14 - Dysplasia and oral cancer

Question 1

How are oral cancers defined?

Answer 1

OCC - oral cavity cancer
OPC - oropharyngeal cancer
X - neither

Question 2

Describe the incidence of OCC.

Answer 2

• men 2:1 women
• most common in south central Asia (50% of cases world-wide)
• incidence is not increasing overall
• decreasing in men, increasing in women due to changes in tobacco use

Question 3

What are the high risk sites for OCC?

Answer 3

• FOM
• lateral border of tongue
• soft palate

Question 4

Describe the incidence of OPC.

Answer 4

• men 4.8:1 women
• rates are rapidly rising in developed countries
• linked to rising HPV epidemic

Question 5

What are the risk factors for oral cancer?

Answer 5

• smoking
• drinking alcohol
• chewing tobacco
• socioeconomic status
• FH
• OH
• sexual history

Question 6

How does smoking affect your oral cancer risk?

Answer 6

• smokers who do not drink x2 risk
• increases with quantity, frequency and duration
• fewer cigarettes for longer period is worse than high number short term
• greatest risk for larynx cancer

Question 7

How does drinking alcohol affect your oral cancer risk?

Answer 7

• drinkers who have never smoked x2 risk
• frequency more important than duration (drinks per day)
• greatest risk for OCC and OPC

Question 8

How does smoking and drinking alcohol affect your oral cancer risk?

Answer 8

• x5 risk
• no safe lower limit
• increases with frequency and duration

Question 9

How does chewing betel leaves affect your oral cancer risk?

Answer 9

Betel quid (paan) risk x3

Question 10

How does SES affect your oral cancer risk?

Answer 10

• x2 risk
• associated with low educational attainment
• risk increased even without other risk factors

Question 11

How does FH affect your oral cancer risk?

Answer 11

• risk not certain
• 1st degree relative with H&N cancer is important

Question 12

How does OH affect your oral cancer risk?

Answer 12

• risk not certain
• suggested that poor OH associated with increased risk

Question 13

How does sexual activity affect your oral cancer risk?

Answer 13

• risk not certain
• suggested that increased risk of OPC with number of sexual partners, oral sexual partners and having sex at a younger age

Question 14

What is the benefit of quitting smoking on oral cancer risk?

Answer 14

• demonstrable benefits seen within 1-4 years of quitting
• risk reduced to similar level as a non smoker after 20 years

Question 15

What is the benefit of quitting drinking alcohol on oral cancer risk?

Answer 15

Demonstrable benefits seen at around 20 years

Question 16

How does diet impact oral cancer risk?

Answer 16

A diet high in fruit and vegetables are associated with reducing the risk by 50%

Question 17

How does obesity impact oral cancer risk?

Answer 17

• not associated with an increased risk
• those with a low BMI are more likely to have oral cancer