THE UNIVERSITY OF WESTERN AUSTRALIA Oral Potentially Malignant Disorders Oral Cancer A/Prof Omar Kujan BDS DipOPath MSc MFDS RCPS PhD FRCPath  #### Course Presentation **A/Prof Omar Kujan** BDS DipOPath MSc MFDS RCPS PhD FRCPath A photo of a man with glasses and a beard, identified as Omar Kujan, in front of a background image of a bridge at sunset. ```markdown # Learning outcomes - Oral potentially malignant disorders - Leukoplakia - Erythroplakia - Oral submucous fibrosis - Palatal lesions in reverse smokers - Actinic cheilitis - Lichen planus - Lupus erythematosus - Oral cancer ``` #### Scope of Study - **Oral potentially malignant disorders** - Leukoplakia - Erythroplakia - Oral submucous fibrosis - Palatal lesions in reverse smokers - Actinic cheilitis - Lichen planus - Lupus erythematosus - **Oral cancer** ```markdown THE UNIVERSITY OF WESTERN AUSTRALIA | Oral Health Centre of Western Australia ## Learning Outcomes - Aetiology and pathogenesis - Clinical features - Histopathologic features - Diagnosis - Treatment ``` #### Clinical and Diagnostic Framework - Aetiology and pathogenesis - Clinical features - Histopathologic features - Diagnosis - Treatment ```markdown The University of Western Australia Importance of Normal Anatomy and Histology to Diagnostication ``` Understanding the baseline of healthy tissue is the fundamental prerequisite for effective clinical oral diagnostication. ```markdown • To recognize changes of the normal tissues • The clinical oral diagnostication must have a thorough and complete knowledge of the normal oral cavity and surrounding regions. ``` #### Requirements for Clinical Assessment To effectively recognize changes in normal tissues, the clinical oral diagnostician must possess a thorough and complete knowledge of the following: - The normal oral cavity. - Surrounding anatomical regions. - In learning to make a differential diagnosis of soft tissue lesions, the first step is to recognize the presence of an abnormal change in **function**, **structure** or **appearance** during a clinical oral examination. #### Initial Steps in Differential Diagnosis In learning to make a differential diagnosis of soft tissue lesions, the primary step is to identify the presence of abnormal changes during a clinical oral examination. These changes are typically categorized by alterations in: - **Function** - **Structure** - **Appearance**  close-up image of a textured surface with a pattern of small, raised, circular structures, possibly biological in nature, such as skin or tissue. the surface appears to have a mix of light and dark areas, with some regions showing a more pronounced texture. the image is overlaid with a digital annotation tool interface, indicating it may be part of a presentation or educational material.  A close-up photograph showing a textured surface with a pattern of small, irregularly shaped brown spots on a lighter background, possibly a biological or medical specimen. A red dot is visible near the center, likely indicating a point of interest or measurement.  A close-up intraoral photograph showing a patient's mouth with visible oral lesions on the tongue and palate, accompanied by an inset image of the upper teeth with blackened edges, possibly indicating dental work or staining.     Close-up photo of an oral cavity showing a lesion on the tongue with white patches and redness, likely indicating a pathological condition. Photo of an oral cavity with visible dental work and a large lesion on the lower jaw, possibly a tumor or ulceration, with surrounding tissue inflammation. Photo showing a surgical site in the mouth with a dental implant and surrounding tissue, indicating a post-operative state with healing. Photo of a dental procedure with a dental instrument in place, showing teeth and gums with signs of inflammation or infection. ```html <table> <tr> <td><strong>Incidence</strong></td> <td><img src="https://example.com/image.png" alt="Incidence Map"></td> </tr> </table> ```  #### Global Incidence Overview Data regarding the global incidence of oral cancer is typically visualized through geographic mapping to identify high-burden regions. World map showing the incidence of cancer of the lip and oral cavity, with countries colored according to age-standardized incidence rates (ASR) for both sexes. The map uses a blue color scale from light to dark to represent rates ranging from less than 1.9 to 5.1+, with data sourced from GLOBOCAN 2012 (IARC). ```markdown Epidemiology - In just India, over 100,000 cases of oral cancer are diagnosed annually, and the numbers are on the increase. - France has the highest incidence rate of oropharyngeal cancer - In Australia during the period from 1982 to 2008, an increased annual rate of 3.2% of the base of tongue cancers was observed GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013 ``` #### Regional Trends and Statistics - **India:** Over 100,000 cases of oral cancer are diagnosed annually, with numbers currently increasing. - **France:** Reports the highest incidence rate of oropharyngeal cancer. - **Australia:** During the period from 1982 to 2008, an annual increase of 3.2% was observed specifically in cancers of the base of the tongue. *Source: GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 (2013).* ```markdown Incidence Projection 2035 THE UNIVERSITY OF WESTERN AUSTRALIA World Lip, oral cavity Number of new cancers in 2035 (all ages) - Both sexes 494897 0 50000 100000 150000 200000 250000 300000 350000 400000 450000 500000 550000 Incidence in 2012 Demographic effect GLOBOCAN 2012 (IARC) (8.6.2016) ```  #### Global Forecast for Lip and Oral Cavity Cancer - **Total Projected New Cases (2035):** 494,897 (all ages, both sexes). - **Growth Drivers:** The increase from 2012 levels is attributed to the demographic effect (population growth and aging). *Source: GLOBOCAN 2012 (IARC).* A horizontal bar chart showing the projected number of new lip and oral cavity cancers worldwide in 2035, with a total of 494,897 cases. The chart is divided into two segments: 'Incidence in 2012' (yellow) and 'Demographic effect' (blue), illustrating the contribution of each factor to the projected incidence. ```markdown Incidence Projection 2035 World Lip, oral cavity Number of new cancers in 2035 (all ages) Male 327537 Female 167360 Legend: ● Incidence in 2012 ● Demographic effect GLOBOCAN 2012 (IARC) (8.6.2016) GLOBOCAN 2012 (IARC) (8.6.2016) <img src="https://i.imgur.com/placeholder.png" alt="Bar chart showing incidence projection for lip and oral cavity cancers in 2035, divided by gender and showing incidence in 2012 versus demographic effect."> ```  #### Gender-Specific Incidence Projections Projected number of new cases for lip and oral cavity cancers by 2035: - **Male:** 327,537 cases - **Female:** 167,360 cases These projections represent the combined total of the baseline incidence recorded in 2012 and the anticipated demographic effect. Stacked horizontal bar chart showing the incidence projection for lip and oral cavity cancers in 2035, divided by gender. The chart indicates 327,537 new cases for males and 167,360 for females, with the bars segmented to show incidence in 2012 (yellow) and demographic effect (light blue). ```markdown Mortality **THE UNIVERSITY OF WESTERN AUSTRALIA** Mortality ASR Both sexes Cancer of the lip and oral cavity - 2.2+ - 1.6-2.2 - 1.1-1.6 - 0.67-1.1 - <0.67 - No Data Source: GLOBOCAN 2012 (IARC) International Agency for Research on Cancer World Health Organization ```  #### Age-Standardized Mortality Rates (ASR) Global mortality rates for cancer of the lip and oral cavity (both sexes) are categorized by the following ASR ranges: - 2.2+ - 1.6 - 2.2 - 1.1 - 1.6 - 0.67 - 1.1 - < 0.67 *Source: GLOBOCAN 2012 (IARC), World Health Organization.* A world map illustrating the mortality age-standardized rate (ASR) for cancer of the lip and oral cavity, with countries color-coded by mortality rate. The map uses a gradient from light pink (lowest rate, <0.67) to dark red (highest rate, 2.2+), showing higher mortality rates in Eastern Europe, parts of Africa, and South America. The source is GLOBOCAN 2012 from IARC. ```markdown Mortality Projection 2035 International Agency for Research on Cancer World Lip, oral cavity Number of cancer deaths in 2035 (all ages) - Both sexes 242886 0 50000 100000 150000 200000 250000 300000 ● Mortality in 2012 ● Demographic effect GLOBOCAN 2012 (IARC) (8.6.2016) ```  #### Global Mortality Forecast - **Total Projected Deaths (2035):** 242,886 (all ages, both sexes). - **Components of Change:** The total reflects the mortality recorded in 2012 plus the projected demographic effect over the intervening years. *Source: International Agency for Research on Cancer.* A horizontal stacked bar chart titled 'Mortality Projection 2035' showing the projected number of cancer deaths for lip and oral cavity cancer worldwide in 2035. The chart is segmented into two parts: yellow representing mortality in 2012 and light blue representing the demographic effect, with a total projected death count of 242,886. The x-axis represents the number of deaths, ranging from 0 to 300,000. <table> <thead> <tr> <th>Gender</th> <th>Mortality in 2012</th> <th>Demographic effect</th> <th>Total Projected Deaths (2035)</th> </tr> </thead> <tbody> <tr> <td>Male</td> <td>~97,000</td> <td>~65,614</td> <td>162,614</td> </tr> <tr> <td>Female</td> <td>~47,000</td> <td>~33,272</td> <td>80,272</td> </tr> </tbody> </table>   #### Mortality Projections by Gender (2035) | Gender | Mortality in 2012 | Demographic Effect | Total Projected Deaths (2035) | | :--- | :--- | :--- | :--- | | **Male** | ~97,000 | ~65,614 | 162,614 | | **Female** | ~47,000 | ~33,272 | 80,272 | Stacked bar chart showing projected cancer deaths in 2035 for males and females, with data from the International Agency for Research on Cancer. The chart indicates that male deaths are projected to be 162,614, with 97,000 from mortality in 2012 and 65,614 from demographic effect, while female deaths are projected to be 80,272, with 47,000 from mortality in 2012 and 33,272 from demographic effect. Table summarizing projected cancer deaths in 2035 by gender, showing that male deaths are projected to be 162,614 (97,000 from mortality in 2012 and 65,614 from demographic effect), and female deaths are projected to be 80,272 (47,000 from mortality in 2012 and 33,272 from demographic effect). ```html <table> <tr> <th>Age grouping</th> </tr> <tr> <td><img src="https://i.imgur.com/9JZzX.png" alt="Line graph showing the trend of Oral and Oropharyngeal Cancer incidence rates by age group, with data sourced from GLOBOCAN 2012 v1.0. The x-axis represents age groups (0-14, 15-39, ..., 75+), and the y-axis represents incidence rates (0 to 25). The graph displays a rising trend with a notable red dot at the 55-59 age group. The line is labeled ASR (W). The source is cited at the bottom: GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013." /></td> </tr> </table> ```  #### Incidence Rates by Age Group Data indicates a clear correlation between age and the incidence of oral and oropharyngeal cancer: - **Trend:** Incidence rates show a steady rise as age increases. - **Key Observation:** A significant increase in incidence is noted starting in the 55–59 age group. - **Measurement:** Data is represented as Age-Standardized Rates (World). *Source: GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 (2013).* Line graph showing the trend of Oral and Oropharyngeal Cancer incidence rates by age group, with data sourced from GLOBOCAN 2012 v1.0. The x-axis represents age groups (0-14, 15-39, ..., 75+), and the y-axis represents incidence rates (0 to 25). The graph displays a rising trend with a notable red dot at the 55-59 age group. The line is labeled ASR (W). The source is cited at the bottom: GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013.     Close-up intraoral photo showing a lesion on the tongue with surrounding teeth and oral mucosa, highlighting the affected area. Intraoral photo of a dental restoration with a red dot indicating a specific point of interest on the gingival tissue. Close-up view of a lesion on the oral mucosa, possibly a tumor, with adjacent teeth and tongue tissue visible. Intraoral photo showing a surgical site with a retracted tongue and a white dressing or gauze, indicating post-operative care. ```markdown Nomenclature and classification - Definition - OPMDs refer to a group of lesions and conditions characterised by a variably increased risk of developing cancers of the lip (C00) and the oral cavity (C02-C06) - ‘pre-cancer’, ‘precursor lesions’, ‘pre-malignant’, ‘intraepithelial neoplasia’ and ‘potentially malignant’ have been used in the international literature to broadly describe clinical presentations that may potentially become cancer. ``` #### Clinical Definition and Terminology Oral Potentially Malignant Disorders (OPMDs) refer to a group of lesions and conditions characterised by a variably increased risk of developing cancers of the lip (C00) and the oral cavity (C02-C06). Various terms have been used in international literature to broadly describe clinical presentations that may potentially become cancer, including: - Pre-cancer - Precursor lesions - Pre-malignant - Intraepithelial neoplasia - Potentially malignant  A stylized white oval shape with a glowing effect, set against a bright orange background. The figure appears to be a logo or emblem, possibly representing a brand or symbol, with a smooth and modern design. [^1]: Original PDF page 1: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=1|L10 OPMDs and Oral Cancer I slides, p.1]] [^2]: Original PDF page 2: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=2|L10 OPMDs and Oral Cancer I slides, p.2]] [^3]: Original PDF page 3: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=3|L10 OPMDs and Oral Cancer I slides, p.3]] [^4]: Original PDF page 4: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=4|L10 OPMDs and Oral Cancer I slides, p.4]] [^5]: Original PDF page 5: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=5|L10 OPMDs and Oral Cancer I slides, p.5]] [^6]: Original PDF page 6: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=6|L10 OPMDs and Oral Cancer I slides, p.6]] [^7]: Original PDF page 7: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=7|L10 OPMDs and Oral Cancer I slides, p.7]] [^8]: Original PDF page 8: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=8|L10 OPMDs and Oral Cancer I slides, p.8]] [^9]: Original PDF page 9: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=9|L10 OPMDs and Oral Cancer I slides, p.9]] [^10]: Original PDF page 10: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=10|L10 OPMDs and Oral Cancer I slides, p.10]] [^11]: Original PDF page 11: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=11|L10 OPMDs and Oral Cancer I slides, p.11]] [^12]: Original PDF page 12: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=12|L10 OPMDs and Oral Cancer I slides, p.12]] [^13]: Original PDF page 13: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=13|L10 OPMDs and Oral Cancer I slides, p.13]] [^14]: Original PDF page 14: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=14|L10 OPMDs and Oral Cancer I slides, p.14]] [^15]: Original PDF page 15: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=15|L10 OPMDs and Oral Cancer I slides, p.15]] [^16]: Original PDF page 16: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=16|L10 OPMDs and Oral Cancer I slides, p.16]] [^17]: Original PDF page 17: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=17|L10 OPMDs and Oral Cancer I slides, p.17]] [^18]: Original PDF page 18: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=18|L10 OPMDs and Oral Cancer I slides, p.18]] [^19]: Original PDF page 19: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=19|L10 OPMDs and Oral Cancer I slides, p.19]] [^20]: Original PDF page 20: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=20|L10 OPMDs and Oral Cancer I slides, p.20]] [^21]: Original PDF page 21: [[L10 OPMDs and Oral Cancer I_slides.pdf#page=21|L10 OPMDs and Oral Cancer I slides, p.21]]