口腔頜面部腫瘤總論口腔頜面腫瘤總論

1、口腔頜面腫瘤總論,張 陳 平上海第二醫(yī)科大學口腔醫(yī)學院附屬第九人民醫(yī)院口腔頜面外科,重點與難點,口腔頜面腫瘤的基本概念 良惡性腫瘤的鑒別診斷,口腔頜面腫瘤的基本概念,定義與命名頭頸解剖分區(qū)良性腫瘤及瘤樣病變惡性腫瘤的病理分級UICC臨床分類分期,,臨床流行病學特點,患病率、發(fā)病率及構(gòu)成比口腔頜面腫瘤發(fā)病特點 ①年輕化，女性發(fā)病上升，發(fā)病部位變化 ②病理復雜化 ③

2、轉(zhuǎn)移性口腔癌 ④隱匿性癌,病因和發(fā)病條件,外 因①物理因素②化學因素③生物因素④營養(yǎng)因素,內(nèi) 因 ①精神因素②內(nèi)分泌因素③免疫因素④遺傳因素,口腔頜面腫瘤的臨床表現(xiàn),良惡性腫瘤的生長特性良惡性腫瘤的危害,口腔頜面良惡性腫瘤的診斷,采集病史臨床檢查影像學檢查組織學檢查,小 結(jié),口腔頜面腫瘤的命名原則口腔頜面良惡性腫瘤的鑒別要點影像學檢查的地位及適應證病理檢查的方法及注意事項,復

3、習思考題,簡述口腔頜面腫瘤的命名原則、病理分級的意義以及TNM分類分期良惡性腫瘤的生長特征與診斷要點試述活組織檢查的主要方法和注意事項各種影像學診斷的地位及適應證,參考書目,邱蔚六主編《口腔頜面外科理論與實踐》1998年人民衛(wèi)生出版社李樹玲主編《頭頸腫瘤外科學》1993年天津科學技術(shù)出版社吳奇光主編《口腔組織病理學》1994年人民衛(wèi)生出版社Stephen T. Sonis, Principles and P

4、ractice of oral medicine, 1995,W.B.Saunders,Philadephia,Squamous Cell Carcinoma (SCC) in OMF,Cancer is the second cause of deathOral cancer has high morbidity and high mortalityEarly detection and treatment can

5、 minimize themMore than 90% of oral cancer are SCCOral cancer is 3% in all cancers,Clinical characteristics,Variety of clinical presentations ulcer, leukoplakia, exophytic formsLocation 38%-lower lip, 2

6、2%-tongue, 17%- mouth floor gingiva, palate, tonsil, buccal mucosa, … Behavior SCC –local invasion and regional metastasis,Diagnosis of oral cancer,Biopsy, cellular smear, toluidine blue stainingBiopsy o

7、ffers the most important information leading to diagnosis aspiration (fine needle aspiration) resection (punch, frozen section),Prognosis of oral cancer,Depends on follow factors size, extent, locati

8、on, nodal involvementResponse (effect) to cancer treatment -- 5 years survival rateLower lip – 84% (localized-87%, lymph-66%)Overall 5 years survival rates of oral cancer –54%, tongue is worsre,Staging of oral

9、cancer,T14cm (AJCC, 1995),5 years survival rate of oral cancer in USA (1983-1990),Overall 5 –year 52.5%Female 58%Male 50%Whites 55%Blacks 34% Black(M) 28%, Blac

10、k(F) 47%,Survival rates,Kochi, Japan (1994-2004), 260 casesTotal 5 yrs survival rate is 73.6% T1,2 is 81.1% T3 is 73.3% T4 is 55.4% Average 5 yrs survival in Japan is 65-70%64.7%