|Oral Cancer - Ætiological Factors
More than 90% of Oral Cancer is Oral Squamous Cell
OSCC accounts for approx 2 - 4% of all cancers in the UK
but is one of the most common cancers on the Indian
Men are more frequently affected than women; most
OSCC patients > 40 and the incidence of rises rapidly
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
|The majority of OSCC involves the lateral border of tongue
± Floor of Mouth. 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
Ætiological Factors for Oral Cancer
Sunlight (lip only)
- Dyskeratosis congenita
- Fanconi’s anæmia
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.
Candida (Candidal Leukplakia)
Candidal infection is common in speckled
leukoplakias especially at the
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
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
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
It does not appear that the HPV 16 acts
synergistically with tobacco or alcohol
and represents a completely unique
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.
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.
|Last Updated 22nd November 2018
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.
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 %.