口腔颌面部肿瘤总论-口腔颌面肿瘤总论.ppt

口腔颌面肿瘤总论,张 陈 平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,重点与难点,口腔颌面肿瘤的基本概念 良恶性肿瘤的鉴别诊断,口腔颌面肿瘤的基本概念,定义与命名头颈解剖分区良性肿瘤及瘤样病变恶性肿瘤的病理分级UICC临床分类分期,临床流行病学特点,患病率、发病率及构成比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 病理复杂化 转移性口腔癌 隐匿性癌,病因和发病条件,外 因物理因素化学因素生物因素营养因素,内 因 精神因素内分泌因素免疫因素遗传因素,口腔颌面肿瘤的临床表现,良恶性肿瘤的生长特性良恶性肿瘤的危害,口腔颌面良恶性肿瘤的诊断,采集病史临床检查影像学检查组织学检查,小 结,口腔颌面肿瘤的命名原则口腔颌面良恶性肿瘤的鉴别要点影像学检查的地位及适应证病理检查的方法及注意事项,复习思考题,简述口腔颌面肿瘤的命名原则、病理分级的意义以及TNM分类分期良恶性肿瘤的生长特征与诊断要点试述活组织检查的主要方法和注意事项各种影像学诊断的地位及适应证,参考书目,邱蔚六主编口腔颌面外科理论与实践1998年人民卫生出版社李树玲主编头颈肿瘤外科学1993年天津科学技术出版社吴奇光主编口腔组织病理学1994年人民卫生出版社Stephen T.Sonis,Principles and Practice 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 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,22%-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 offers 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,location,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 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%,Black(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%in Shanghai(1999),Davos,