oral field cancerization - Dr Sanjana Ravindra

oral field cancerization - Dr sanjana Ravindra

1. Meenakshi Mohan, Nithya Jagannathan Oncology Reviews 2014; 8:244 ORAL FIELD CANCERIZATION: AN UPDATE ON CURRENT CONCEPTS

2. Introduction Liviu Feller, Johan Lemmer . Oral Squamous Cell Carcinoma: Epidemiology, Clinical Presentation and Treatment. Journal of Cancer Therapy , 2015, 3, 263-268 Oral cancer holds the 9th position in the cancer incidence ranking worldwide

3. Estimated New Cancer Cases and Deaths Worldwide for Leading Cancer Sites by Level of Economic Development, 2013. Source: GLOBOCAN 2013 Ahmedin Jemal et al, Global Cancer Statistics, CA CANCER J CLIN 2014;61:69–90 Estimated new cases Estimated deaths 1,30,900 74,500 3 Introduction

4. `Nair K et al, Cancer: Current scenario, intervention strategies and projections for 2015 4

5. In india , Fourh most common cancer in females 90% occur in patients over 45 years of age Introduction COMMON SITES OF OCCURENCE

6. Introduction Liviu Feller, Johan Lemmer . Oral Squamous Cell Carcinoma: Epidemiology, Clinical Presentation and Treatment. Journal of Cancer Therapy , 2015, 3, 263-268

7. OSCC develops from exposure to different carcinogens resulting in genetic or epigenetic mutations . This type of cancer is particularly devastating to patients because treatment entails excision of facial structures essential for esthetics and function. Introduction

8. INTRODUCTION

9. FIELD CANCERIZATION FIELD DEFECT F IELD EFFECT INTRODUCTION

10. Anaplasia  (from ancient Greek: ana , "backward" + plasis , "formation") is a condition of cells in which they have poor cellular differentiation, losing the morphological characteristics of mature cells and their orientation with respect to each other and to endothelial cells. TOBACCO INTRODUCTION

11. INTRODUCTION

12. NON CARCINOGENENIC TAR FOUND IN TOBACCO COMBINE WITH OXYGEN ON SLOW COMBUSTION CARCINOGENIC TAR EPOXIDE FORMS A REACTIVE CARCINOGEN COMBINES TO GUANINE IN DNA HIGH CANCER RISK!

13. Criteria used to diagnose multiple carcinomas WARREN AND GATES

14. 67- 96 MONTHS PRE MALIGNANT FIELD INVASIVE CARCINOMA

15. History of field cancerization Analyzed the tissues adjacent to squamous cell carcinoma.The first examined in the aerodigestive tract due to a progressive transformation of the tissue adjacent to the tumor rather than the expansion of pre-existing cancer cells into the adjacent tissue Oropharynx esophagus lungs stomach, colon cervix anus skin and bladder

16. Concept of field cancerization FIELD CANCERIZATION higher-than-expected rate of multiple local second primary tumors the clonal expansion of premalignant daughter cells in a particular field

17. Theories of field cancerization POLYCLONAL MONOCLONAL

18. INVESTIGATIONS

19. The process of carcinogenesis begins with a stem cell which develops one or more genetic and epigenetic alterations. Subsequently a clone of genetically altered cells forms a patch or a cluster. Field cancerization model

20. PATCH PHASE EXPANDING FIELD PHASE PRECURSOR LESION WITHIN FIELD DEVELOPMENT OF CARCINOMA CARCINOMA EXCISED SECOND FIELD TUMOUR PATCH FIELD CARCINOMA MODEL

21. SECOND PRIMARY TUMOR Despite advances in therapy long term survival of head and neck cancer patients has not significantly improved in the last 20 years. An important reason for this lack of progress is the development of secondary primary tumor in the upper aerodigestive tract. Patients at highest risk are those with early-stage disease, when control of the first tumor, and therefore survival, is greatest. Jayam R. Oral field cancerization -A review. Journal of Indian Academy of Oral Medicine and Radiology 2010;22:201-5 .

22. For SPT, ( a) Each of the tumors must present a definite picture of malignancy ( b) Each must be distinct (c) The probability of one being a metastasis of the other must be excluded. Histological sections: To exclude the possibility of a local recurrence - use a distance of at least 2 cm between the first tumor and the SPT. Warren and Gates(1932) SECOND PRIMARY TUMOR Jayam R. Oral field cancerization -A review. Journal of Indian Academy of Oral Medicine and Radiology 2010;22:201-5 .

23. DISTANT SECOND LESIONS The distance between two malignancies does not necessarily predict clonality but distant, peripheral, solitary, squamous lung lesions in conjunction with HNSCC are thought to be metastases and concurrent esophageal tumors are thought to be separate primary tumors. While the probability of synchronous aerodigestive tract tumors remains high with environmental exposure, the relationship between them is often predicted by the anatomic subset rather than distance. Alok A, Singh ID, Panat SR, Singh S, Kishore M. Oral Field Cancerization : A Review. Int J Dent Med Res 2014;1(3): 98-104

24. Markers in the determination of field cancerization .

25. THERAPEUTIC IMPLICATIONS FOR FIELD CANCERIZATION

26. Conclusions The journey of a thousand miles must begin with a single step

27. Puig S, Puig-Butillé JA, Díaz MA, Trullas C, Malvehy J (2014) Field cancerisation Improvement with Topical Application of a Film-Forming Medical Device Containing Photolyase and UV Filters in Patients with Actinic Keratosis, a Pilot Study. J Clin Exp Dermatol Res 5: 220 . Kini R, Naik V, Singla S. Field cancerisation of oral cavity. A case report and clinical implication. Alok A, Singh ID, Panat SR, Singh S, Kishore M. Oral Field Cancerization : A Review. Int J Dent Med Res 2014;1(3):98-104 Aparna M ., Shenai P, Chatra L, Veena K. Field cancerization : A review. Archives of Medicine and Health Sciences / Jul-Dec 2013 / Vol 1 | Issue 2 Kishore KS, Shenai KP, Chatra LK. Field cancerization - A case report. Journal of Indian Academy of Oral Medicine and Radiology 2006;18:124-8. Jayam R. Oral field cancerization -A review. Journal of Indian Academy of Oral Medicine and Radiology 2010;22:201-5 . Liviu Feller, Johan Lemmer . Oral Squamous Cell Carcinoma: Epidemiology, Clinical Presentation and Treatment. Journal of Cancer Therapy , 2015, 3, 263-268 References

28. Bascones -Martínez A, Rodríguez- Gutierrez C, Rodríguez-Gómez E, et al. Evaluation of p53, Caspase-3, Bcl-2, and Ki-67 markers in oral squamous cell carcinoma and premalignant epithelium in a sample from Alava Province (Spain). Med Oral Patol Oral Cir Bucal 2013;18:e846-50 . Bloching M, Soulsby H, Naumann A, et al Tumor risk assessment by means of immunocytochemical detection of premalignant chages in buccal smears. Oncol Rep 2008;19:1373-9. Eisbruch A, Blick M, Lee JS, et al. Analysis of the epidermal growth factor receptor gene in fresh human head and neck tumors . Cancer Res 1987;47:3603-5. . Christensen ME, Engbaek F, Therkildsen MH, et al. A sensitive enzyme-linked immunosorbent assay used for quantitation of epidermal growth factor receptor protein in head and neck carcinomas : evaluation , interpretations and limitations. Br J Cancer 1995;72:1487-93 . Shin DM, Ro JY, Hong WK, Hittelman WN. Dysregulation of epidermal growth factor receptor expression in premalignant lesions during head and neck tumorigenesis . Cancer Res 1994;54:3153-9. Bergle W, Bier H, Ganzer U. The expression of epidermal growth factor receptors in the oral mucosa of patients with oral cancer . Arch Otorhinolaryngol 1989;246:121-5. Schwindt AE, Savino TM, Lanfranchi HE, et al. Nuclear organizer regions in lining epithelium adjacent to squamous cell carcinoma of human oral mucosa. Cancer 1994;73:2674-9. Weinberg WC, Howard JC, Iannaconne PM. Histological demonstration of mosaicism in a series of chimeric rats produced between congenic strains. Science 1985;227:524-7. Worsham MJ, Wolman SR, Carey TE, et al. Common clonal origin of synchronous primary head and neck squamous cell carcinomas : analysis by tumor karyotypes and fluorescence in situ hybridization . Human Pathol 1995;26:251-61. Shin DM, Kim J, Ro JY, et al Activation of p53 expression in premalignant lesions during head and neck tumorigenesis . Cancer Res 1994;54:321-6. Lee N, Ye Y, Li X, et al. Allelic loss on chromosome 13 can precede histological changes in head and neck cancer. Int J Oncol 1994;5:205-10 . Welkoborsky HJ, Bernauer HS, Riazimand HS, et al. Patterns of chromosomal aberrations in metastasizing and nonmetastasizing squamous cell carcinomas of the oropharynx and hypopharynx . Ann Otol Rhinol Laryngol 2000;109:401-10. Gandor DW, Meyer J. A simple two-dye basic stain facilitating recognition of mitosis in plastic embedded tissue sections. Stain Technol 1988;63:75-81 . References

29. Reibel J. Prognosis of oral pre-malignant lesions: significance of clinical , histopathological , and molecular biological characteristics . Crit Rev Oral Biol Med 2003;14:47-62 . Dakubo G, Jakupciak J, Birch- Machin M. Clinical implications and utility of field cancerization . Cancer Cell Inter 2007;7:2. Hong WK, Endicott J, Itri LM, et al. 13-cis-retinoic acid in the treatment of oral leukoplakia. N Engl J Med 1986;315:1501-5. Shen L, Kondo Y, Rosner GL, et al. MGMT promoter methylation and field defect in sporadic colorectal cancer. J Natl Cancer Inst 2005;97:1330-8 . Suzuki H, Watkins DN, Jair KW, et al Epigenetic inactivation of SFRP genes allows constitutive WNT signaling in colorectal cancer . Nat Genet 2004;36:417-22. Yan PS, Venkataramu C, Ibrahim A, et al. Mapping geographic zones of cancer risk with epigenetic biomarkers in normal breast tissue . Clin Cancer Res 2006;12:626-36. Endoh M, Tamura G, Honda T, et al. ASSF2, a potential tumour suppressor , is silenced by CpG island hypermethylation in gastric cancer . Br J Cancer 2005;93:1395-9. Mehrotra J, Varde S, Wang H, et al. Quantitative, spatial resolution of the epigenetic field effect in prostate cancer. Prostate 2008;68:152-60 . Nonn L, Ananthanarayanan V, Gann PH. Evidence for field cancerization of the prostate. Prostate 2009;69:1470-9. Takahashi T, Habuchi T, Kakehi Y, et al. Clonal and chronological genetic analysis of multifocal cancers of the bladder and upper urinary tract . Cancer Res 1998;58:5835-41. Punnya VA, Savitha JK, Sanjay S, et al. Oral field cancerization : current evidence and future perspectives. Oral Maxillofac Surg 2012;16:171-80 . Boudewijn JMB, Maarten PT, Alain KJ, et al. A genetic explanation of Slaughter’s concept of field cancerization : evidence and clinical implications . Canc Res 2003;63:1727-30. References

30. T h a n k y o u