide excision or radiotherapy
T3, 4: wide excision + + deseksi supraomohioid postoperative radiotherapy
carcinoma of the buccal
T1, 2: wide excision. When the commissure oris, radiotherapy provide relief to the function
and better cosmetic
T3, 4: wide excision + + deseksi supraomohioid surgical radioterapipasca
carcinoma ginggiva
T1, 2: wide excision with marginal mandibulektomi
T3: wide excision with marginal mandibulektomi dissection supraomohioid + + postoperative
radiotherapy
T4 (infiltration of bone / tooth extraction after tumor): wide excision with segmental
mandibulektomi dissection supraomohioid + + postoperative radiotherapy
carcinoma of the palate
T1: wide excision to periost
T2: wide excision to the underlying bone
T3: wide excision to the underlying bone dissection supraomohioid + +
postoperative radiotherapy
T4 (bone infiltration): Maksilektomi infrastructural partial / total lesion
depends extensive dissection supraomohiod + + postoperative radiotherapy.
Retromolar trigone carcinoma
T1, 2: wide excision with marginal mandibulektomi
T3: wide excision with marginal mandibulektomi dissection supraomohioid + +
postoperative radiotherapy
T4 (bone infiltration): Wide excision with segmental mandibulektomi
dissection supraomohioid + + postoperative radiotherapy
For carcinoma of the oral cavity T3 and T4, N0 handling do deseksi selective
neck or postoperative regional radiotherapy. While N1 obtained at each T to
do deseksi radical neck. Where possible, wide excision of the primary tumor
and neck deseksi should be done en-block.
Giving regional radiotherapy after surgery depends on the results of
pathological lymph node metastases (the number of positive lymph node
metastasis, lymph node capsule penetration / extra lymph nodes).
1. Curative Therapy
Curative treatment for cancer of the oral cavity is given in oral cavity
cancer stage I, II, and III.
a. The main therapy
Primary therapy for stage I and II is that surgery or radiotherapy,
each of which has advantages and disadvantages of each. Whereas for
stage III and IV are still operabel is a combination of surgery and
postoperative radiotherapy .
In curative therapy should be considered:
According to proper procedure, because if one of the results are not to be
curative.
Function mouth to speak, eat, drink, swallow, breathe, stay well.
Cosmetic quite acceptable
Operation
Indication of operation:
Case operabel
Age is relatively young
The general state of good
There is no co-morbidity of severe

The basic principle of operation of oral cancer are:
The opening should be large enough to be able to see the entire tumor with extension
The basic principle of operation of oral cancer are:
Exploration of tumor: to determine the extent of tumor extension
Wide excision of tumor
The tumor does not invade the bone, 1-2 cm wide excision of tumor beyond
Invaded bones, wide excision with resection of the invaded bone
regional nodes dissection (RND = Radical Neck Disection or modification), if there are
regional nodes metastasis. Enblok dissection is done with the primary tumor whenever
possible.
Determine radicalism durante operation of edge incision surgery with frozen
cut checks. If you do not create a radical new line of larger incision to free the
tumor.
Reconstruction of defects that occur.
radiotherapy
indications of radiotherapy
The case of inoperable
T1, 2 specific place (see above)
Cancer of the tongue
Age is relatively old
Reject operation
There is a severe co-morbidities
Radiotherapy can be given by:
Teletherapy wear: ortovoltase, Cobalt 60, Linec dose of 5000-7000 rads.
Brachytherapy: a booster with intratumoral implantation of radium needles Irridium 192
or 226 at a dose of 2000-3000 rads.
b. Additional Therapy
Radiotherapy
Additional radiotherapy is given in the case of the main therapy surgery.
post-surgical radiotherapy
Given on T3 and T4a after surgery, the case can not be done radical excision, radikalitasnya
doubtful, or the operating field contamination by cancer cells.
pre-surgical radiotherapy
Pre-surgical radiotherapy is given in cases operabilitasnya doubt or inoperable.
Operation
Operations Carried out in cases of therapy after primary radiotherapy or
radiotherapy to operabel residif arising after radiotherapy.
Chemotherapy
Chemotherapy given in the case of the operating field contamination by
cancer cells, cancer stage III or IV or raised residif after surgery and or radiotherapy.

c. Therapy Complications
Therapeutic Complications of disease
In general, stage I to II disease has been no Complications, but Complications
can occur due to therapy.
Treatment depends on the Complications that exist, for example (Sunarto, 2003)
- Pain: analgesics
Infection: antibiotic
Anemia: haematinics
Therapeutic Complications of therapy
Complications of surgery: by type of complication
Complications of radiotherapy: by type of complication
Complications of chemotherapy: by type of complication
c. Therapy Complications
Therapeutic Complications of disease
In general, stage I to II disease has been no Complications, but
Complications can occur due to therapy.
Treatment depends on the Complications that exist, for example
(Sunarto, 2003)
- Pain: analgesics
Infection: antibiotic
Anemia: haematinics
Therapeutic Complications of therapy
Complications of surgery: by type of complication
Complications of radiotherapy: by type of complication
Complications of chemotherapy: by type of complication

d. assisted therapy
Can be given proper nutrition, vitamins, etc. ..
e. secondary therapy
If there is a secondary disease therapy was given According to the
type of illness.

2. Palliative Therapy
Palliative therapy is to improve the quality of life of patients and reduce
the grievances especially to people who are no longer curable. Palliative
therapy given to patients with oral cavity cancer :
Stage IV has demonstrated distant metastases
There are severe co-morbidities with a short life expectancy
Curative treatment fails
Very advanced age
Complaints need palliation include:
Loko regional
ulcers in the mouth / throat
Pain
It is difficult to eat, drink, swallow
Oral smell
Anorexia
oro-cutaneous fistula
Systemic:
Pain
Shortness of breath
It is difficult to talk
Cough-cough
The agency took care
A weak
1) The Main Therapy
a) Without distant metastases: Radiotherapy dose
5000-7000 rads.
If you need to combine the operations
b) There are distant metastases: Chemotherapy
Chemotherapy can be used include:
epidermoid carcinoma:
Drugs that can be used: Cisplatin, Methotrexate,
Bleomycin, Cyclophosphamide, Adryamycin, with
numbers 20 -40% remission. For example:
a single drug: Methotrexate 30 mg/m2 2x a week
Drug combinations:
V = vincristine: 1.5 mg/m2 hl
B = Bleomycin: 12 mg/m2 hl + 12 hours ==> repeated
every2-3 weeks
M = Methotrexate: 20 mg/m2 h3, 8
adeno carcinoma:
Drugs that can be used include: Flourouracil,
Mithomycin-C, Ciplatin, Adyamycin, the remission rate 20
30%.
For example:
single drug: Flourouracil
Dose starters: 500 mg/m2
Maintenance dose: 20 mg/m2 every 1-2 weeks

Drug combinations:
F = Flourouracil: 500 mg/m2, hl, 8,14,28
A = Adryamycin: 50 mg/m2, hl, 21 ==> repeated every
M = Mithomycin-C: 10 mg/m2, h1 6 weeks

2) Additional Therapy
If necessary: Surgery, chemotherapy, or radiotherapy

3) Treatment of complications
Pain: analgesics according to the "step ladder WHO
Shortness of breath: tracheostomy
Difficult to dine: gastrostomy
Infection: antibiotic
Halitosis: mouthwash
Etc..

4) Therapeutic aid
Good Nutrition
vitamin

5) Secondary Therapy
If there is a secondary disease, treatment according to
disease concerned.


Tongue Carcinoma
Tongue is the sense of taste has a role as an important
function of taste in the mouth, and the benefits of allowing
one to choose according to his favorite food, and by the need
for certain nutrients physiologically, generally tongue has at
least four functions of primary taste sour, salty, sweet, and
bitter.
Nearly 80% of tongue cancer is the 2/3 anterior tongue
(usually on the lateral edge and under the tongue) and in
small amounts in the posterior tongue. Symptoms depend on
the location in patients with cancer. When located at the 2/3
anterior tongue, the main complaint is the emergence of a
mass that often feels no pain. When you arise in the 1/3
posterior, the cancer is not always known to the patient and
the pain experienced is usually associated with throat pain.
Mechanism of carcinoma of the mouth and tongue:
Leukoplakia
Leukoplakia is pramaligna abnormalities in the oral cavity with
a picture of hyperkeratosis. The occurrence of these disorders are
affected by chronic stimulation, such as use of tobacco, betel nut,
alcohol, or a prosthesis that does not fit. Leukoplakia seen as white
patches are slightly thickened and usually do not cause complaints.
Leukoplakia is often found in the gums, buccal mucosa and tongue,
generally the adult males (Sjamsuhidayat, 2007).
The lesion was not painful but sensitive when touched or
exposed to spicy foods. If left unchecked, a small part of it will turn
out to be malignant in time can not be determined, sometimes for
decades. If a lesion is suspected as leukoplakia, it is necessary to
scrape smear cytological examination. When the results of
cytological examination showed grade I s / d III, repeated
cytological examination the next 3 months while eliminating the
factors that cause leukoplakia. When the results of cytological
examination showed class IV-V, need to do a biopsy with
histopathological examination to determine whether malignant
change.

Erythroplakia
Erythroplakia appears as reddish spots demarcated,
soft and thickened. Usually found in men aged 65-74
years, and is often associated with smoking.
Erythroplakia generally located bottom mouth, tongue
and soft palate. Sometimes erythroplakia located on the
edge of leukoplakia.
Microscopic erythroplakia can be severe dysplasia,
carcinoma in situ, or invasive squamous cell carcinoma
in 90% of patients.
Eksisional biopsy needs to be done to find a picture
hitopatologisnya. Wide excision performed if the results
of histopathologic examination showed malignancy.
Erythroplakia often recur, and therefore needs to be
monitored for a long time.

LIP CARCINOMA
The cause of squamous cell carcinoma that is not known. The cause is
suspected carcinogens and related materials predisposisi.4 factors of oral
cancer incidence associated with age may reflect a buildup, genetic changes
and the length of exposure to initiators and promoters (such as chemical,
physical irritants, viruses, and hormonal influences), and cellular aging decline
due to aging immunologic. Predisposing factors that can lead to the
development of oral cancer include tobacco, alcohol, and other supporting
factors such as chronic illness.
KSS molecular pathogenesis reflects the accumulation of genetic changes
that occur over a period of many years. These changes occur in genes that
encode proteins that control the cell cycle, the safety cell, cell motility and
angiogenesis dental, nutritional deficiencies, fungal, viral, and environmental
factors.
Lip cancer is always associated with people who have outside activities
such as fishing and farming. Sunlight may be involved in cancer Datogenese
lips. Generally more common in the lower lip finger on upper lip.

At the beginning of growth, the lesions may be small module or ulcer that does
not heal. Detection of tumors in this situation provides an opportunity to find an early
carcinoma. Lesions that can further shape papillari, ulcerative or infiltrative. Type
papilomatous can be initiated from a thickened epithelium and most of these remain
on the epithelial superficial. Ulcerative lesions and infiltrative initiated from epithelial
thickening but subsequently experienced a deeper infiltration. The most important
sign is the induration are obtained on the outskirts of the ulcer. Each genetic
mutations provide a selective growth advantage, allowing clonal expansion of mutant
cells with increased potential for malignancy.
Carcinogenesis is a genetic process that leads to changes in cell morphology and
behavior. The main genes involved in SCC include the proto-oncogenes and tumor
suppressor genes (tumor suppresor genes / TSGs). Another factor that played a role in
the progression of the disease include loss of alleles on the other chromosome ratio,
mutations in proto-oncogenes and TSG, or epigenetic changes such as DNA
methylation or histonin acetylated. Cytokine growth factors, angiogenesis, cell
adhesion molecules, immune function and homeostatic regulation in normal cells that
surround also play a role. formation of squamous cell carcinoma is malignant due
menyirih composition, menyirih frequency, duration menyirih, and use all night.
Clinical features of squamous cell carcinoma at an early stage often show no
obvious symptoms. No complaints and no pain. Generally the form of leukoplakia,
erythroplakia or at an advanced stage of erosion and can be shaped in the form
eksofitik papules and nodules, which can be either or endofitik ulcer, erosions,
fissures.
At the beginning of growth is the most common ulcer. Cancer of the lip has a
varied clinical picture of cancer eksofitik large ulcerations that the above process until
a mild swelling of the edge of the vermilion, or crusty lesions that are not suspicious.

BSIA MOUTH CANCER
Cancer of the floor of the mouth is usually associated
with the use of alcohol and tobacco. At the initial stage
may not cause symptoms. When lesions develop patient
will complain of a lump in the mouth or feeling
uncomfortable.
Clinically the most common form of ulceration are
lesions with a raised edge and hardened located near the
lingual frenulum. The other form is a thickening of
mucosal redness, nodules that do not hurt or be derived
from the leukoplakia. In the advanced stages of cancer
can occur eksofitik or infiltrative growth.
CHEEK MUCOSA CANCER

In developing countries, cancer of the cheek mucosa
associated with the habit of chewing a mixture of areca
nut, betel leaf, lime and tobacco. Susur is in contact with
the left and right cheek mucosa for several hours.
At first the lesions do not cause symptoms, seen as an
erythematous area, a small ulceration, induration and red
areas are sometimes associated with the type of nodular
leukoplakia. With the increasing size of the tumor, trauma
will be targeted at chew, so tend to become ulcerated and
infiltrative.
CANCER IN GINGGIVA

Cancer of the gingiva usually come from areas where
the quid of tobacco were placed on the people who have
this habit. The area involved is usually more frequent in
mandibular gingiva than maxillary gingiva.
Early lesions appear as Ulger indolent, small
granulomas or as nodules. Overview lesions appear
similar to lesions produced by trauma or chronic
inflammatory hyperplasia. Lesions were more in the form
of growth or growth eksofitik infiltrating deeper. Growth
eksofitik like cauliflower, bleeds easily. Infiltrative growth
usually grows invasive mandibular bone and cause
desdruktif.
CANCER IN PALATE
In areas where people have the habit of smoking
cigarettes in reverse, on the palate cancer is cancer of the oral
cavity are common of all oral cancers. Changes that occur in
the oral mucosa associated with cigarette smoking in reverse
is the ulceration, erosions, nodules and spotting areas.
Describing a microinvasive carcinoma to describe an early
lesion in the form of a small, oval or round reddish color, the
smooth erosion areas surrounding hyperkeratotic lesions
usually occur in the glandular zone of the hard palate and
asymptomatic. If you are getting pressure to bleed.
Most of palate cancer is eksofitik growth and extensive
grounds with bernodul surface. If the lesion is growing will
probably fill the entire palate. Cancer of the palate can lead to
perforation of the palate and extends to the nasal cavity.