Manifestations of cancer in the oral cavity

Manifestations of oral cancer are relatively frequent' and diverse'. The most common include:

• Hemorrhage
• Ulceration
• Infiltration
• Infection
• Lymphadenopathy

Hemorrhagia

• Hemorrhages are common in patients with diseases related to thrombocytopenia, such as acute leukemia, aplastic anemia, or idiopathic thrombocytopenic purpura.
• Very often only petechiae are symptomatic, sometimes bleeding occurs while brushing teeth.
• Prolonged profuse bleeding after tooth extraction may be the only sign of myeloproliferative disease.

Ulceration

• Ulcerations are severe in patients with granulocytopenia.
• The site of manifestation is: gums, tongue, palate, cheek mucosa.
• They are very painful.

Most infections in patients with granulosytopenia are caused by E. colli, Klebsiella and Pseudomonas.

Infiltration

• So-called diffuse gingival hypertrophy occurs in patients with leukemia. The degree of this hypertrophy corresponds with the number of abnormal cells in the peripheral blood.
• As a result, the teeth are completely covered by the gingiva, which bleeds and becomes easily infected.
• Microscopy:
  • epithelium is absent or hypertrophic
  • the connective tissue is infiltrated with leukemic cells
• Gingival tissue may necrotize due to vascular thrombosis.
• Loosening of the teeth occurs due to necrosis of the dental periosteum.

Infection

• In patients with granulocytopenia, aplastic anemia, acute leukemia, and other myeloproliferative diseases that are associated with granulocytopenia.

Lymphadenopathy

• In patients with chronic lymphocytic leukemia, where the submandibular and cervical lymph nodes are often leukemically infiltrated.

Patients with acute lymphocytic leukemia have tonsillar hypertrophy. There may also be airway and Eustachian tube obstruction due to lymphoid tissue involvement of the Waldayer lymphatic circuit. The Mikulicz syndrome (i.e., xerostomia and xerophthalmia) may also occur with leukemic infiltration of the lacrimal and salivary glands.

References

References used

• JANOUŠEK, Václav. Pathological physiology for dentists :  Textbook for medical faculties. 1. edition. Prague : Avicenum, zdravotnické nakladatelství, n. p, 1990. 284 pp. pp. 166 - 187. ISBN 80-201-0053-9.