Методичні розробки 3 модуль

A.Mobility of a frontal teeth.

B.Mobility molars, trismus.

C.Exophthalmus, diplopia, watering.

D.Exophthalmus, diplopia, anesthesia in a zone of 3 branches of a trigeminal nerve.

E.Asymmetry of the face.

(The right answer: С)

2. X-ray picture оf odontogenic carcinoma (a primary cancer) the mandible?

A.A cell of rarefication in bone tissue with precise limits, regeneration as a processes in a surrounding bone are absent.

B.A cell of rarefication in bone tissue without precise limits, regeneration as a processes in a surrounding bone are absent.

C. A cell of rarefication in bone tissue with precise limits, are expressed regeneration as a processes in a surrounding bone.

D.A cell of rarefication in a bone without precise limits, are expressed regenerative processes in a surrounding bone.

E.A cell of dilution, (rarefaction) of bones with precise limits as « soap bubbles »

(The right answer: В)

3. A synonym of a primary (central) cancer of a jaw:

A.A sarcoma of a jaw.

B.Ewing's sarcoma.

C.Odontogenic carcinoma.

D.Paget`s disease.

E.AAmeloblastoma.

(The right answer: С)

D. Educational tasks of 3-rd level (atypical tasks):

1. On what sectors planes by Ongren conditionally divide maxillary sinus? (the Answer:

·Forward -bottom -back;

·Back -top -internal;

·Back -top -external.)

8.What include in the block of tissues which removal of the lymphatic system of a neck by Crile, 1906?

(The answer: a cellular tissue and lymph nodes of a neck, sternocleidomastoideus muscle, internal jugular vein, an additional nerve, submandibular gland and the lower pole of parotid gland.)

3.What are into the block of tissues which removal at operation by Vanash, 1911?

(The answer: removal submental, submandibular lymph nodes, deep cervical lymph nodes, which in a zone from a m. digastricus to the top edge of a sinew of a m.omohyoideus, plus both submandible glands and the lower pole of parotid gland.)

7. Literature:

7.1. Basic literature:

1.James, H. (1979). Promises in the Dark. New York: Bantam Books. ISBN 0-553-13453-1. Story of a young girl's osteosarcoma fight and its effect on her relationship with her boyfriend

2.Belshaw, Sheila M. (2001). Fly With a Miracle. Denor Press. ISBN 0-9526056-7-8. The story of a family's journey through teenage osteosarcoma and its aftermath.

3.Trottier, Maxine (2005). Terry Fox: A Story of Hope. Markham, Ont: Scholastic Canada. ISBN 0-439-94888-6. About Terry Fox and his quest to raise $25 million for cancer research by running across Canada on his prosthetic leg. Also The Terry Fox Story, a 1983 movie.

4.Jaffe, N. (2010). Pediatric and Adolescent Osteosarcoma. New York: Springer. ISBN 978-1- 4419-0283-2. Osteosarcoma research: past, present and future.

7.2.Additional literature:

1.Cawson R A, Binnie W H, Barrett A W, Wright J M 2001 Oral disease,3rd Edn

Mosby-Wolfe, London

Ministry of health Ukraine

Higher state educational establishment of Ukraine

«Ukrainian medical stomatological academy»

It is «ratified» at meeting of chair of surgical stomatology and maxillofacial surgery with plastic and reconstructive surgery of the head and neck

The Head of the chair

doctor of medicine Aveticov D. S.

METHODICAL INSTRUCTION

FOR INDEPENDENT WORK OF STUDENTS DURING PREPARATION FOR PRACTICAL

(SEMINAR) LESSON

Poltava – 2012

1. SUBJECT URGENCY.

In recent years continuous growth of frequency of incidence on a cancer of a mucous membrane of an oral cavity and tongue is observed. Therefore future doctor should be informed with the reasons of emergence of a cancer; necessary understanding of carcinogenesis without what it is not possible to prove theoretically application both preventive measures, and treatment methods. Efficiency of treatment of malignant tumors completely depends on diagnostics condition., mastering by principles and practical skills from prevention, early diagnostics, knowledge of indications and contra-indications to modern methods of treatment of oncological diseases and the organization of oncological service is necessary for the timely direction of patients with tumors to specialists oncologists.

2. SPECIFIC GOALS:

2.1.To analyze incidence of malignant new growths of a lip, language, a mucous membrane of an

oral cavity.

2.2.To explain pathogenesis of emergence of malignant new growths of lips, a mucous membrane of an oral cavity, tongue.

2.3.To offer methods of diagnostics of malignant new growths of lips, a mucous membrane of an oral cavity, tongue.

2.4.To classify malignant new growths of lips, a mucous membrane of an oral cavity, tongue.

2.5.To treat pathological anatomy of malignant new growths of a lip, tongue, a mucous membrane of an oral cavity.

2.6.To draw schemes, graphics of malignant new growths of a lip, tongue, a mucous membrane of an oral cavity.

2.7.To analyze conclusions of diagnostic methods of malignant new growths of a lip, tongue, a mucous membrane of an oral cavity, to establish the diagnosis.

2.8.To combine the plan of treatment of malignant new growths of a lip, tongue, a mucous membrane of an oral cavity depending on a stage of a disease and clinical group.

3.BASIC LEVEL OF PREPARATION.

4. TASKS FOR INDEPENDENT WORK DURING PREPARATION FOR LESSON.

4.1. The list of the main terms, parameters, characteristics which the student should know during preparation for lesson:

4.2. Theoretical questions to lesson:

1.What factors influence emergence of malignant new growths of lips, tongue, a mucous membrane of an oral cavity.

2.How malignant new growths of lips, tongue, a mucous membrane of an oral cavity (domestic classification) are classified?

3.How malignant new growths of lips, tongue, a mucous membrane of an oral cavity behind TNM classification (the international classification of WHO) are classified?

4.What principles of diagnostics of malignant new growths of lips, tongue, mucous membrane of an oral cavity.

5.What is the cytological method of research? At malignant new growths of lips, tongue, a mucous membrane of an oral cavity you know what methods of a fence of a material? Performance techniques.

6.What is the biopsy? You know what methods of a biopsy of lips? Techniques of performance of different methods of a biopsy.

7.It is necessary to adhere to what rules during a biopsy capture?

8.What principles of treatment of malignant new growths of lips, tongue, mucous membrane of an oral cavity.

9.What is the combined treatment?

10.What is the complex treatment?

11.What is the palliative treatment?

12.How medical examination of patients with malignant new growths of lips, tongue, a mucous membrane of an oral cavity is carried out?

4.3. Practical works (task) which are carried at the lesson:

1.To investigate the patient with a malignant new growth of lips, a mucous membrane of an oral cavity or tongue.

2.To fill medical documentation on the patient with a malignant new growth of lips, a mucous membrane of an oral cavity or tongue.

3.To combine the plan of investigation of the patient with a malignant new growth of lips, a mucous membrane of an oral cavity or tongue.

4.To take a material for cytological research of a tumor.

5.To carry out a fence to a material for cytological research of lymph nodes.

6.To carry out a fence to a material for histological research (to execute a biopsy).

7.To put and prove the clinical diagnosis.

8.To combine and prove the treatment plan.

9.To appoint to the patient dispensary supervision.

5. ORGANIZATION OF THE MAINTENANCE OF THE TRAINING MATERIAL.

Possible signs of lip and oral cavity cancer include a sore or lump on the lips or in the mouth.

These and other symptoms may be caused by lip and oral cavity cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

A sore on the lip or in the mouth that does not heal.

A lump or thickening on the lips or gums or in the mouth.

A white or red patch on the gums, tongue, tonsils, or lining of the mouth.

Bleeding, pain, or numbness in the lip or mouth.

Change in voice.

Loose teeth or dentures that no longer fit well.

Trouble chewing or swallowing or moving the tongue or jaw.

Swelling of jaw.

Sore throat or feeling that something is caught in the throat.

Lip and oral cavity cancer may not have any symptoms and is sometimes found during a regular

dental exam.

Tests that examine the mouth and throat are used to detect (find), diagnose, and stage lip and oral cavity cancer.

The following tests and procedures may be used:

Physical exam of the lips and oral cavity: An exam to check the lips and oral cavity for abnormal areas. The doctor or dentist will feel the entire inside of the mouth with a gloved finger and examine the

oral cavity with a small long-handled mirror and lights. This will include checking the insides of the cheeks and lips; the gums; the roof and floor of the mouth; and the top, bottom, and sides of the tongue.

The neck will be felt for swollen lymph nodes. A history of the patient‘s health habits and past illnesses and medical and dental treatments will also be taken.

Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.

X-rays of the head, neck, and chest: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. If leukoplakia is found, cells taken from the patches are also checked under the microscope for signs of cancer.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Certain factors affect prognosis (chance of recovery) and treatment options.

Prognosis (chance of recovery) depends on the following:

The stage of the cancer.

Where the tumor is in the lip or oral cavity.

Whether the cancer has spread to blood vessels.

For patients who smoke, the chance of recovery is better if they stop smoking before beginning radiation therapy.

Treatment options depend on the following:

The stage of the cancer.

The size of the tumor and where it is in the lip or oral cavity.

Whether the patient's appearance and ability to talk and eat can stay the same.

The patient's age and general health.

Patients who have had lip and oral cavity cancer have an increased risk of developing a second cancer in the head or neck. Frequent and careful follow-up is important. Clinical trials are studying the use of retinoid drugs to reduce the risk of a second head and neck cancer.

Stages of Lip and Oral Cavity Cancer

After lip and oral cavity cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lip and oral cavity or to other parts of the body.

The process used to find out if cancer has spread within the lip and oral cavity or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose lip and oral cavity cancer are also used to stage the disease.

The three ways that cancer spreads in the body are:

Through tissue. Cancer invades the surrounding normal tissue.

Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for lip and oral cavity cancer:

Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I In stage I, cancer has formed and the tumor is 2 centimeters or smaller. Cancer has not spread to the lymph nodes.

Stage II In stage II, the tumor is larger than 2 centimeters but not larger than 4 centimeters, and cancer has not spread to the lymph nodes.

Stage III In stage III, the tumor:

may be any size and has spread to a single lymph node that is 3 centimeters

or smaller, on the same side of the neck as the cancer or is larger than 4 centimeters. Stage IV is divided into stages IVA, IVB, and IVC as follows:

In stage IVA, the tumor:

has spread to nearby tissues in the lip and oral cavity; or

is any size and may have spread to nearby tissues in the lip and oral cavity. Cancer has spread to 1 or more lymph nodes on one or both sides of the neck, and the involved lymph nodes are 6 centimeters or smaller.

In stage IVB, the tumor:

may be any size and has spread to one or more lymph nodes that are larger than 6

centimeters; or

has spread to the muscles or bones in the oral cavity, or to the base of the skull and/or the carotid artery. Cancer may have spread to one or more lymph nodes on one or both sides of the neck.

In stage IVC, the tumor has spread beyond the lip and oral cavity to other parts of the body. The tumor may be any size and may have spread to the lymph nodes.

Lip cancer is a type of oral cancer that can affect the tissues of the lip. The uncontrollable growth of cells in the lip tissues leads to formation of the cancer. This cancer can spread to other parts of the mouth and face. It can spread as the nerves in the lips are interconnected with other nerves in the face. When the cancer forms in the flat cells of the lips, mouth and tongue, it is referred to as oral squamous cell carcinoma. The lip cancer symptoms are often non-specific. They appear similar to a non-serious conditions and thus overlooked. However, early detection of the cancer will help in maximum treatment of the condition.

Factors that Lead to Lip Cancer. The exact cause of lip cancer is still a bit dicey. It is often seen in people who live in areas that receive maximum sunlight. Even the slightest damage by the sun, can lead to cancer of the lips. Other risk factors that lead to cancer of the lips include:

Excessive use of tobacco products like cigarettes, cigars and chewing tobacco

Chronic and heavy alcohol use

Infection with human papillomavirus (HPV)

Light colored skin people exposed to a lot of sunlight

Common in men and people over the age of 40 to 45 years of age

Signs that Indicate Lip Cancer

The lip cancer signs are often similar to other health conditions that are not very serious. Many times, dentists tend to observe presence of oral cancers during a routine dental examination. Some of the

lip cancer symptoms include the following:

People who develop sores on their lips or within the mouth like a cold sore that does not heal for a long time, may indicate lip cancer.

A lump on the lip or the mouth that may be painful and does not heal quickly indicates cancer. This lump may even be present in the throat, indicating an oral cancer.

An unusual white or red patch on the gums, tongue or the inner lining of the mouth or under the inner side of the lip may indicate cancer.

Bleeding from the lip from the ulcers or sores that do not heal.

Change in color of the lips or a small patch on the lip may indicate the presence of cancerous

cells.

Unusual Sensations. Constant or persistent numbness, tingling, pain or paresthesia in the lips for no reason at all may be one of the symptoms.

Thickened Lip. Lips are generally soft and supple in nature. But, if you feel the lip(s) are hardening or thickening in a particular area, it is better to pay a visit to a doctor.

If one observes other serious symptoms like loss of consciousness, high fever, excessive bleeding

from lips, rapid heartbeat and lethargy along with any of the above symptoms, visit a medical health care provider immediately.

Treatment Options by Stage

Stage I Lip and Oral Cavity Cancer

Treatment of stage I lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

Surgery (wide local excision).

Internal radiation therapy with or without external radiation therapy. Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

Surgery (wide local excision).

Internal radiation therapy with or without external radiation therapy.

Radiation therapy to lymph nodes in the neck.

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

Surgery (wide local excision) for tumors smaller than 1 centimeter, with or without internal and/or external radiation therapy.

Surgery (wide local excision with skin graft) or radiation therapy for larger tumors.

Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

Surgery (wide local excision) for tumors smaller than ½ centimeter.

Surgery (wide local excision) or radiation therapy for larger tumors. Lower gingival

If cancer is in the lower gingiva (gums), treatment may include the following:

Surgery (wide local excision, which may include removing part of the jawbone, and skin

graft).

Radiation therapy with or without surgery. Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

Surgery (wide local excision, which may include removing part of the jawbone.)

Radiation therapy with or without surgery.

Upper gingiva or hard palate

If cancer is in the upper gingiva (gums) or the hard palate (the roof of the mouth), treatment is usually surgery (wide local excision) with or without radiation therapy.

Stage II Lip and Oral Cavity Cancer

Treatment of stage II lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

Surgery (wide local excision).

External radiation therapy and/or internal radiation therapy. Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

Radiation therapy and/or surgery (wide local excision).

Internal radiation therapy with surgery (neck dissection). Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include

the following:

Radiation therapy for tumors that are 3 centimeters or smaller.

Surgery (wide local excision) and/or radiation therapy for larger tumors. Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

Surgery (wide local excision)

Radiation therapy

Surgery (wide local excision) followed by external radiation therapy, with or without internal radiation therapy, for large tumors

Lower gingival

If cancer is in the lower gingiva (gums), treatment may include the following:

Surgery (wide local excision, which may include removing part of the jawbone, and a

skin graft).

Radiation therapy alone or after surgery.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

Surgery (wide local excision, which includes removing part of the jawbone).

Radiation therapy with or without surgery.

Upper gingiva or hard palate

If cancer is in the upper gingiva (gums) or the hard palate (the roof of the mouth), treatment may include the following:

Surgery (wide local excision) with or without radiation therapy.

Radiation therapy alone.

Stage III Lip and Oral Cavity Cancer

Treatment of stage III lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

Surgery and external radiation therapy with or without internal radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of hyperfractionated radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

External radiation therapy with or without internal radiation therapy.

Surgery (wide local excision) followed by radiation therapy.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of hyperfractionated radiation therapy. Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include

the following:

Surgery (wide local excision) with or without radiation therapy.

Radiation therapy

A clinical trial of chemotherapy before or after surgery.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of hyperfractionated radiation therapy. Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

Surgery (wide local excision, which may include removing part of the jawbone, with or without neck dissection).

External radiation therapy with or without internal radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of hyperfractionated radiation therapy.

Lower gingival

If cancer is in the lower gingiva (gums), treatment may include the following:

Surgery (wide local excision) with or without radiation therapy. Radiation may be given before or after surgery.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of hyperfractionated radiation therapy.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

Surgery to remove the tumor, lymph nodes, and part of the jawbone, with or without radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of hyperfractionated radiation therapy.

Upper gingival

If cancer is in the upper gingiva (gums), treatment may include the following:

Radiation therapy

Surgery (wide local excision) and radiation therapy.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of hyperfractionated radiation therapy. Hard palate

If cancer is in the hard palate (the roof of the mouth), treatment may include the following:

Radiation therapy

Surgery (wide local excision) with or without radiation therapy.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of hyperfractionated radiation therapy.

Lymph nodes

For cancer that may have spread to lymph nodes, treatment may include the following:

Radiation therapy and/or surgery (neck dissection).

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of hyperfractionated radiation therapy.

Stage IV Lip and Oral Cavity Cancer

Treatment of stage IV lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

Surgery and external radiation therapy with or without internal radiation therapy.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of hyperfractionated radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

Surgery to remove the tongue and sometimes the larynx (voice box) with or without radiation therapy.

Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of hyperfractionated radiation therapy.

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

Surgery (wide local excision) and/or radiation therapy.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of hyperfractionated radiation therapy.

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

Surgery before or after radiation therapy.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of hyperfractionated radiation therapy. Lower gingival

If cancer is in the lower gingiva (gums), treatment may include the following:

Surgery and/or radiation therapy.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of hyperfractionated radiation therapy. Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may

include the following:

Surgery to remove the tumor, lymph nodes, and part of the jawbone, followed by radiation therapy.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of hyperfractionated radiation therapy.

Upper gingiva or hard palate

If cancer is in the upper gingiva (gums) or hard palate (the roof of the mouth), treatment may include the following:

Surgery with radiation therapy.

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of hyperfractionated radiation therapy. Lymph nodes

For cancer that may have spread to lymph nodes, treatment may include the following:

Radiation therapy and/or surgery (neck dissection).

A clinical trial of chemotherapy and radiation therapy.

A clinical trial of chemotherapy before or after surgery.

A clinical trial of hyperfractionated radiation therapy.

Treatment Options for Recurrent Lip and Oral Cavity Cancer

Treatment of recurrent lip and oral cavity cancer may include the following:

Surgery, if radiation therapy was used before.

Surgery and/or radiation therapy, if surgery was used before.

A clinical trial of chemotherapy with or without radiation therapy.

A clinical trial of hyperthermia therapy.

Tongue Cancer

The most common type of cancer of the tongue is called Squamous Cell Carcinoma. There are other types of cancers of the tongue but they are statistically uncommon. If you have questions about some of these more rare cancers, read more.

The tongue is actually divided into 2 separate anatomical areas, the oral tongue is the part you can "stick out" at somebody and extends backward to a V-shaped group of lumps on the back of the tongue which are actually specialized taste buds. The base of tongue is behind these. The oral tongue and the base of the tongue comprise the whole tongue but it is important to know that they develop from different embryonic tissue and really are somewhat dissimilar. Most importantly, this explains why the treatment for squamous cell carcinoma for the oral tongue is usually quite different from the treatment for squamous cell carcinoma of the base of tongue.

Squamous Cell Cancer of the oral tongue.

This tumor is usually located on the side, or what we call the lateral border, of the oral tongue. It is usually somewhat ulcerated and is grayish-pink to red in color. It will often bleed easily if bitten or touched. It is generally seen in the older age groups though we have had one 21 year old woman present with a small cancer, and just recently a 32 old lady from the Austin area come to us from the Internet for treatment of a significant squamous cell cancer of the tongue. Smoking and drinking are known to contribute to the formation of the cancers, although some folks have developed squamous cancer of the tongue with no known extra risk factors.