Dysplasia and Oral Cancer P1

Question 1

How to define Oral cancer?

Answer 1

• International Classification of Disease for Oncology (ICD-O)
• too many different sites
• makes comparison difficult
• makes epidemiology difficult
• makes tx planning difficult

1. X- not being part of head and neck cancer
2. OC- oral cancer
3. OP- oral pharyngeal cancer

Question 2

Epidemiology of OC

Answer 2

2 distinct disease pattern
- Oral cavity cancer (OCC)
- Oro-pharyngeal cancer (OPC)

• different populations
• different outcome
• different risks

Question 3

Epidemiology of OC (INHANCE)

Answer 3

• The International Head and Neck Cancer Epidemiology Consortium
• Collaboration of research groups of large epidemiological (case control) studies
• investigating risk factors for H&N cancer including oral cavity and oro-pharyngeal cancer subsites

Question 4

Oral Cavity Cancer

Answer 4

• 2.5 per 100000 pop
• half (48.7%) in south central asia
• male: female 2:1
• incidence not increasing worldwide
• decrease in men, increasing in women
• reduction in tobacco use (tobacco use falling in men, increasing in female)
• Scottish Cancer Registry
  (10% increase 2001-2012)

Question 5

Common sites

Answer 5

High risk sites
- FoM
- Lateral border of tongue
- Retromolar regions
- Soft and hard palate
- Gingivae
- BM

1. tongue
2. tonsil

• could happen in other sites too

Question 6

Oro-pharyngeal Cancer

Answer 6

• 1.4 per 100, 000 pop
• most in north america and south central asia
• M:F (4.8:1)
• rates rapidly rising (linked to rising HPV)
• Scottish Cancer Registry
• 85% increase 2001-2012- highest increase for any cancer

Question 7

Risk factors for Oral Cancer

Answer 7

1. Smokers who don’t drink (x2 risk)
   - increases with quantity, duration and frequency of tobacco use
   - fewer cigarettes for longer duration worse than high number, short term
2. Drinkers (3-4 drinks/ day) - x2 risk
   - never smoke population
   - frequency more important than duration
3. Smoke and drink (x5 risk)
   - increase with frequency and duration of smoking and alcohol consumption
   - no safe lower limit
4. Betel quid (paan) - x3 risk
   - mixture of substance including areca but with/ without tobacco wrapped in betel leaf and placed in mouth
5. Socioeconomic status (x2 risk)
   - even without other risk
   - low educational attainment
   - they are likely to smoke and drink more

Question 8

Other risks that are not yet certain

Answer 8

1. Family history
2. Oral Health
   - poor oral health
3. Sexual activity
   - slight increase risk of oro-pharyngeal cancer
   - 6 or more lifetime sexual partners
   - 4 or more lifetime oral sex partners
   - probably linked to HPV

Question 9

Benefits of stopping smoking

Answer 9

• benefits are identified within 1-4 years after stopping smoking
• risks reduced and reached a similar level to those who had never smoked after 20 yrs of quitting
• risk effects associated with quitting heavy alcohol consumption takes 20 yrs to begin to emerge
• reduce smoking may increase benefits quicker than drinking

Question 10

Reducing risk of SE status

Answer 10

• on a par with smoking and alcohol (x2 risk)
• if low educational and low income
• not fully explained by smoking and alcohol being the cause

Question 11

Reducing risk in diet

Answer 11

• high intake of fruits and vege will reduce cancer risk by half
• obesity is not linked with this
• low income = less fruits and vege