Oral cancer in Enugu, Nigeria, 1998–2003

Re-Emphasizing the Roles of General Medical and Dental Practitioners Regarding Oral Cancer Eradication in Nigeria

The burden of oral cancer in Nigeria is largely under-reported. The available data on oral cancer etiology/risk factors, clinical features, disease burden, and literacy rate in Nigeria points towards a possible explosion in prevalence in the near future, which poses a serious public health concern. The general medical and dental practitioners (GMDPs) in Nigeria can salvage this looming problem through appropriate public health and clinical interventions. This narrative review article re-emphasizes the key roles of GMDPs towards oral cancer eradication in Nigeria. It also discusses oral cancer case definition, etiology, risk factors, and the epidemiological burden in the Nigerian context.

Global incidence of oral and oropharynx cancer in patients younger than 45 years versus older patients: A systematic review

Head and neck squamous cell carcinoma (HNSCC) is typically regarded as a disease of elderly people. However, increasing numbers of patients worldwide with HNSCC at younger age (defined as <45 years old) have been reported in recent years. To assess geographical variations and trends worldwide in incidence of oral and oropharyngeal cancer in young patients, a systematic review was conducted in PubMed and Google scholar databases from 1975 to June 2016. Seventy-eight studies were selected for further study. Nineteen population-based studies on incidence rate were available from 13 countries, showing a prominent increase over time except for the Netherlands. A notable rise of oral (mobile) tongue cancer among white women and oropharyngeal cancer in white men was observed. Data suggest that cancer in young patients may be a distinct clinical entity and characterised by different aetiology and pathogenesis. Additionally, the relative proportion of oral and oropharyngeal cancer in young patients to total incidence revealed a significant difference between estimates from North America (5.5%) and both Africa (17.2%) and Middle East (14.5%). It is concluded that (i) a rising trend in oral and oropharynx cancers is observed in young patients worldwide; (ii) incidence studies should properly define outcomes in age cohorts and use a consensus cut-off for young patients; (iii) more population-based studies should be performed in non-Western regions to get accurate global measures of incidence for these cancers in young subpopulations and (iv) there is an urge to identify new aetiological factors in these young patients.

An Audit of Malignant Oro-facial Tumors Presenting at a Tertiary Hospital in Lagos

Oro-facial malignancies are reported to have a high mortality and morbidity, this is further worsened when patient report late. To analyze the malignant oro-facial lesions seen at a Hospital in the Lagos, Nigeria. Successive patients that presented in the hospital and met criteria of study during 15 months period were recruited into the study. Demographics, clinical variables, and treatment provided for each patient in the hospital was recorded. Data collected were presented as tables and percentages. There were 36 cases seen, their ages ranged from 10 to 72 years (median 49 years), and there were 21 males and 15 females. Time lapse before presentation to the clinic ranged from 2 to 30 months, mean (9.9 (±5.5 months and the largest dimension of lesions at presentation ranged from 2 cm to 12 cm (mean 6.4 ± 2.0 cm). Most common site of presentation was posterior tongue (16.7%; 6/36) and Squamous cell carcinoma (41.6%; 15/36) was the most common histopathologic diagnosis. Twenty-three patients (63.9%; 23/36) had primary surgeries in the hospital. Patients seen in this case series generally reported late with large lesions.

Influence of Educational Level, Stage, and Histological Type on Survival of Oral Cancer in a Brazilian Population: A Retrospective Study of 10 Years Observation

The mortality rate associated with oral cancer is estimated at approximately 12,300 deaths per year, and the survival rate is only 40% to 50% for diagnosed patients and is closely related to the duration of time between disease perception and its diagnosis and treatment. Socioeconomic risk factors are determinants of the incidence and mortality related to oral cancer. We conducted a retrospective, cross-sectional study of 573 records of patients with oral cancer at Haroldo Juaçaba Hospital - Cancer Institute of Ceará from 2000 to 2009 to evaluate the influence of socioeconomic factors on survival and epidemiological behavior of this neoplasia in a Brazilian population. In this study, patients with oral cancer were males greater than 60 years of age, presented squamous cell carcinoma in the floor of mouth and were characterized by low education levels. A total of 573 lesions were found in oral cavities. Cox proportional hazards regression model showed that the histological type, tumor stage, and low degree of education significantly influenced survival. A lower patient survival rate was correlated with a more advanced stage of disease and a worse prognosis. Squamous cell carcinoma is associated with a higher mortality when compared with other histological types of malign neoplasia.

Is it worthy? Removal of level IIB nodes during selective neck dissection (I-III) for oral carcinomas

Aims:

The aim was to correlate the incidence of metastasis to Level IIB of neck lymph nodes (LNs) for oral cavity carcinomas with the site, size, and histological grade of tumor.

Settings and Design:

Total 30 patients of either sex, with biopsy-proven oral squamous cell carcinoma of any site, size or histologic grade, but N0/N1 were taken for selective neck dissection (SND).

Materials and Methods:

Thirty patients who underwent SND for oral carcinoma were analyzed for the relation of the site, size, and histological grade of malignancy with metastatic involvement to Level IIB nodes. Level IIB nodes were dissected separately and sent for histopathological examination.

Statistical Analysis Used:

The data were entered in custom written software in Excel (MS office 2007, Windows XP) and the data were analyzed using statistical software STATA version 10.0. The statistical test used for the analysis of the result was Chi-square test. The critical level of statistical significance chosen was P < 0.05.

Results:

Only 2 of 30 patients (6.6%) had the involvement of Level IIB neck nodes. There was no relation between the site, size, and histologic grade of primary tumor with the metastasis to Level IIB. The Level IIA nodes were positive in both the positive cases of Level IIB.

Conclusions:

For tumors in oral cavity (N0/N1), while performing elective or therapeutic SND the dissection of Level IIB nodes could be omitted as it will provide significant decrease in operative time and also less of spinal accessory nerve trauma-related complications.

Estimation of Nickel in Different Smokeless Tobacco Products and Their Impact on Human Health of Oral Cancer Patients

It has been extensively investigated that the chewing of smokeless tobacco (SLT) products may enhance the inflammation of the oral cavity. The aim of the present study is to evaluate the relationship between nickel (Ni) exposure via different SLT products with oral cancer (different sites) incidence in the population of Sindh, Pakistan. The different brands of SLT products (mainpuri, gutkha, and moist snuff) commonly consumed by the studied population were analyzed for Ni contents. The biological samples of oral cancer patients and noncancerous control subjects of both genders, who have or have not consumed SLT products, were collected. The concentration of Ni in biological samples and SLT products were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by using certified reference materials. The results of this study showed that the Ni level was significantly higher in scalp hair and blood samples of oral cancer patients compared to controls (P < 0.01). The study suggested that exposure of Ni as a result of chewing different SLT products may be synergistic with risk factors associated with oral cancer.

Review: Head and neck squamous cell carcinoma in sub-Saharan Africa

AIM

Review the literature from 1990 to 2013 to determine known anatomic sites, risk factors, treatments, and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa.

METHODS

Using a systematic search strategy, literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics, anatomic sites, histology, stage, treatment, and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV), human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed.

RESULTS

Of the 342 papers identified, 46 were utilized for review, including 8611 patients. In sub-Saharan Africa, the oropharyngeal/oral cavity was found to be the most common site, with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity, making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx, nasal cavity, or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases), and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available, 43% used tobacco and 42% used alcohol, and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC, but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare.

CONCLUSIONS

The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies, but a majority of patients did not use tobacco and alcohol.

Estimation of lead in biological samples of oral cancer patients chewing smokeless tobacco products by ionic liquid-based microextraction in a single syringe system

Several studies have reported that the chewing habit of smokeless tobacco (SLT) has been associated with oral cancer. The aim of the present study was to evaluate the trace levels of lead (Pb) in biological samples (blood, scalp hair) of oral cancer patients and referents of the same age group (range 30-60 years). As the concentrations of Pb are very low in biological samples, so a simple and efficient ionic liquid-based microextraction in a single syringe system has been developed, as a prior step to determination by flame atomic absorption spectrometry. In this procedure, the hydrophobic chelates of Pb with ammonium pyrrolidinedithiocarbamate (APDC) were extracted into fine droplets of 1-butyl-3-methylimidazolium hexafluorophosphate [C4MIM][PF6] within a syringe while using Triton X-114 as a dispersant. Factors influencing the microextraction efficiency and determination, such as pH of the sample, volume of [C4MIM][PF6] and Triton X-114, ligand concentration, and incubation time, were studied. To validate the proposed method, certified reference materials were analyzed and the results of Pb(2+) were in good agreement with certified values. At optimum experimental values of significant variables, detection limit and enhancement factor were found to be 0.412 μg/L and 80, respectively. The coexisting ions showed no obvious negative outcome on Pb preconcentration. The proposed method was applied satisfactorily for the preconcentration of Pb(2+) in acid-digested SLT and biological samples of the study population. It was observed that oral cancer patients who consumed different SLT products have 2-3-fold higher levels of Pb in scalp hair and blood samples as compared to healthy referents (p < 0.001). While 31.4-50.8% higher levels of Pb were observed in referents chewing different SLT products as compared to nonconsumers (p < 0.01).

Determination of nickel in blood and serum samples of oropharyngeal cancer patients consumed smokeless tobacco products by cloud point extraction coupled with flame atomic absorption spectrometry

Oropharyngeal cancer is a significant public health issue in the world. The incidence of oropharyngeal cancer has been increased among people who have habit of chewing smokeless tobacco (SLT) in Pakistan. The aim of present study was to evaluate the concentration of nickel (Ni) in biological samples (whole blood, serum) of oral (n = 95) and pharyngeal (n = 84) male cancer patients. For comparison purposes, the biological samples of healthy age-matched referents (n = 150), who consumed and did not consumed SLT products, were also analyzed for Ni levels. As the Ni level is very low in biological samples, a preconcentration procedure has been developed, prior to analysis of analyte by flame atomic absorption spectrometry (FAAS). The Ni in acid-digested biological samples was complexed with ammonium pyrrolidinedithio carbamate (APDC), and a resulted complex was extracted in a surfactant Triton X-114. Acidic ethanol was added to the surfactant-rich phase prior to its analysis by FAAS. The chemical variables, such as pH, amounts of reagents (APDC, Triton X-114), temperature, incubation time, and sample volume were optimized. The resulted data indicated that concentration of Ni was higher in blood and serum samples of cancer patients as compared to that of referents who have or have not consumed different SLT products (p = 0.012-0.001). It was also observed that healthy referents who consumed SLT products have two to threefold higher levels of Ni in both biological samples as compared to those who were not chewing SLT products (p < 0.01).

Oral squamous cell carcinoma among Yemenis: Onset in young age and presentation at advanced stage

Objectives: Oral cancer represents a health burden worldwide. Up to 90% of oral cancer cases are squamous cell carcinomas (SCC). The data on oral SCC in Yemen are lacking. The objective of this study therefore was to describe and analyze the demographic, clinical and histological characteristics of Yemeni patients with oral SCC. Study Design: In this cross-sectional study, two sets of retrospective data for Yemeni cancer patients were obtained officially by two different registries. Patients with oral SCC were included. Their ages were dichotomized using 40 and 45 years alternately as individual cut-points for young and old patients. The patients` demographic, clinical and histological characteristics were statistically analyzed. Results: There were 457 Yemenis with oral SCC; 253 patients (55.4%) were men. The overall mean age was 58.15±14.11 years. The tongue was the most affected oral sub-site accounting for 53% of the reported cases. The well and moderately differentiated oral SCC accounted for 55.5% and 25.6% of the total cases respectively. Noteworthy, 62 patients (14%) were affected by the age of ?40; this increased to 105 patients (23%) aged ?45 years. Additionally, a high proportion of oral SCC patients (62%, 283) were diagnosed at advanced tumor stages (regional extension or metastasized). The distributions of histological grades and tumor stages in young and old patients were significantly different (P=0.006 and 0.026 respectively). Conclusion: The relative frequency of oral SCC among Yemeni young people is high. Unfortunately, most of oral SCC patients in Yemen were diagnosed at advanced stage.

Key words:Oral squamous cell carcinoma, Yemen, young patients, advanced stage.

Why must physicians know about oral diseases?

BACKGROUND

Poor oral health reflects social inequalities, hence the prevention of oral diseases should be a priority in developed and underdeveloped countries around the world. Medical practitioners must play an active role in oral health promotion.

SUMMARY

Proper knowledge of oral diseases is crucial in medical practice due to the following reasons: (a) Periodontal disease is associated with multiple systemic conditions of medical interest, (b) a large number of systemic diseases have oral manifestations, (c) many drugs are associated with oral adverse drug reactions, (d) physicians are generally not sufficiently trained to detect oral cancer manifestations, (e) physicians could play a pivotal role in oral public health, and (f) early detection of oral diseases by physicians could improve the oral health status of the population.

CONCLUSIONS

Physicians need to get more involved in oral health promotion. Moreover, oral health education should be included in the curriculum of future medical students.

Evaluation of cadmium and zinc in biological samples of tobacco and alcohol user male mouth cancer patients

There is compelling evidence in support of positive associations between zinc (Zn) deficiency and high accumulation of cadmium (Cd) in biological samples of different cancerous patients. The incidence of mouth cancer has been increased among people who possess habit of drinking alcohol, tobacco smoking and chewing with gradients in Pakistan. In the present study, Cd and Zn contents of blood and scalp hair samples of 92 male mouth cancer patients and 78 referents of same age group (range 35-65 years), socio-economic status, localities and dietary habits. Among referent male subjects, 56 consumed tobacco (smoking/chewing), 22 had none of smoking and chewing tobacco habits, while none of them admitted for alcohol drinking. The scalp hair and whole blood samples were oxidized by 65% nitric acid and 30% hydrogen peroxide (2:1) ratio in microwave oven. The Zn in digests was determined by flame atomic absorption while Cd was determined by electrothermal atomic absorption spectrometry. The average Cd concentration was higher, while level of Zn was lower in the blood and scalp hair samples of mouth cancer patients as compared to referent subjects (p < .001). The male referents consuming tobacco (chewing and smoking) have high level of Cd in both their biological samples as compared to those not smoking or chewing tobacco (p < .012). The Cd/Zn ratio in both biological samples was found to be higher in patients than in referent subjects.

Incidents malignant neoplasias maxillofacial area

Cancer is regarded as abnormal cellular multiplication; it is not controlled by the organism, and its cells present a differentiated DNA. Initially, the disease does not show clinical signs, but it can be diagnosed by laboratory examinations. When tumors are present in the maxillofacial area, the carrier can lose structures in this area, resulting to the carrier's social environment exclusion. This article aims to show incidences and causes of malignant neoplasias in the maxillofacial area.