口腔颌面肿瘤总论口腔颌面肿瘤总论张张张张 陈陈陈陈 平平平平上海第二医科大学口腔医学院上海第二医科大学口腔医学院上海第二医科大学口腔医学院上海第二医科大学口腔医学院上海第二医科大学口腔医学院上海第二医科大学口腔医学院附属第九人民医院口腔颌面外科附属第九人民医院口腔颌面外科附属第九人民医院口腔颌面外科附属第九人民医院口腔颌面外科附属第九人民医院口腔颌面外科附属第九人民医院口腔颌面外科重点与难点重点与难点nn口腔颌面肿瘤的基本概念口腔颌面肿瘤的基本概念口腔颌面肿瘤的基本概念口腔颌面肿瘤的基本概念 nn良恶性肿瘤的鉴别诊断良恶性肿瘤的鉴别诊断良恶性肿瘤的鉴别诊断良恶性肿瘤的鉴别诊断口腔颌面肿瘤的基本概念口腔颌面肿瘤的基本概念n nn定义与命名定义与命名定义与命名定义与命名n nn头颈解剖分区头颈解剖分区头颈解剖分区头颈解剖分区n nn良性肿瘤及瘤样病变良性肿瘤及瘤样病变良性肿瘤及瘤样病变良性肿瘤及瘤样病变n nn恶性肿瘤的病理分级恶性肿瘤的病理分级恶性肿瘤的病理分级恶性肿瘤的病理分级n nnUICCUICCUICCUICC临床分类分期临床分类分期临床分类分期临床分类分期临床流行病学特点临床流行病学特点n nn患病率、发病率及构成比患病率、发病率及构成比n nn口腔颌面肿瘤发病特点口腔颌面肿瘤发病特点 年轻化，女性发病上升，发病部位变化年轻化，女性发病上升，发病部位变化年轻化，女性发病上升，发病部位变化 病理复杂化病理复杂化病理复杂化 转移性口腔癌转移性口腔癌转移性口腔癌 隐匿性癌隐匿性癌隐匿性癌病因和发病条件病因和发病条件外外外外 因因因因物理因素物理因素物理因素物理因素化学因素化学因素化学因素化学因素生物因素生物因素生物因素生物因素营养因素营养因素营养因素营养因素内内内内 因因因因 精神因素精神因素精神因素精神因素内分泌因素内分泌因素内分泌因素内分泌因素免疫因素免疫因素免疫因素免疫因素遗传因素遗传因素遗传因素遗传因素口腔颌面肿瘤的临床表现口腔颌面肿瘤的临床表现nn良恶性肿瘤的良恶性肿瘤的生长特性生长特性nn良恶性肿瘤的良恶性肿瘤的危害危害口腔颌面良恶性肿瘤的诊断口腔颌面良恶性肿瘤的诊断nn采集病史采集病史采集病史采集病史nn临床检查临床检查临床检查临床检查nn影像学检查影像学检查影像学检查影像学检查nn组织学检查组织学检查组织学检查组织学检查小小 结结nn口腔颌面肿瘤的命名原则口腔颌面肿瘤的命名原则nn口腔颌面良恶性肿瘤的鉴别要点口腔颌面良恶性肿瘤的鉴别要点nn影像学检查的地位及适应证影像学检查的地位及适应证nn病理检查的方法及注意事项病理检查的方法及注意事项复习思考题复习思考题n nn简述口腔颌面肿瘤的命名原则、病理分级的简述口腔颌面肿瘤的命名原则、病理分级的意义以及意义以及TNMTNM分类分期分类分期n nn良恶性肿瘤的生长特征与诊断要点良恶性肿瘤的生长特征与诊断要点n nn试述活组织检查的主要方法和注意事项试述活组织检查的主要方法和注意事项n nn各种影像学诊断的地位及适应证各种影像学诊断的地位及适应证参考书目参考书目nn邱蔚六主编邱蔚六主编口腔颌面外科理论与实践口腔颌面外科理论与实践19981998年人民卫生出版社年人民卫生出版社nn李树玲主编李树玲主编头颈肿瘤外科学头颈肿瘤外科学19931993年天津科学技术出版社年天津科学技术出版社nn吴奇光主编吴奇光主编口腔组织病理学口腔组织病理学19941994年人民卫生出版社年人民卫生出版社nnStephen T. Stephen T. SonisSonis, Principles and Practice of , Principles and Practice of oral medicine, oral medicine, 1995,W.B.Saunders,Philadephia1995,W.B.Saunders,Philadephia Squamous Cell Carcinoma (SCC) in OMFn nCancer is the second cause of deathCancer is the second cause of deathn nOral cancer has high morbidity and high mortalityOral cancer has high morbidity and high mortalityn nEarly detection and treatment can minimize themEarly detection and treatment can minimize themn nMore than 90% of oral cancer are SCCMore than 90% of oral cancer are SCCn nOral cancer is 3% in all cancersOral cancer is 3% in all cancersClinical characteristicsn nVariety of clinical presentations ulcer, ulcer, leukoplakialeukoplakia, , exophyticexophytic forms formsn nLocation 38%-lower lip, 22%-tongue, 17%- mouth floor 38%-lower lip, 22%-tongue, 17%- mouth floor gingivagingiva, palate, tonsil, , palate, tonsil, buccalbuccal mucosa, mucosa, n nBehavior SCC local invasion and regional metastasis SCC local invasion and regional metastasis Diagnosis of oral cancern nBiopsy, cellular smear, Biopsy, cellular smear, toluidinetoluidine blue staining blue stainingn nBiopsy offers the most important information Biopsy offers the most important information leading to diagnosisleading to diagnosis aspiration (fine needle aspiration) aspiration (fine needle aspiration) resection (punch, frozen section) resection (punch, frozen section)Prognosis of oral cancern nnDepends on follow factorsDepends on follow factors size, extent, location, nodal involvement size, extent, location, nodal involvementn nnResponse (effect) to cancer treatmentResponse (effect) to cancer treatment - 5 years survival rate - 5 years survival raten nnLower lip 84% (localized-87%, lymph-66%)Lower lip 84% (localized-87%, lymph-66%)n nnOverall 5 years survival rates of oral cancer Overall 5 years survival rates of oral cancer 54%, tongue is 54%, tongue is worsreworsreStaging of oral cancerStage IStage IT1N0M0T1N0M0Stage IIStage IIT2N0M0T2N0M0Stage IIIStage IIIT3N0M0T3N0M0or any T with N1M0or any T with N1M0Stage IVStage IVAny T with N2/N3Any T with N2/N3Or any T/N withM1Or any T/N withM1T12cm, 2cm T24cm (AJCC, 1995)5 years survival rate of oral cancer in USA (1983-1990)n nnOverall 5 year 52.5%Overall 5 year 52.5%Overall 5 year 52.5%n nnFemale Female Female 58%58%58%n nnMale Male Male 50%50%50%n nnWhites Whites Whites 55%55%55%n nnBlacks Blacks Blacks 34%34%34% Black(M) 28%, Black(F) 47%Black(M) 28%, Black(F) 47%Black(M) 28%, Black(F) 47%Survival ratesn nnKochi, Japan (1994-2004), 260 casesKochi, Japan (1994-2004), 260 casesn nnTotal 5 yrs survival rate is Total 5 yrs survival rate is 73.6%73.6% T1,2 is 81.1% T1,2 is 81.1% T3 is 73.3% T3 is 73.3% T4 is 55.4% T4 is 55.4% n nnAverage 5 yrs survival in Japan is Average 5 yrs survival in Japan is 65-70%65-70%n nn64.7% in Shanghai (1999)64.7% in Shanghai (1999)DavosDavos