Inferior lip cancer

The incidence
In the republic of Moldova inferior lip cancer occupy 7 place and
constitute 5,5% of all cancers morbidity. Mostly affected is man, age
vulnerable is 60 – 70 years old.
The risk persons which working on the air (fisherman, agricultures).

Etiology:
1. Insolations + wind
2. Chronical trauma
3. Michroconbushion
4. Smoking
5. Viruses

The lip cancer appear on the background of “precancerous states”.

 Pretumoral clasification:

I. Facultative
1. Diffuse diskeratosis + soft, dry, desquamations and fissure.
2. Productive diskertosis
II. Precancers with high potential of malignization
1. Destructive diskeratosis
- Chronical fissures of inferior lip
2. Productive diskeratosis
- cutaneous corn
- leucoplasia
- papilomas
- keratoakantoma

Clinical view of precancers states

The most high potential malignization of precancerous states is

keratoakantoma which consider as initial stage of lip cancer.
 The surface of keratoakantoma is keratinizated in the central on the all
surface of the lip. The next step in the center of focus there is detaching of
keratine mussels, discovered a deep shape as a crater, covered by pilose
epithelium . These disease is called as “pseudoulcer”, never bleeding and
lymphatic alimination.
The specific clinical science of keratoakantoma is the presence of ditch about 0.5
– 2mm around of center.
The malignization of keratoakantoma is manifest by fast growing. The main
differential diagnosis between keratoakantoma and lip cancer is grade of
elasticity mostly on the edge of tumor. In the keratoakantoma the consistence
could be as elastic as rigid, wihle in cancer is hard.

Treatment of precancerous states

1. Conservative method
a. bucal cavity sanation
b. smoking abandon
c. in difficult cases – prednisolon ointment
2. Surgical method
For keratoakantoma surgical method is not adequate method of treatment.
3. Radiological method
Using contact reonghenotherapy summery doses 4000 – 5500rad.
4. Combinate method
Constitute by two steps.
a. primary tumor irradiation.
b. Vanach operation
5. Cryosurgery

Inferior lip cancer

Lip cancer is added to paviment group cancers, the skin and mucosa is
secondary affected. Keratinizated cancer has a slow evolution and has
horizontal spreading with no metastazation. Cancer without keratinization
fast ulcerated, infiltrative spreading with early lymphnodes metastasis.
 Clinical pictures
The inferior lip cancer have no tendency of generalization and is
manifest by local and regional spreading.
Clinical evolution of lip cancer is manifest by a few forms:

1.Papilary form (exophitic)

2. Verucosis form (exophitic)
3. Ulcerative form
4. Ulcero-infiltrative form

In advanced stages of infiltrative form it could be invaded in to

muscles skin and bones. Appears lymphatic metastasis submentonien and
submandibular, later invaded the skin with necrosis and bleeding.
 The treatment of lip cancer
The treatment depend of spreading grade (stage) and clinical form.
Radiotherapy

In the I – II stage of lip cancer in papillary form more adequate is contact

radiotherapy.
In III stage in ulcer and ulcer-infiltrative form is the associated method
(telegamatherapy + contact radiotherapy).
In stage IV first step apply radiotherapy preoperatory, and second wide
surgery or combinate.

Surgical treatment
The surgical treatment is apply mostly in radiorezistent tumors,
recidive form and local advanced proces.

1. Trapezoid form
2. Rectangular form
 Cryosurgery
Advantage:
-no need general anesthesia
-could be apply ambulatory
- postoperative period goes more slightly without seriously complication
- no bleeding
- fine scar
- no expansive aparatus

Medicamentosis therapy

Chemotherapy is using in complex treatment in wide spreading form and regional

metastasis.
1. Regional chemotherapy
2. Systemic Chemotherapy