Tropical Doctor, October 1977
ORAL CANCER - IMPORTANCE OF EARLY DIAGNOSIS
I 175
Surgical Practice
Oral cancer - importance of early diagnosis v. Cugadasan, FDSRCS (Eng.) Lecturer in Oral Surgery, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
prises about 30-40% of all oral cancers and the prognosis depends mainly on the absence or presence of cervical metastases. Detailed clinical examination and early diagnosis are therefore vital for the safety of the above group of patients. (Thoma 1970; Shafer 1975)· RELATED FACTORS
TROPICAL DOCTOR,
1977,7, 175-176
INTRODUCTION
Carcinoma of the oral cavity usually presents as a painless mass, an area of thickening or induration or an ulcer and may become painful if secondarily infected. This condition is mainly a disease of the elderly but it may occur in younger patients. Large numbers of elderly patients, particularly those in poorer countries, are not aware of the presence of malignant disease because the early lesion is asymptomatic. Lesions near the base of the tongue can invade quietly and when advanced the patient may come to the hospital with a complaint of sore throat or dysphagia. The oral cavity is readily accessible for detailed examination by the clinician and many patients could be cured of malignancy if this is detected early (Mehta et al. 1969). Any ulcer or lump in the oral cavity that does not respond to the normal method of treatment after two weeks should be treated with suspicion. Carcinoma of the tongue com-
Food, habit, industry, and social customs are all factors that have some connection with the causation of cancer and pre-cancerous states like leukoplakia (Nelson and Ship 1971). Leukoplakia or white patch on the tongue, lip, cheek mucosa, oesophagus, or vagina may contain potential cancer cells that can degenerate into malignancies. Chronic irritation from ill-fitting dentures, sharp edge of teeth, and the habit
Fig.
Fig. 1. Leukoplakia of the mucosa of the cheek and mandibular alveolus.
2.
Squamous cell carcinoma of retro-molar region.
Fig. 3. Carcinoma of lateral border of tongue (history includes excessive use of tobacco).
176
I ORAL CANCER
Tropical Doctor, October I977
IMPORTANCE OF EARLY DIAGNOSIS
of chewing betel nut as commonly practised in India and Sri Lanka are associated with this condition. Presence of salivary calculi can give rise to chronic inflammation of gingival tissues which in turn may be a causative factor in some cases. Syphilis is said to predispose to the cancer of the tongue. Excessive use of alcohol and eating or drinking hot food are blamed and burn scars are prone to develop cancerous growths (Jafarey and Zaidi 1976). ROLE OF HEALTH PERSONNEL
Large numbers of patients of the low income group attend the out-patient departments of hospitals and rural health centres run by the state. Medical and dental personnel working in these centres have a special responsibility in the campaign for early detection of cancer. The dental surgeon and his auxiliary staff are the first to detect the early malignancy and should be aware of this life-saving responsibility. The medical/dental officer should always carry out a thorough intra-oral examination together with examination of face and neck. Any abnormal swelling of the face or neck region should be noted. Examination of the oral cavity should include a careful scrutiny of lip, tongue, cheek mucosa, gums, corners of the mouth, hard and soft palate and retro-molar areas. Full movement of the tongue must be tested and examination of the floor of the mouth carried out. Palpation of the sub-lingual, sub-mandibular, and cervical regions will help to detect the presence of lymphatics of these regions. Other diagnostic aids include taking of smears, cytological studies, and toluidine blue test. In every case of abnormal and
Fig. 5. Carcinoma of oral cavity with involvement of sub-mandibular lymph-node. (Patient came to the dentalclinic with the complaint of shaky or mobile teeth.) suspect lesion a biopsy should be taken for purposes of pathological examination (Maimon and Steinfeld 1972). Any lesion in the oral cavity that does not respond favourably to accepted methods of treatment within a reasonably short period should be considered suspicious. Some examples of oral cancers or precancerous conditions ofthe mouth seen in our practice are shown in Figs 1-5. CONCLUSION
With early detection of oral carcinoma about 80% of the patients can be cured of the disease. Delay in diagnosis is mainly due to the fact that these lesions are asymptomatic and many patients in developing countries are either ignorant of the ill effects or too nervous to undergo a medical examination. The oral cavity can be easily examined by the medical personnel and their auxiliary staff. If malignancy is suspected, immediate arrangements should be made for a biopsy and other special investigations. REFERENCES
Fig. 4. Cancer of mandibular alveolus invading bone (history includes betel nut chewing - 20 years).
Jafarey, N. A., and Zaidi, S. H. M. (1976). Trop. Doctor, 6, 63. Maimon, H. N., and Steinfeld, A. D. (1972). Ohio St. med. J., 68, 356. Mehta, F. S., et al. (1969). Cancer, 24, 832. Nelson, J. F., and Ship, I. I. (1971). J. Amer. dent. Ass., 82,564. Shafer, W. G. (1975).J. Amer, dent. Ass., 90, 1262. Thoma, G. W. (1970). Oral Surg., 30, 817.
ORAL CANCER - IMPORTANCE OF EARLY DIAGNOSIS
I 175
Surgical Practice
Oral cancer - importance of early diagnosis v. Cugadasan, FDSRCS (Eng.) Lecturer in Oral Surgery, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
prises about 30-40% of all oral cancers and the prognosis depends mainly on the absence or presence of cervical metastases. Detailed clinical examination and early diagnosis are therefore vital for the safety of the above group of patients. (Thoma 1970; Shafer 1975)· RELATED FACTORS
TROPICAL DOCTOR,
1977,7, 175-176
INTRODUCTION
Carcinoma of the oral cavity usually presents as a painless mass, an area of thickening or induration or an ulcer and may become painful if secondarily infected. This condition is mainly a disease of the elderly but it may occur in younger patients. Large numbers of elderly patients, particularly those in poorer countries, are not aware of the presence of malignant disease because the early lesion is asymptomatic. Lesions near the base of the tongue can invade quietly and when advanced the patient may come to the hospital with a complaint of sore throat or dysphagia. The oral cavity is readily accessible for detailed examination by the clinician and many patients could be cured of malignancy if this is detected early (Mehta et al. 1969). Any ulcer or lump in the oral cavity that does not respond to the normal method of treatment after two weeks should be treated with suspicion. Carcinoma of the tongue com-
Food, habit, industry, and social customs are all factors that have some connection with the causation of cancer and pre-cancerous states like leukoplakia (Nelson and Ship 1971). Leukoplakia or white patch on the tongue, lip, cheek mucosa, oesophagus, or vagina may contain potential cancer cells that can degenerate into malignancies. Chronic irritation from ill-fitting dentures, sharp edge of teeth, and the habit
Fig.
Fig. 1. Leukoplakia of the mucosa of the cheek and mandibular alveolus.
2.
Squamous cell carcinoma of retro-molar region.
Fig. 3. Carcinoma of lateral border of tongue (history includes excessive use of tobacco).
176
I ORAL CANCER
Tropical Doctor, October I977
IMPORTANCE OF EARLY DIAGNOSIS
of chewing betel nut as commonly practised in India and Sri Lanka are associated with this condition. Presence of salivary calculi can give rise to chronic inflammation of gingival tissues which in turn may be a causative factor in some cases. Syphilis is said to predispose to the cancer of the tongue. Excessive use of alcohol and eating or drinking hot food are blamed and burn scars are prone to develop cancerous growths (Jafarey and Zaidi 1976). ROLE OF HEALTH PERSONNEL
Large numbers of patients of the low income group attend the out-patient departments of hospitals and rural health centres run by the state. Medical and dental personnel working in these centres have a special responsibility in the campaign for early detection of cancer. The dental surgeon and his auxiliary staff are the first to detect the early malignancy and should be aware of this life-saving responsibility. The medical/dental officer should always carry out a thorough intra-oral examination together with examination of face and neck. Any abnormal swelling of the face or neck region should be noted. Examination of the oral cavity should include a careful scrutiny of lip, tongue, cheek mucosa, gums, corners of the mouth, hard and soft palate and retro-molar areas. Full movement of the tongue must be tested and examination of the floor of the mouth carried out. Palpation of the sub-lingual, sub-mandibular, and cervical regions will help to detect the presence of lymphatics of these regions. Other diagnostic aids include taking of smears, cytological studies, and toluidine blue test. In every case of abnormal and
Fig. 5. Carcinoma of oral cavity with involvement of sub-mandibular lymph-node. (Patient came to the dentalclinic with the complaint of shaky or mobile teeth.) suspect lesion a biopsy should be taken for purposes of pathological examination (Maimon and Steinfeld 1972). Any lesion in the oral cavity that does not respond favourably to accepted methods of treatment within a reasonably short period should be considered suspicious. Some examples of oral cancers or precancerous conditions ofthe mouth seen in our practice are shown in Figs 1-5. CONCLUSION
With early detection of oral carcinoma about 80% of the patients can be cured of the disease. Delay in diagnosis is mainly due to the fact that these lesions are asymptomatic and many patients in developing countries are either ignorant of the ill effects or too nervous to undergo a medical examination. The oral cavity can be easily examined by the medical personnel and their auxiliary staff. If malignancy is suspected, immediate arrangements should be made for a biopsy and other special investigations. REFERENCES
Fig. 4. Cancer of mandibular alveolus invading bone (history includes betel nut chewing - 20 years).
Jafarey, N. A., and Zaidi, S. H. M. (1976). Trop. Doctor, 6, 63. Maimon, H. N., and Steinfeld, A. D. (1972). Ohio St. med. J., 68, 356. Mehta, F. S., et al. (1969). Cancer, 24, 832. Nelson, J. F., and Ship, I. I. (1971). J. Amer. dent. Ass., 82,564. Shafer, W. G. (1975).J. Amer, dent. Ass., 90, 1262. Thoma, G. W. (1970). Oral Surg., 30, 817.
