| Exodontia.Info |
| Oral Cancer - Ætiological Factors |
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Carcinoma Carcinoma (OSCC).
OSCC accounts for approx 2 - 4% of all cancers in the UK
but is one of the most common cancers on the Indian
subcontinent.
Men are more frequently affected than women; most
OSCC patients > 40 and the incidence of rises rapidly
with age.
The lower lip is the most common site & related to actinic
(sun / solar) damage.
The tongue (the sides especially further back
[postero-laterally]), is the most common site within the
mouth.
OSCC accounts for approx 2 - 4% of all cancers in the UK
but is one of the most common cancers on the Indian
subcontinent.
Men are more frequently affected than women; most
OSCC patients > 40 and the incidence of rises rapidly
with age.
The lower lip is the most common site & related to actinic
(sun / solar) damage.
The tongue (the sides especially further back
[postero-laterally]), is the most common site within the
mouth.
| The majority of OSCC involves the lateral border of tongue ± FOM. Why are these sites predisposed to tumour development? Perhaps carcinogens pool in saliva in the so called ‘graveyard’ or ‘coffin’ area and there is increased permeability to these chemicals in these areas. |
Heavy tobacco smoking & alcohol consumption tend to be
associated with the development of OSCC; in India & SE
Asia, betel & areca nut chewing may be more important.
Ætiological Factors for Oral Cancer
Carcinogens
Sunlight (lip only)
Infections
Mucosal Diseases
Genetic Disorders
associated with the development of OSCC; in India & SE
Asia, betel & areca nut chewing may be more important.
Ætiological Factors for Oral Cancer
Carcinogens
- Tobacco
- Alcohol
- Areca nut / betel
Sunlight (lip only)
Infections
- Syphilis (Syphilitic leukoplakia)
- Candidiasis (Candidal leukoplakia)
- Viruses (HPV)
Mucosal Diseases
- Dysplastic lesions
- Oral Lichen Plamus
- Oral Sub-Mucous Fibrosis
Genetic Disorders
- Dyskeratosis congenita
- Fanconi’s anæmia
Tobacco
Alcohol
Areca Nut / Betel
Syphilis (Syphilitic Leukoplakia / Glossitis)
Syphilitic leukoplakia, especially of the tongue dorsum is
a feature of tertiary syphilis (rarely seen now) but the
malignant potential is high.
Carcinoma developing near the centre of the tongue
dorsum is typically the sequel to syphilitic leukoplakia.
Given the decline in late-stage syphilis, it is exceedingly
rare in this site now.
Syphilitic leukoplakia, especially of the tongue dorsum is
a feature of tertiary syphilis (rarely seen now) but the
malignant potential is high.
Carcinoma developing near the centre of the tongue
dorsum is typically the sequel to syphilitic leukoplakia.
Given the decline in late-stage syphilis, it is exceedingly
rare in this site now.
Candida (Candidal Leukplakia)
Candidal infection is common in speckled leukoplakias
especially at the commissures.
It may be associated with an increased risk of malignant
change.
Candidal Leukoplakia responds well to anti-fungals & the
cessation of smoking. The tongue dorsum is also a
common site.
Candidal infection is common in speckled leukoplakias
especially at the commissures.
It may be associated with an increased risk of malignant
change.
Candidal Leukoplakia responds well to anti-fungals & the
cessation of smoking. The tongue dorsum is also a
common site.
Human Papilloma Virus 16 (HPV 16)
HPV related cancers appear to occur on the tonsillar
area, the base of the tongue and the oro-pharynx
(non-HPV positive tumours tend to involve the anterior
tongue, floor of the mouth, the mucosa that covers the
inside of the cheeks and alveolar ridges).
In general, it appears that HPV-positive tumours occur
most frequently in a younger group of individuals than
tobacco-related malignancies. They occur more in white
males and in non-smokers. The HPV-positive group is the
fastest growing segment of the oral cancer population.
It does not appear that the HPV 16 acts synergistically
with tobacco or alcohol and represents a completely
unique disease process.
HPV related cancers appear to occur on the tonsillar
area, the base of the tongue and the oro-pharynx
(non-HPV positive tumours tend to involve the anterior
tongue, floor of the mouth, the mucosa that covers the
inside of the cheeks and alveolar ridges).
In general, it appears that HPV-positive tumours occur
most frequently in a younger group of individuals than
tobacco-related malignancies. They occur more in white
males and in non-smokers. The HPV-positive group is the
fastest growing segment of the oral cancer population.
It does not appear that the HPV 16 acts synergistically
with tobacco or alcohol and represents a completely
unique disease process.
Oral Lichen Planus
It is estimated that 1 – 4% of patients develop
carcinomata after a decade. Plaque-like & erosive OLP
in unusual sites (such as the fauces & tongue) should be
regarded with suspicion.
In view of the commonplaceness of OLP, its importance
as a pre-malignant lesion may be considerable.
Cutaneous LP appears to carry no risk of malignant
change.
It is estimated that 1 – 4% of patients develop
carcinomata after a decade. Plaque-like & erosive OLP
in unusual sites (such as the fauces & tongue) should be
regarded with suspicion.
In view of the commonplaceness of OLP, its importance
as a pre-malignant lesion may be considerable.
Cutaneous LP appears to carry no risk of malignant
change.
Sub-Mucous Fibrosis (SMF)
SMF affects those from the Indian sub-continent & SE
sclerosis but limited to the oral tissues & without the
immune abnormalities.
Arecoline, a stimulant derive from the areca nut is thought
to induce fibroblast proliferation & collagen synthesis.
Clinically, there is symmetrical fibrosis (scarring) of the
buccal mucosæ, soft palate & the inner aspects of lips.
The overlying mucosa may be normal or there may be a
vesiculating stomatitis. Fibrosis & ishæmia causes
extreme pallor of the affected area which becomes so
hard that it can’t be indented by your finger.
Progressive trismus making it very difficult to eat / drink.
Malignant change is from 4.5 – 8 %.
SMF affects those from the Indian sub-continent & SE
sclerosis but limited to the oral tissues & without the
immune abnormalities.
Arecoline, a stimulant derive from the areca nut is thought
to induce fibroblast proliferation & collagen synthesis.
Clinically, there is symmetrical fibrosis (scarring) of the
buccal mucosæ, soft palate & the inner aspects of lips.
The overlying mucosa may be normal or there may be a
vesiculating stomatitis. Fibrosis & ishæmia causes
extreme pallor of the affected area which becomes so
hard that it can’t be indented by your finger.
Progressive trismus making it very difficult to eat / drink.
Malignant change is from 4.5 – 8 %.
Useful Articles:
Dental Protection. Risk Management Module. Oral
Cancer.
Dental Update 2000. An Overview of the Prevention of
Oral Cancer and Diagnostic Markers of Malignant Change.
1. Prevention
Dental Update 2000. An Overview of the Prevention of
Oral Cancer and Diagnostic Markers of Malignant Change.
2. Markers of Value in Tumour Diagnosis
Preventive Dentistry 2006. Oral Cancer - A Growing
Concern.
Oral Oncology 2008. Oral cancer prevention and control –
The approach of the World Health Organization.
Oral Oncology 2009. Review. Global epidemiology of oral
and oro-pharyngeal cancer.
BMJ 2010. Head & Neck cancer - Part 1. Epidemiology,
presentation & prevention.
Dental Protection. Risk Management Module. Oral
Cancer.
Dental Update 2000. An Overview of the Prevention of
Oral Cancer and Diagnostic Markers of Malignant Change.
1. Prevention
Dental Update 2000. An Overview of the Prevention of
Oral Cancer and Diagnostic Markers of Malignant Change.
2. Markers of Value in Tumour Diagnosis
Preventive Dentistry 2006. Oral Cancer - A Growing
Concern.
Oral Oncology 2008. Oral cancer prevention and control –
The approach of the World Health Organization.
Oral Oncology 2009. Review. Global epidemiology of oral
and oro-pharyngeal cancer.
BMJ 2010. Head & Neck cancer - Part 1. Epidemiology,
presentation & prevention.
| Last Updated 5th March 2012 |