M.Aqeel Maqsood

Roll# 146

Epidemiology , Etiology and Prevention of Oral cancer

What is Cancer?

Defined as:_

• An uncontrolled, uncoordinated, excessive and abnormal growth of cells is called cancer.

Benign Vs. Malignant

• Does not spread• Rarely life threatening• Can be removed

• Spreads to other parts of the body

• Life threatening• Can be removed, but

it may grow back

Types of Cancer

• Benign• Malignant

–Carcinoma• epithelial origin• E.g. squamous cell carcinoma

–Sarcoma• Mesenchymal origin

Oral cancer

• Defined as:_Indurated, ulcerated lump or sore that may or may not be painful and is often associated cervical lymph adenopathy.

Tongue34%

Retromolar 2%Ginggiva Max

12%Ginggiva Mand

7%

Buccal24%

Lower Lip16%

Palatum5%

Distribution of Oral Cancer According to Locations

Why is it such an important public health issue?

• Closely associated with tobacco and alcohol.• 2nd most common cause of death• In 2003-according to world health report 7.1

million deaths were reported.• Estimated 50% increase in death rate in next 20

years.• In Bangladesh, Sirilanka and Pakistan most

common type of cancer.• And 1/3rd of all the cancers.

Signs and Symptoms

• Sores that do not heal within 14 days

• Bleeding in mouth • Lump in neck• Earache• Loose teeth• Dentures will not fit

well

• Pain or numbness in mouth

• Difficulty chewing or swallowing

• Bad breath• Patches on the lip or

in the mouth that are red, white, or a mixture of both

Epidemiology of oral cancer

Agent

Environment

Host

Host factors

1. Age – Incidence increases with age.– 98% cases in the west are over 40yrs old.– More than 50% of cases include ages above 50yrs.

2. Gender– Incidence is more in

• Men• Industrial areas

– Women have more incidence of lip carcinoma– Men have high incidence of buccal carcinoma

3. Occupation– Textile workers and leather industries have high incidence of

buccal cavity and larynx carcinoma.

Host Factors

4. Immunity– AIDS patients are prone to Kaposi carcinoma.

5. Social Class

6. Custom and habits

7. Race

Agent Factors

• Biological– HIV– Candida

• Chemical– Arsenic,dyes,nickel,chromium

• Mechanical– Ill fitting dentures– Sores from jagged teeth

Agent factors

• Nutritional– Precarcinogens in food– Increase consumption of fat– Deficiency in folic acid– Deficiency of proteins– Increase in red chili

Environmental factors

• Water contamination• Air pollution• Geographic variation

– Netherland buccal mucosa– Switzerland lip and tongue– Canadian Eskimos salivary glands

• Solar heat– Prolonged exposure causes melanoma

Etiology

• Due to – Tobacco– Unhealthy diet– Alcohol– Physical inactivity – Infection– Nutrients– Physical irritants

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Risk Factors

• Tobacco is the main culprit– Mainly chewing tobacco

– 75% of those diagnosed are tobacco users.• Alcohol 2nd largest risk factor• Combination of alcohol and tobacco use

– 15x greater risk for oral cancer• Excessive sun exposure

– Lip cancer

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Risk Factors

• X-rays– Cumulative exposure

• Other biological factors– Viruses and fungus– HPV 16

• Main agent in cervical cancer• Now has been linked to oral cancer

Tobacco

• Its an important risk factor of oral cancer.• 90% of cancers are caused by tobacco• Tobacco can be broadly classified into smokeless

and smoking forms.

Smoking forms

Bidi• Most popular

form of tobacco

• Estimated nictinic content is 1.7-3mg

Cigar• Cured

tobacco wrapped in dried tobacco leaves.

Chilum• Conical clay pipe

for smoking tobacco

• Filed with coarsely cut tobacco pieces

• Glowing charcoal is kept on top of tobacco

Hookah• Indinan

origin• Also

known as water pipe.

Cigerrete• 1gram tobacco

cured by sunlight is coverred by paper.

• 1-1.4mg Nicotinic content.

• More common in urban areas

Smokeless forms

Paan• Most common

habit of smokeles tobacco.

• May also include• Cardamom• Cocnut• Clove• Sugar• Tobacco wraped in

beetle leave

Snuff• Finely

powdered air cured and fire cured tobacco leaves.

Mishri• Prepared by

roasting tobacco on hot metal plate then powdered

• Also used to clean the teeth

Khaini• Powdered

sundried tobacco.

• Simply placed in mouth and chewed

Mainpuri Tobacco• Ingredients

include• Tobacco• Slaked lime• Camphor• cloves

Prevention

primary

secondary

tertiary

Primary

Program to educate

adolescence

Program for tobacco users

Regular check up

good oral hygiene

Secondary

Screening

Early detection

Referral

Tertiary

• Surgery• Chemotherapy

– Cytotoxic drugs• Radiotherapy

What you can do:

• Make yourself aware or your mouth• Stop smoking and drinking excessively• Be informed• Have a good diet and stay healthy• Behavioural modification

Prevention as a dentist

• Regular check up• Suspected patients be thoroughly checked• Patient should be educated about the preventive

aspects of oral cancers including– Behavioral– Physical– community

Any Question