THE ROLE OF GENERAL PRACTITIONER

ON SCREENING ORAL CANCERS

Dr. Fanaye G/Meskel (DMD,MDS)

Assistant Professor in Oral and Maxillofacial surgery
Yekatit 12 Hospital Medical College
Addis Ababa
Ethiopia
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INTRODUCTION

 Oral cancer is recognised as the sixth most common cancer

worldwide, with recent epidemiological data reporting
263,900 new cases of lip and oral cavity cancer in 2008.
 Globally, there is a wide geographical variation in the
incidence of oral cancer.

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Fig. 1 Global results of lip and oral cavity (C00-C06), ASR(W) in comparison to other sites
of
head and neck cancer by gender and age 0–85+. Age-standardised rates to World Standard
Population (Source : Cancer Incidence in Five Continents Volume X)

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 The highest incidence rates of this cancer (excluding lip) are found in
the South and Southeast Asia (e.g. Sri Lanka, India, Pakistan and
Taiwan),
 Western (e.g. France) and Eastern Europe (e.g. Hungary, Slovakia
and Slovenia),
 Latin America and the Caribbean (e.g. Brazil, Uruguay and Puerto
Rico) and
 In the Pacific regions (e.g. Papua New Guinea and Melanesia) .
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 Oral cancer is usually a disease that occurs in males after the fifth
decade of life.
 Several studies suggest that 4–6 % of oral cancers now occur at
ages younger than 40 years.
 For most countries, the overall 5-year survival rate for oral cancer
is around 50 % for all anatomical sites and stages.
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ORAL POTENTIALLY MALIGNANT DISORDERS

 Recommended by an International Working Group convened by the WHO
Collaborating Centre for Oral Cancer and Precancer in London in 2005.
 Leukoplakia,
 erythroplakia,
 oral submucous fibrosis,
 lichenplanus, palatal lesions in reverse smokers, actinic keratosis, discoid
lupus erythematosus,
 dyskeratosis congenita and epidermolysis bullosa are described under the
broad definition of OPMD.

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GLOBAL PREVALENCE OF OPMD

 global prevalence of OPMD range from 1 to 5 %

 South-East Asia, usually with a male preponderance, e.g. in Sri Lanka (11.3 %)
, Taiwan (12.7 %) and Pacific countries like Papua New Guinea (11.7 %) .
 Wide geographical variations across countries and regions are mainly due to
differences in socio-demographic characteristics, the type and pattern of
tobacco use and clinical definitions of disease.

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CLINICAL PRESENTATION OF OSCC

 Entirely asymptomatic
 Oral cancer may present as solitary oral lump, ulcer, white or red
patch persisting for more than 3 weeks or non-healing socket.
 Unexplained loose tooth or pain or numbness of the tongue should
also cause concern until proven otherwise.
 Abnormal tongue movements,
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 sudden poor fit of dentures,

 alterations of speech,
 neck swelling and
 obstructive disease of the submandibular glands from carcinoma in
the floor of the mouth

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RISK FACTORS FOR OSCC

 Tobacco usage in various forms

 Heavy alcohol drinking,
 Areca nut/betel quid chewing,
 Radiation exposure,
 Infections,
 Immunoincompetence
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TOBACCO

Cigarette and Cigars

 Nicotine, not in itself carcinogenic, is toxic and addictive.
 strong carcinogens such as polycyclic aromatic hydrocarbons (PAHs),
nitrosamines and aromatic amines and weak carcinogens such as
acetaldehyde.
 exerted through DNA adducts
 dose dependent with multiplicative synergism seen with alcohol drinking.

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ALCOHOL AND ORAL CANCER

 Alcohol consumption being an independent risk factor for the development of OSCC
 Excess risk for ‘high’ exposure varied from 2.2 (>56 drinks/week) to 12.0 (>90
drinks/week)
 secondary mechanisms by which ethanol indirectly causes genetic damage, thus
leading to carcinogenesis.
 Acetaldehyde is a highly reactive aldehyde that is produced during the breakdown of
ethanol.

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MICROORGANISMS

 Poor oral hygiene may be an independent risk factor in oral cancer

 Poor dental status, tooth loss and periodontal disease have been
shown to increase the risk of oral cancer.
 Bacterial infections may induce cancer by triggering cell
proliferation, inhibiting apoptosis, interfering with cellular
signalling pathways and up-regulating tumour promoters.
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HUMAN PAPILLOMAVIRUS

 More than 130 types have been identified in this heterogeneous

virus family. These types have been classified into low- or high-
risk groups according to their potential for oncogenesis based on
persistent infection.
 genotypes 16 and 18 play a role in the aetiology of head and neck
cancers, particularly tonsil and oropharyngeal carcinoma
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CANDIDA

 Positive role for yeast Candida in the multistep process of oral

mucosal carcinogenesis.
 Candida can cause a spectrum of oral mucosal lesions.
 Presence of Candida in association with dysplastic or malignant
lesions
 secondary infection with a pre-existing altered epithelium.
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IMMUNE DEFICIENCY AND TRANSPLANTATION

 human immunodefi ciency virus (HIV) are at higher risk for certain
types of cancer including lip, oral cavity, pharyngeal and oesophageal
cancer compared to the general population.
 Solid organ transplant recipients who receive iatrogenic immune
suppression are two- to fourfold more susceptible to developing cancer
, this finding being generally attributed to immunosuppression.

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DETECTION OF ORAL CANCER AND ORAL POTENTIALLY

MALIGNANT LESIONS

 Early clinical detection of oral lesions of OPMD,

 Current standard for detection of OPMDs and OSCCs is a
conventional oral examination (COE), involving visual inspection
and digital palpation of the oral cavity using incandescent light.

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 COE is the mainstay of early detection for general practitioners but

is incapable of identifying all OPMDs and OSCCs.
 cannot differentiate between progressive and non-progressive
lesions
 clinical presentations similar to precancerous and cancerous lesions
(keratinisation, ulceration, inflammation, etc.)
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DIAGNOSTIC ADJUNCTS IN ORAL CAVITY CANCER

Toluidine Blue
 is a metachromatic, acidophilic dye which selectively stains acidic
tissue components such as nucleic acids ad affinity for DNA and RNA.
 an adjunctive technique for diagnosis of OSCCs
 as well as to delineate the margins and extension of lesions more
effectively
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OPTICAL FLUORESCENCE IMAGING

 a phenomenon whereby an extrinsic light source is used to excite

endogenous fluorophores causing the natural emission of light from
these compounds.
 Endogenous fluorophores include certain amino acids, metabolic
products and structural proteins, among others.

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 The excitation and emission wavelength varies greatly between fl

uorophores.
 Within oral mucosa, the most relevant fluorophores are
nicotinamide adenine dinucleotide (NADH), flavin adenine
dinucleotide (FAD) and collagen.

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