diagnosis of oral malignancy its crucial effect on 迟发性口腔恶性肿瘤的诊断具有决定性的作用课件

DelayedDiagnosisoforalMalignancy Itscrucialeffectonmanagementandprognosis DrHassanElAbdin Introduction Malignantconditionoftheoralcavitycomprisesabout5 6 ofallmalignanttumoursofthehumanbody inSaudiArabia1 Itisthethirdmostcommontumourinfemalesandthefourthinmales 1Ajarim DProceSaudiOncolSymp1995 Introduction IntheUnitedStates itisrelativelyuncommon andrepresent2 5 ofthetotal 2ShaferJADA1975IntheScandinaviancountries itcomprisesabout2 ofallmalignanttumours andtheprognosisispoorcomparedwithmalignanciesinothersites 3BruunOralSurg1976 Introduction Delayeddiagnosisofmalignantconditionandparticularlyoftheoralcavity isofcrucialimportancefortheclinicalmanagement costofcareandtheoutcome Introduction Oralmalignantconditionscanbeeasilydiagnosed Notonly istheoralcavityaccessibletoexamination buttheorallesionproducesarecognizablewarningsigns Introduction Despitethefactthatoralcavityissecondonlytoskinintheaccessibilityforexaminationandearlydetectionofcancer thefive yearsurvivalrateislow Itisvariesbetween15 52 whichisthefifthlowest5 yearsurvivalrate Introduction Thesurvivaloforalcancerpatientdependonearlydiagnosisandtreatment Moststudiesonoralmalignancyprovethatthemortalityratedropseffectively ifthelesionsarerecognized treatedearly 4James A G Introduction Tonguecancer the5 yearsurvivalratewillrisefrom15 to55 ifthelesionisdiagnosedandtreatedwhileitissmallandlocalized Introduction Unfortunately earlylesionsarefrequentlyasymptomatic small innocuousandoverlookedbytheclinicianduringroutineoralexamination Introduction Itistheresponsibilityofthecliniciancarefullyexamineanysuspiciouslesion referimmediatelyforhistologicalinvestigationThecliniciansarealsoresponsibleforinformingthepopulationregardingtheriskfactor Introduction Unlikeothermalignancies orallesionsandthesurroundingtissuescontinuetocauseconsiderablemortalityandseriousmorbidityinthiscountry Thedelaywaslinkedtothepatientaswellastheclinicianeventhoughexaminationtheoralcavityiseasilyperformed Introduction Patient sdelayinvolvesthetimeelapsedfromfirstsymptomstoconsultingadentistorphysicianClinician sdelayistheperiodduringwhichthepatientisundercareuntildiagnosis AimoftheStudy Toinvestigatetheroleofthegeneraldentalpractitionerintheearlydiagnosisandreferraloforalcancerpatientandrelatethistothetreatmentandprognosis Tostudyandanalyzethefactorsresponsibleforsuchdelay Methods Patients Therecordsofthirty seven 37 patientsdiagnosedwithmalignantlesionswereretrospectivelyreviewed AllthepatientswerediagnosedattheOral MaxillofacialsurgerydepartmentandverifiedhistologicallybythedivisionofOralPathologyatthecollegeofDentistryandthePathologydepartmentatKKUHandcollegeofMedicine Methods Patients Thefollowingparameterswereevaluated sex age symptoms referraldiagnosistimelapsefromfirstsymptomsuntilconsultationfinaldiagnosis previoustreatment finaltreatmentandsurvivalperiodDefinitivetreatmenttookplaceatKKUHandRiyadhMilitaryHospital Result Distributionofcasesaccordingtosex Result Distributionofpatientsaccordingtoage Results Distributionofcasesaccordingtorace Result Distributionofcaseaccordingtohistogenesis Result SitesofOralTumours Result Chiefcomplaintatpresentation Result Initialmismanagement inappropriatetherapy Result Typeoftreatmentinstituted Discussion Oralmalignantlesionconstitutelessthan5 ofallmalignanttumoursoccurringintheKingdomMortalityfromoralcancershowsslightdeclinebutisstillconsiderablewith5 yearsurvivalratelessthan50 Itthefifthlowest 6Yelllowitz etalJAmDentAssoc1995 Discussion Inthisstudythemortalityrateconstitutearound16 2 andthe2 yearsurvivalapproaches83 8 The5 yearsurvival64 9 andthe10 yearrate45 9 Discussion Theprognosticfactorsforahigher5 yearsurvivalrateincludesite size TNMstage histologyandresponsetotreatment Discussion Aconsistentanddirectrelationshipwasfoundbetweenthedelayinthediagnosisandtumoursize nodalinvolvement presenceofmetastasisandhistologicalgradeofthedisease Discussion Theresultofthisstudysuggestthat amongpatientswithoralmalignancy aprofessionaldelayof3monthsandmore arecontributingtoanincreasedriskforbeingdiagnosedasalatestagedisease Discussion DelaywasthepredominantfeatureinallthecasesanditwasmainlytheclinicianwhowastoblameinthisstudyTheperiodvariedbetween3monthsinacaseofENNHLand16monthsfortheadenoidcysticcarcinoma Discussion Alllesionsthatdonotrespondtoadequatetherapyin14daysshouldbesuspectedofbeingmalignantandthepatientshouldbereferredtoaspecialistforproperdiagnosis Ahighindexofsuspicionisaprerequisiteforearlydiagnosisandreferralofpatientswithoralcancerforbetterprognosis Discussion Patientssufferingfrommalignanttumoursoftheoralcavitymaywaitfor3monthsorlongerbeforeconsultingaphysicianordentist 7Thelackofpatientawarenessabouttheseriousnessofthediseasetheyhave isthemainreason PogrelBritDent J1974 Discussion Inourstudymorethanonethirdofthepatients 37 delayedseekingprofessionaladviceformorethan3monthsandaround25 formorethanayear afterbeingawareofthelesion Thestudyrevealedthatlimitedandsometimesbiascancerknowledgeplayamajorroleinthisdelay Discussion In1990 aEuropeanconferenceheldinDenmarkrecommendedthatGDPshouldplayanimportantroleinpreventingoralcancerandperformingoralscreening Discussion In1990theBritishPostgraduateMedicalFederationhasissuedavideoentitled theimportanceofbeingearly tothedentalpractices 5Itwastopromoteearlydetectionandearlyreferral Anydelayinreferralrepresentsafailedearlydiagnosis Brit D J 170 5 1991 Conclusion TreatmentofearlylesioncarriesanexcellentprognosisDentistswillrequiregreatertrainingintherecognitionof