Lower jaw cancer

In cancer of the mucosa of the alveolar process, the lower jaw is predominantly affected secondarily. Primary cancer of the lower jaw, which, in the opinion of some authors, arises from the dental rudiment, is extremely rare. Often, when establishing such a diagnosis, the examination reveals metastases of epithelial tumors of other localizations in the lower jaw. Treatment of secondary tumors is the same as with other localizations of cancer of the oral mucosa.

[1], [2], [3]

Cancer of the lower jaw of non-epithelial nature

Among malignant tumors of the jaws a special place is occupied by non-epithelial cancer of the lower jaw, the source of development of which can serve as bone, connective tissue, and bone marrow, dental germ tissues, soft tissues surrounding the jawbones. This leads to a variety of histological forms of non-epithelial tumors, and the rarity of this pathology causes the inadequate knowledge of the physicians of clinical manifestations and the possibilities of various methods of treatment of non-epithelial tumors of the jaws.

International histological classification of tumors of the lower jaw cancer is classified by its histological affiliation, with all neoplasms divided into three groups of bone, soft-tissue and monotonous.

Bone carcinoma of the lower jaw.

1. Bone-forming tumors.
   1. Osteogenic sarcoma.
   2. Parostal sarcoma.
2. Cartilaginous tumors.
   1. Chondrosarcoma.
3. Bone marrow tumors.
   1. Reticulosarcoma.
   2. Plasmacytoma.
   3. Lymphosarcoma.
4. Vascular cancer of the lower jaw.
   1. Hemangiopericytoma.
   2. Angiosarcoma.
5. Connective tissue tumors.
   1. Malignant fibrous histiocytoma.
   2. Fibrosarcoma.
   3. Undifferentiated sarcoma.
6. Neurogenic sarcoma.
7. Unclassified sarcoma.

Soft-tissue cancer of the lower jaw.

1. Leiomyosarcoma.
2. Rhabdomyosarcoma.
3. Synovial sarcoma.

Odontogenic cancer of the lower jaw.

1. Malignant ameloblastoma.
2. Mixosarcoma.
3. Ameloblastic sarcoma.
4. Ameloblastic odontosarcoma.

The most common osteogenic sarcoma, chondrosarcoma. Malignant fibrous histiocytoma, recently isolated from the group of polymorphonuclear sarcomas and fibrosarcomas, rhabdomyosarcoma and leiomyosarcoma. Other types of neoplasms are extremely rare.

[4], [5], [6], [7], [8], [9], [10]

Osteogenic sarcoma

Osteogenic sarcoma is 22% among all non-epithelial neoplasms of the jaws. This is one of the most malignant forms of cancer of the lower jaw. When localized on the upper jaw, 91% comes from the alveolar process, its anterior external part.

Symptoms

The first symptom is the deformation of the affected bone, moderately painful on palpation. Sometimes before the appearance of pain, paresthesia appears in the area of the infraorbital or chin nerves. Changes in the skin in the form of a vascular pattern are determined by common processes. Hyperemia of the skin and mucous membrane in osteogenic sarcoma are not characteristic for this tumor and are found only in children.

Diagnostics

Radiologically distinguish three types of osteogenic sarcoma: osteoblastic, osteolytic and mixed. When the lower jaw is affected, the third variant of the lesion is predominantly encountered. Osteogenic sarcoma is characterized by small and medium-scleral destruction, sometimes against a background of bone thinning, foci of destruction alternate with foci of compaction.

In more than half of the cases, the cancer of the lower jaw is accompanied by destruction of the cortical plate, periosteal reaction in the form of needle or linear periostic (presence of spicules), which indicates the invasion of the neoplasm into surrounding soft tissues.

The extra-osseous tumor component contains dense inclusions. In the case of a lytic variant, a pathological fracture of the lower jaw is possible. At the same time, it is not always possible to conduct differential diagnosis between osteogenic sarcoma and chondrosarcoma.

At present, CT scan is widely used in radiation diagnosis of the facial skeleton, which provides a lot of additional information. One of the clinical signs is metastasis to distant organs, metastasis is rarely seen in regional lymph nodes. Before determining the treatment plan, a biopsy and a histological examination should be performed. The percentage of local relapses is very high. Preliminary diagnosis is supplemented on the basis of clinical-x-ray data by morphological studies.

Treatment

The main method of treatment is surgical. In osteogenic sarcomas, it can be independent or combined. The volume of the operation and the possibility of radical removal of the neoplasm largely depends on the localization, the features of the clinical course, the prevalence and direction of tumor growth.

Given the high sensitivity of the osteogenic sarcoma of the limbs to drug treatment, the improvement of survival rates in combined treatment with non-adjuvant or adjuvant chemotherapy, the use of epirubicin drugs is advisable.

Chondrosarcoma

Among malignant neepithelial neoplasms of the jaw this lower jaw cancer is found in 2.1-5% of observations.

Symptoms

The tumor is more latent than osteogenic sarcoma, however, along with slow-flowing forms, neoplasms are rapidly growing.

Clinically conditionally, two forms of chondrosarcom: peripheral and central. The peripheral form develops in the anterior part of the lower jaw, has rapid growth, often recurs. Clinically, the cancer of the lower jaw manifests itself in the form of a node covered with a mucous membrane of bright red color. When injured with teeth, as a rule, ulcerates. The central form at first proceeds asymptomatically, sometimes minor pains are noted. With further growth of the tumor, deformation of the jaw arises. Relapses with chondrosarcomas occur in 48%, distant metastases - in 16%.

Diagnostics

For chondrosarcoma is characterized by the presence of dense inclusions, in connection with which on the radiographs there are erratic accumulations of calcareous inclusions, cloddy calcification both in the intraosseous component of the neoplasm, and in the soft tissue. This characteristic feature makes it possible to correctly diagnose by roentgenological data. However, the final diagnosis is established on the basis of morphological research, therefore, before determining the therapeutic tactics, a biopsy of the tumor is necessary.

Histologically, with slowly growing cancer of the lower jaw, well-differentiated cartilaginous cells are distinguished, separated from each other by a large amount of interstitial substance. The absence or rarity of mitosis does not always indicate a benign neoplasm, since chondrosarcoma cells multiply mainly by an amitotic route. Rapidly growing and less differentiated chondrosarcomas are much richer in cells, and chondrosarcomas prone to metastasis are abundantly vascularized.

Treatment

Treatment is surgical. This cancer of the mandible is almost not sensitive to drug and radiation treatment, which are used only for palliative purposes.

[11], [12], [13], [14],

Malignant fibrous histiocytoma

This species has only recently been isolated from the group of polymorphic cell sarcomas and fibrosarcoma, therefore, literary information about it is extremely limited. Meanwhile, among malignant non-epithelial tumors, it ranks third in frequency of occurrence (9%).

Symptoms

Clinically, the cancer of the lower jaw differs little from the fibrosarcom and represents a tuberous growth that occurs in the peripheral parts of the jaw. The mucous membrane over the tumor is purplish-red, with trauma there is ulceration. This form of sarcoma is most prone to recurrence. Relapses in malignant fibrotic histiocytoma occur in 69% of cases. At the same time, regional metastases occur infrequently - in 14% of cases, distant - in 9%.

Diagnostics

Radiological picture of a malignant fibrous histiocytoma is characterized by significant destructive changes, bone tissue lysis without clear boundaries.

The final diagnosis of this type of neoplasm is established on the basis of the histological examination data. However, the interpretation of the histological picture in some cases presents certain difficulties.

Treatment

This cancer of the lower jaw is treated surgically. Consider the tendency of the tumor to recur, the volume of the operation should be extended. In recent years, there have been encouraging results in the drug therapy of this tumor.

[15], [16], [17], [18]

Ewing's sarcoma

In jaw bones it is rare.

Symptoms

Cancer of the lower jaw can begin with an attack of aching, dull pain in the area of the tumor, a burning sensation and heat, which are soon joined by loosening of the teeth, swelling, and fever.

Diagnostics

The radiological picture of the neoplasm is non-specific and is characterized by a different form of destruction of bone tissue with elements of sclerosis. When the tumor spreads to the cortical layer and periosteum, the reaction of the tumor manifests itself in the form of a needle or bulbous period. Histologically, Ewing's sarcoma is a cell-rich undifferentiated tissue. The cells have a round, slightly oval shape, the same size, contain a large hyperchromic core. Are located densely, evenly, sometimes in the form of layers and can simulate a low-grade cancer.

Treatment

Ewing's sarcoma, like other bone marrow neoplasms (reticulosarcoma, plasmacytoma, lymphosarcoma), is highly sensitive to radiation and drug treatment. According to MA. Kropotov. Of 5 cases of this type of sarcoma in chemoradiotherapy in all achieved complete regression of the tumor, while in other histological forms of tumors, this effect was observed only in single observations.

[19], [20], [21], [22], [23], [24]

Reticular sarcoma

Clinically and radiologically, the reticular sarcoma differs little from Ewing's sarcoma, belongs to the group of bone marrow tumors, histologically differs by larger cell sizes, the presence of a gentle network of reticulin fibers. The incidence of regional lymph node involvement in bone marrow sarcomas is 29%.

[25]