Chapter 15. Oncological Alertness. Diagnostics of Oral Neoplasms

Problems of clinical oncology remain a constant focus of attention for physicians around the world due to the increasing morbidity and mortality from malignant tumors. Every year, more and more cases of malignant neoplasms are detected, and oncological diseases now occupy the 2nd and 3rd place in the list of causes of death in general. This is largely due to the imperfection of primary and secondary prevention, as well as untimely diagnostics and, as a consequence, insufficient efficiency of treatment. In medicine, there is a concept of “Oncological Alertness”. This means that when examining a patient, doctors of any specialty of every treatment and preventive care establishment must pay special attention to the symptoms that cause suspicion of a presence of oncological pathology.

Oncological Alertness includes:

• knowledge of the symptoms of malignant tumors in the early stages;
• knowledge of precancerous diseases and their treatment;
• organization of oncological care, a network of oncological medical institutions and the quick referral of a patient with a detected or suspected tumor to a specia­lized institution;
• a thorough examination of each patient who has consulted a doctor of any specialty in order to identify a possible oncological disease;
• the habit of thinking about the possibility of an atypical or complicated course of a malignant tumor in difficult cases of diagnosis.

The main tasks of a dentist in his work on the prevention of oncological pathology is the timely recognition and treatment of precancerous conditions (facultative, obligate precancer), against which the development of cancer is possible, as well as early diagnostics of malignant neoplasms.

Early diagnostics of malignant neoplasms depends both on the oncological caution of doctors and on further tactics in relation to the patient. The knowledge of early symptoms of malignant tumors and research methods in the primary diagnostics of dental diseases is of paramount importance. Diagnosis of any disease is made on the basis of complaints, anamnesis and clinical presentation. Clinical picture of malignant tumors depends on their localization, morphological signs and the extent of the process. Features of tumor localization in an organ itself also may change the clinical picture. Special and laboratory research methods confirm the correctness of the dia­gnosis. Morphological verification is one of the main criteria affecting the treatment and prognosis. In case of suspicion of a tumor process, it is necessary to pay attention to the following complaints:

• swelling, ulcer, infiltration;
• pain, paresthesia, numbness;
• paresis, paralysis of facial muscles;
• exophthalmos, diplopia;
• difficulty in nasal breathing, a discharge mixed with blood from the nose;
• restriction of mouth opening and tongue movement, difficulty in swallowing;
• hearing loss;
• changes in general condition (weakness, loss of appetite, weight loss, increased body temperature, etc.).

The correct collection of medical history of a disease (anamnesis morbi) is of great importance in identifying the early forms of a tumor process. It is necessary to pay attention to the duration of the disease (when it was detected) and the factors with which the patient connects the onset of its symptoms, the duration and rate of their growth, dynamics, as well as the conducted treatment. When collecting medical history of life (anamnesis vitae), it is necessary to find out the heredity (the presence of oncological diseases), past and concomitant diseases, occupational hazards (contact with carcinogenic substances, work in unfavorable meteorological conditions, etc.), bad habits (smoking, alcohol, eating excessively hot food, etc.).

During the initial clinical examination of a patient by an oral surgeon, the skin, oral cavity, and lymph nodes are subject to mandatory examination.

The period of recommended examinations of a patient by an oral surgeon should not exceed 5-7 days. After the clarification of the diagnosis, the patient is sent to an oncological institution for further diagnostics and treatment.

Tumors of the MFR account for up to 15% of all dental diseases. Up to 25% of human neoplasms are accounted for by the MFR. As epidemiological studies show, the incidence of oral malignant tumors is associated with certain patterns: the influence of environmental factors, everyday habits and nutrition.

According to statistics, malignant neoplasms very often affect oral mucosa, facial and lip skin, and salivary glands. Among oral neoplasms, 65% are the malignant tumors of the tongue; among other localizations of oral malignant tumors, 12.9% are on the buccal mucosa, 10.9% ― on the floor of the mouth, 8.9% ― on the mucous membrane of the alveolar processes of the upper jaw and hard palate, 6.2% ― on the soft palate, 5.9% ― on the mucous membrane of the alveolar process of the lower jaw, 1.5% ― on the uvula, 1.3% ― on the anterior palatine arches. Malignant tumors of the oral cavity develop in men 5-7 times more often than in women, and people aged 60-70 are more frequently affected. Usually, the number of cases increases after the age of 40, and significantly decreases after the age of 80.

The leading localization in the general structure of cancer incidence is the skin. In most cases, skin cancer develops in open areas, with the majority of tumors developing in the face. Squamous cell carcinoma unevenly spreads in the tissues. The ulcer, gradually increasing, reaches a large size. A metastasis in the parotid, submandibular lymph nodes is observed in 1-2% of cases.