EPIDEMIOLOGY AND ETIOLOGY

OF ORAL CANCER

ByDr. R.S.CHAITANYA B.D.S

CONTENTS

INTODUCTION EPIDEMIOLOGY ETIOLOGY TOBACCO ALCOHOL DIET AND NUTRITION UV RADIATION FUNGAL INFECTIONS VIRAL INFECTIONS TRAUMA AND DENTAL IRRTATION GENETIC FACTORS

INTRODUCTION

Cancer is one of the major threats to public health in developed and developing countries.

Cancer is second most common cause of death.

Cancer has 4 characteristics Clonality Autonomy Anaplasia Metastasis

CLONALITY

Originates from single cell – proliferates to clone of malignant cell

Autonomy

Growth is not regulated

Anaplasia

Lack of normal coordinated cell differentiation

Metastasis

Capacity for discontinuous growth and dissemination of other parts of the body

ORAL CANCER is classified based on location LIPS TONGUE PALATE CHEEKS GINGIVA FLOOR OF THE MOUTH

According to INTERNATIONAL CLASSIFICATION OF DISEASES (WHO 9th version)

EPIDEMIOLOGY

Oropharyngeal cancer is the eighth most common cancer in worldwide.

The prevalence of oral cancer is particularly high among men.

Incidence rates can vary in men from 1 to 10 cases per 1,00,000 population.

The high incidence rates relate directly to risk behaviors such as smoking, smokeless tobacco, alcohol consumption.

EPIDEMIOLOGY

47%of Indians aged 15years or more use tobacco in one form or other.

EPIDEMIOLOGY

A dose relationship has been shown between the chewing habit and oral cancer.

chewing risk 2 times/day 8.4 6 times/day 17.6 over night 63 Increased risk of oral cancer is seen in those

who only chew as compared to those who only smoke.

ETIOLOGY

TOBACCO ALCOHOL DIET AND NUTRITION UV RADIATION FUNGAL INFECTIONS VIRAL INFECTIONS TRAUMA AND DENTAL IRRTATION GENETIC FACTORS

TOBACCO

Derived from Nicotiana tabacum and Nicotiana rusticum.

CONSTITUENTS: Nicotine Tar Carbon monoxide Nitrogen oxide Hydrogen cyanide and other ciliatoxics Metals Radioactive compounds

TOBACCO CONSTITUENTS

CONSTITUENTS

Nicotine Tar Carbon monoxide

Nitrogen oxides Hydrogen cyanide

Metals Radioactive compounds

EFFECTS

Carcinogen Stains the teeth Myocardial oxygenation,

atherosclerosis Lung damage Deleterious effect on the

cilia of lung Carcinogens Carcinogens

TOBACCO PREPARATIONS

SMOKED TOBACCO

Bidi Chillum Chutta Cigarettes Dhumti Hookah Hookli

SMOKELESS TOBACCO

Khaini Mainpuri tobacco Mawa Mishri Paan Snuff Zarda Gutka Gudaku

BIDI

0.2 to 0.3 gms of sun dreied tobacco flakes are hand rolled.

Nicotine 1.7 to 3.0 mgsTar 45to50mgs

CHILLUM

A 14 cms straight conical clay pipe

Coarsely cut tobacco pieces and a glowing charcoal is kept on top

It is held vertically and to prevent tobacco from entering mouth a pebble stone is introduced

CHUTTA

Cured tobacco is wrapped in a dried tobacco leaf.

It is also called as cigar

CIGARETTES

1 gm of tobacco cured in the sun or artificial heat is covered with a paper

Nicotine 1-1.4mgTar 19-27mg

DHUMTI

Rolled leaf tobacco is used inside a leaf of jack fruit tree

HOOKAH

Tobacco smoke is drawn through the water in the base of hookah which cools and filters the smoke

It is also called water pipe or hobble-bubble

HOOKLI

Clay pipe of 7 to 10 cms long with a mouth piece and a bowl

KHAINI

Powdered sundried tobacco, slaked lime-paste mixture occasionally with used with areca nut

MAINPURI TOBACCO

Tobacco, slaked lime, finely cut areca nut, camphor,cloves

MAWA

Thin shavings of areca nut + tobacco + slaked lime are wrapped in cellophane paper and tied in a shape of a ball

It should be vigorously mixed before consumption

MISHRI

The roasted tobacco is powdered + catechu(a residual extract obtained by soaking the heartwood of acacia catechu

PAAN

Betel leaf+ areca nut+ tobacco +lime+ cinnamon or coconut or cloves or sugar are wrapped in betel leaf

SNUFF

Finely powdered air cured and fire cured tobacco leaves+ areca nut + lime carried in a metal container

It is locally called MUKKU PODUMU

ZARDA

Tobacco leaf is boiled in water along with lime and spices until evaporation. The residual tobacco is dried and coloured with dyes.

GUTKA

Crushed betel nut, tobacco, sweet or savory flavorings

GUDAKHU

Paste of powdered tobacco, molasses, and other ingredients primarily used to clean the teeth.

ALCOHOL

Synergistic effect between tobacco and alcohol.

Heavy drinkers who smoked 20 cigarettes/day– 24 times to get cancer.

Dehydrating effect of alcohol on mucosa increases the potential carcinogens

DIET AND NUTRITION

Vitamin A, C, E &Antioxidant[β-carotene] , copper zinc and

manganeseshows protective effect against

cancer.

Red chilli powder has emerged as a risk factor to cancer

UV LIGHT

Squamous cell carcinoma of vermillion border of lip especially in those who work outdoors

Increased risk in factor individuals

FUNGAL INFECTIONS

Dysplastic lesions[leukoplakia] with candidial infection have greater risk of malignancy

VIRUSES

Human herpes virus1Herpes simplex virus1Human

immunodeficiency virus have been associated with squamous cell carcinoma

TRAUMA AND DENTAL IRRITATION

Continuous irritation from jagged teeth and dentures poor oral hygiene are risk factors for oral cancer

GENETIC FACTORS

Alterations in in many genes have been implicated in development and progression oral cancer

Eg:3p (FHIT) 9P (CDKN2A)

ANY QUERIES……???