Aetiology of oral cancer Clinical features of oral cancer

Author: van Zyl A1, Bunn BK.

Abstract:

Oral cancer (OC) is a major cause of global morbidity and mortality Squamous cell carcinoma accounts for more than 90% of oral malignancies and occurs most frequently in middle-aged to elderly patients who smoke and drink heavily. The overall outlook for patients diagnosed with oral squamous cell carcinoma (OSCC) remains poor, largely due to late clinical presentation. Early lesions are frequently undetected due to the lack of accompanying symptoms. Early recognition, diagnosis and treatment of OSCC significantly enhance patient survival and minimise the need for extensive surgery. It is thus essential that the oral health care worker (OHW) be familiar with the variable clinical manifestations of both potentially malignant disorders (PMD) as well as invasive malignancy. OC screening, particularly in high-risk patients should be an integral component of routine intra-oral clinical examination. The aim of this article is to highlight the varied clinical appearance of OC and to emphasise the importance of early recognition and diagnosis.


Epidemiology of oral squamous cell carcinoma
Authors: Muhammed Hanif Abram, Willie van Heerden, Paul Rheeder, Andre W Van Zyl

Abstract:

The National Cancer Registry (NCR) of South Africa publishes the pathology-based cancer incidence in the country and is the main cancer data source. The data published by the NCR have been used extensively in the development of the draft national guidelines for cancer prevention and control as well as for cancer research. The list of contributing pathology laboratories is fairly inclusive. Data from the NCR and the University of Limpopo, Department of Oral Pathology for the five years 1997-2001 were combined and then filtered for sites in the oral and oropharyngeal region. Age-Standardised Incidence Rates (ASIR) and the Cumulative Lifetime Risk (LR) for males and females in the different population groups were determined. Comprehensive reporting of oral and oropharyngeal cancer incidence will influence the allocation of government resources for prevention and treatment of oral cancers.


Oropharyngeal carcinoma: A sexually transmitted disease

Author: Willie van Heerden, Andre W Van Zyl

Abstract:

Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is on the increase and accounts for 18% to 63% of OPC. It occurs mostly in young males with no other identifiable risk factors. The vast majority of HPV-associated OPC is attributable to HPV16. The prognosis of patients with HPV-positive OPC is better than patients with HPV-negative OPC. Oral HPV infection is linked to sexual transmission. The natural history, prevalence and possible risk factors in local communities should be studied to implement appropriate prevention strategies.


Surgical pathology of oral cancer

Author: Willie van Heerden, Andre W Van Zyl

Abstract:

Oral squamous cell carcinoma (OSCC) is a common malignancy with an increase in incidence reported in some developing countries. Although the aetiological risk factors are well documented and advances have been made in the different treatment modalities, the mortality and morbidity of OSCC have not improved significantly over the last decades. The histopathologist is an important member of the multidisciplinary team responsible for the management of OSCC patients. This review will discuss the different histological subtypes of OSCC as well as other pathological features that can influence the behaviour of OSCC and should be included in a histopathology report.


Clinical features of Oral Cancer

Author: Andre W Van Zyl, Belinda Bunn

Abstract:

Oral cancer (OC) is a major cause of global morbidity and mortality Squamous cell carcinoma accounts for more than 90% of oral malignancies and occurs most frequently in middle-aged to elderly patients who smoke and drink heavily. The overall outlook for patients diagnosed with oral squamous cell carcinoma (OSCC) remains poor, largely due to late clinical presentation. Early lesions are frequently undetected due to the lack of accompanying symptoms. Early recognition, diagnosis and treatment of OSCC significantly enhance patient survival and minimise the need for extensive surgery. It is thus essential that the oral health care worker (OHW) be familiar with the variable clinical manifestations of both potentially malignant disorders (PMD) as well as invasive malignancy. OC screening, particularly in high-risk patients should be an integral component of routine intra-oral clinical examination. The aim of this article is to highlight the varied clinical appearance of OC and to emphasise the importance of early recognition and diagnosis.


The role of the dentist in the early detection of oral cancer

Author: Van Heerden, W.F.P, Van Zyl, Andre W.

Abstract:

All patients, and especially high-risk patients, visiting their dentist should receive a thorough examination for the presence of potentially malignant disorders or early oral cancer. It is well documented that early detection significantly improves the 5-year survival rate of patients with oral cancer (90% for early and as low as 20% for late, diagnosis).


Correlation Between Dysplasia and Ploidy Status in Oral Leukoplakia

Author: Andre W. van Zyl, Marlene B. van Heerden, Emil Langenegger,Willie F. P. van Heerden

Abstract:

Oral leukoplakia and other potentially malignant disorders (PMD) may progress to oral squamous cell carcinoma (OSCC). The gold standard for assessing the potential for malignant transformation remains histologic examination with the aim of grading the dysplastic changes. However, not all lesions with dysplasia will progress to OSCC. DNA ploidy has been suggested as a method to predict the clinical behaviour of PMD. This study reports on the use of high-resolution flow cytometry to determine the ploidy status of formalin-fixed, paraffin-embedded material from PMD compared to their dysplasia grade on histology. Aneuploidy was found in 13 % of mild, 31 % of moderate, and 54 % of severe dysplasia cases. This difference was statistically significant (p = 0.011). The differences in ploidy status were more significant when grouping the dysplasia into low-risk and high-risk categories (p = 0.008). These findings indicate that the ploidy status of PMD as determined by high-resolution flow cytometry may be of value in predicting biological behaviour in PMD such as leukoplakia.

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