早期口腔癌检查及诊断方法的研究进展

过去几十年,口腔癌的治疗方法取得了很大进步,但中晚期口腔癌的预后并未碍到明显改善,早期诊断、早期治疗仍然是提高治愈率的关键措施.早期确诊的主要方法是切取活检,但该方法有创,且异常增生与早期口腔癌的区分过于依赖病理医师的临床经验.为诊断口腔异常增生和早期口腔癌,迫切需要可在门诊条件下操作简便、实用且无创的诊断工具.目前发展迅速的早期口腔癌检测方法包括光学系统检查、活组织染色、唾液检测、刷取活检、DNA分析等.本文对这些方法诊断口腔鳞癌及癌前病损的价值进行回顾与评价.     

Basic and important points regarding the diagnosis of oral cancers using fluorine-18-labeled fluoro-2-deoxy-<Emphasis Type="SmallCaps">d</Emphasis>-glucose positron emission tomography–computed tomography: a review

Numerous studies, including our own, have revealed that positron emission tomography–computed tomography (PET/CT) using fluorine-18-labeled fluoro-2-deoxy-d-glucose (¹⁸F-FDG) is effective for the diagnosis of oral cancers. Large amounts of new information about primary tumors and metastatic lymph nodes have been acquired, and the use of ¹⁸F-FDG PET/CT has been shown to improve diagnostic precision in determining both the pathological characteristics of primary oral cancers and the presence of metastatic lymph nodes. However, substantial variations in ¹⁸F-FDG uptake in the oral and maxillofacial regions have been identified, and the differential diagnosis of some oral cancers and metastatic lymph nodes remains difficult for radiologists. Therefore, based on the previous research, the aim of the present study was to review the basic and important points regarding the diagnosis of primary oral cancers and metastatic lymph nodes using ¹⁸F-FDG PET/CT.     

口腔癌早期诊断的研究现状

口腔癌是第6位常见的癌症,预后较差,5年生存率在50%左右,早期诊断和早期治疗是提高患者生存率和生存质量的关键。但当患者出现如疼痛、出血、溃疡、肿块、影响语言或吞咽疼痛等临床症状时,肿瘤可能已经出现了浸润和转移。因此,如何在患者出现临床症状前,筛选出口腔癌高危人群,实现早期诊断,是所有临床医师努力的目标。临床上除了常规的检查口腔病变(包括由口腔科医师、耳鼻咽喉科医师和内科医师检查)外,口腔组织的活体染色、光谱分析和刷取活检等手段有望实现口腔癌的早期诊断。     

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提要：口腔癌是全身第6位常见肿瘤,近几十年5年存活率没有明显改善,严重危害患者的生命和生存质量。其中一个主要原因是由于缺乏行之有效的监测和筛查早期口腔癌的方法。本文旨在结合笔者多年从事临床病理的经验,对检测早期口腔癌的方法进行评述。除作为金标准的组织学检查外,细胞学检查、DNA定量分析、分子生物学检查将有望成为早期口腔癌检测及筛查的重要手段。     

Malignant oral tumors in iran: ten-year analysis on patient and tumor characteristics of 1042 patients in Tehran

This study analyzed characteristics of oral cancer patients from Tehran, Iran, and their tumors. Data came from the patient records of 30 major hospitals in Tehran. Patients (n = 1042), diagnosed with invasive oral cancer in 1993-2003, were classified by primary tumor site according to ICD-10 (C00-C10). Data were analyzed separately for lip, oral cavity and salivary gland tumors. Statistical evaluation included chi and t-test. Of all cases, 59% were male. Age for all cases ranged from 6-103 years, mean age was 58.8 years (SD 16; median 62); 89% were older than 40. Tumor site breakdown was 65% oral cavity, 21% major salivary glands and 14% lip. A clear gender difference (P < 0.001) appeared regarding the primary tumor sites: women dominated in oral cavity cancers and men in lip cancers. The most common cancer site was the tongue (32%), accounting for 50% of the oral cavity cancers. Histologically, 88% of all oral cavity and lip cancers were squamous cell carcinomas, 10% of those were in age /= age 65. At the time of diagnosis, 59% of oral cavity cancers and 29% of lip cancers were at stage III or IV (P < 0.001). The results emphasize an urgent need for a national program focusing on early detection of oral cancers, including educational information addressed to oral health professionals.     

Contemporary concepts in the diagnosis of oral cancer and precancer

This article addresses several issues in the approach to diagnosis of oral cancer. The term oral cancer is clarified. Key aspects of the biologic basis of development of oral cancer and the known risk factors associated with the disease are summarized. The clinical presentation of oral cancers and precancerous lesions and their histopathologic correlates is discussed. The importance of conventional tissue biopsy as the prevailing gold standard for diagnosis is emphasized. Other current technologies available for detecting and diagnosing oral cancer and premalignant lesions are acknowledged, and their respective strengths and weaknesses are discussed.     

口腔及涎腺癌患者唾液与血清中CEA和CA-50含量的研究

目的 探讨口腔及涎腺恶性肿瘤患者唾液及血清中 CEA和 CA-50的含量。方法 应用酶联免疫和放射免疫法对80例口腔及涎腺恶性肿瘤、40例良性肿瘤、80例健康对照者进行唾液CEA和CA-50含量测定,其中60例恶性肿瘤患者同时行血清CEA和CA-50测定。结果 唾液CAE和CA-50含量在恶性肿瘤组、良性肿瘤组及健康对照组组间差异有显著性（P<0.01）。 60例恶性肿瘤血清 CEA 7例轻度升高,CA-50仅见 3例升高。结论 检测口腔及涎腺恶性肿瘤患者唾液 CEA和 CA-50含量较血清敏感,对恶性肿瘤的早期诊断有一定参考价值。     

Epidemiology, aetiology, and clinical aspects of oral cancer and premalignant lesions

Since oral cancer can be considered to be a relatively rare disease, dental practitioners will only rarely be confronted with it. Nevertheless, dental practitioners have a key role to play in the early diagnosis and referral to an oral and maxillofacial surgeon. The major part of oral cancers are squamous cell carcinomas, recognizable during routine oral inspection. Early referral is essential since treatment of small, not yet metastasized cancers have the best chance of long-term disease-free survival. Moreover, oral carcinoma is often preceded by white and/or red pre-malignant lesions of the salivary glands. These can similarly be detected by routine inspection. Here too, dentists play an important role in recognizing such diseases and referring patients to an oral and maxillofacial surgeon.     

Gingival squamous cell carcinoma: diagnostic delay or rapid invasion?

BACKGROUND: The similarity between gingival squamous cell carcinoma (GSCC) and more common periodontal lesions may lead to a delay in diagnosis or misdiagnosis. Neoplastic lesions of gingival tissues are frequently diagnosed at an advanced stage. METHODS: To assess the relative time from when patients first become aware of the problem to histopathologic diagnosis (total diagnostic time), 59 consecutive oral cancer cases were examined in this study. The following variables were considered: age, gender, smoking habits, tumor stage at diagnosis, and total diagnostic time. The median of the patients' total diagnostic time (1.5 months) was used as a cutoff point to distinguish between delayed and non-delayed cases. Analysis of the variables was undertaken using the Student t test and chi2 test, with a 95% confidence interval (CI). RESULTS: The total diagnostic time was <1.5 months for 75% of gingival carcinomas, 50% of tongue carcinomas, and 78% of floor-of-the-mouth carcinomas. It was >1.5 months for 25% of gingival carcinomas, 50% of tongue carcinomas, and 21% of floor-of-the-mouth carcinomas. No significant differences in time before diagnosis were found when gingival cancers were compared to other oral tumors (chi2=0.21; 95% CI=-0.40 to 0.26). However, by the time of diagnosis, gingival cancers had invaded adjacent structures more frequently than other oral cancers (chi2=13.51; 95% CI=0.18 to 0.85). CONCLUSIONS: The gingival location of oral squamous cell carcinoma (OSCC) was associated with advanced stages at the time of diagnosis, due to early invasion of contiguous bone tissue (T4-primary tumor). This would indicate that even earlier referral and diagnosis are necessary.     

口腔颌面部多原发癌的临床分析

目的:分析口腔颌面部多原发癌的发生时间、部位,诊断和治疗.方法:1993年1月至2004年12月在我院口腔颌面外科治疗的多原发癌患者9例,男性6例,女性3例,最小年龄49岁,最大年龄70岁,平均年龄60.4岁.8例作了根治性治疗,1例作了姑息性治疗.结果:9例均为异时癌,第二原发癌与第一原发癌平均间隔时间为:107.4个月.不同部位的多原发癌分别为:颊 软腭1例,舌 腭1例,鼻咽 口腔5例,口腔 颈下部1例,食道 口腔1例.组织学类型:鳞癌 鳞癌6例,恶性淋巴瘤 鳞癌2例,鳞癌 恶性黑色素瘤1例.二重癌8例,三重癌1例.结论:第一原发癌治疗后要长期密切随访,力争早期发现多原发癌,并注意与复发癌、转移癌鉴别,使多原发癌得到及时有效的治疗.     

口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读

美国癌症联合委员会《AJCC肿瘤分期手册》与美国国立综合癌症网(NCCN）肿瘤学临床实践指南已广泛用于临床实践中。NCCN肿瘤诊治指南与TNM分期密切相关,指南为不同TNM分期的肿瘤制定了较为详细的诊治标准,作为依据指导临床应用。2017年第8版口腔及口咽癌TNM分期新增了较多内容,如侵袭深度（DOI）、淋巴结外扩展（ENE）、人乳头瘤病毒（HPV）等指标用于了新的分期中,并且为HPV相关的口咽癌制定了一个新的TNM分期。2018年版NCCN口腔与口咽癌指南及时反映了第8版口腔及口咽癌TNM分期中新的变化,同时亦为HPV相关的口咽癌制定了相应的诊治指南。新的TNM分期及NCCN诊治指南对口腔与口咽癌患者诊疗策略的制定及治疗方案的选择具有较大的指导意义。为了临床工作的需要,本文结合两者的变化进行了部分解读。     

Epidemiologic and demographic update in oral cancer: California and national data--1973 to 1985

The number of new oral cancers diagnosed in the United States increases each year, with 31,000 cases reported in 1989. Unfortunately, in spite of advances in surgery, radiation, and chemotherapy, only about 50% of patients with oral cancer will survive their disease. During the past 12 years in which information is available, there have been no decided changes in age (mean 63), gender (males slightly outnumber females two to one), or sites (tongue most common). The lip is the only oral site showing an interval-decreased incidence. There is a slight trend toward an improvement in earlier detection; however, about two-thirds of all oral cancers are advanced (Stage III and IV) at the time of diagnosis.     

An epidemiologic study of 70 oral cancer cases at the Institute of Dental Medicine, Yangon, Myanmar, 1985-1988.

This study shows that in Myanmar, South-East Asia, the prevalence of oral cancers is a serious fact as they rank fifth among all cancers being known there. On the 70 oral cancer cases reported at the Institute of Dental Medicine, Yangon, the findings stressed that most patients, male or female, came from the metropolitan division (Yangon), had smoking and chewing habits. Also most of these patients came to hospital only at the severe and late stage. It confirms us in our opinion that early diagnosis and prompt treatment are a necessity.     

An update on squamous carcinoma of the oral cavity, oropharynx, and maxillary sinus

There are more than 45,000 new cancer cases involving the head and neck diagnosed each year within the United States. Squamous cell carcinoma accounts for the majority of cases, often occurring within the oral cavity and oropharynx. This article reviews current literature and various controversial topics involving the diagnosis and treatment strategies for patients with oral cavity/oropharyngeal cancers. Although not considered cancer within the oral cavity, maxillary sinus squamous cell carcinoma is discussed.     

Fast-track referrals for oral lesions: a prospective study

Since the introduction of the 14-day rule for referrals for cancer in 1999 there has been some suspicion that rates of detection of cancer are low and the number of inappropriate referrals is high. We undertook a prospective study of 150 consecutive patients with oral lesions referred to a department of oral and maxillofacial surgery in a teaching hospital that uses a "two week wait" fast-track referral system for head and neck cancers. The main outcome measures were the number of cancers detected, the age and sex of the patients, the number seen within 2 weeks, by whom, and the final diagnosis. Most patients (n=120, 80%) were referred with oral ulceration. All patients were seen within 2 weeks (mean 6 days). Nine patients (6%) had a diagnosis of malignancy and 17 (11%) had no detectable abnormality. The study confirms what others have shown, that the yield of diagnoses of malignant disease from fast-track referrals is low and the number of non-urgent referrals is high.     

Maryland dentists' knowledge of oral cancer prevention and early detection

To reduce the morbidity and mortality associated with oral cancers, dentists must have accurate knowledge and skills to detect and diagnose oral cancers at early stages. The authors' study found gaps in dentists' knowledge of risk factors and procedures for diagnosing oral cancers. Increasing health literacy for oral cancers among dental professionals may lead to increased health literacy for oral cancers among the public because dental professionals are a key source of oral health information for the public.     

The sun and skin cancer. What you need to know about diagnosis and treatment.

Skin cancer is the most common malignancy in man, with an incidence of 1,000,000 new cases diagnosed in the United States in 1999. There are three recognized types of skin cancer: basal cell carcinoma, squamous carcinoma, and melanoma. These cancers frequently occur on the sun-exposed areas (face, ears, scalp, etc.) of the head and neck. These areas are amenable to examination by general dentists during routine oral examinations. Early diagnosis of skin cancers and subsequent treatment result in high cure rates. Dentists are in a unique position to help in the diagnosis of skin cancer in their patients due to their frequent contact with patients compared to other health care practitioners.     

口腔癌患者心理健康状况的调查分析

为探讨口腔癌发生与心理健康状况的关系。根据1:1配对原则,应用深入访谈法和症状自评量表,对41例口腔癌患者和41例正常人进行评定。结果,不良人际关系、不幸遭遇和不良应对策略与个体口腔癌的发生有非常明显的关系,不良家庭气氛和缺少社会支持,与其发生有一定关系。口腔癌患者的SCL-90总分及躯体化、忧郁、焦虑因子显著高于正常人(P<0.01),人际敏感因子显著低于正常人(P<0.05)。因此认为口腔癌的发生与个体的心理健康状况有一定关系,及时正确的心理治疗和干预,对口腔癌的发生有重要意义。     

The Need for Health Promotion in Oral Cancer Prevention and Early Detection

Objectives : This review paper provides a rationale for using health promotion to help reduce morbidity and mortality due to oral cancers by identifying barriers to prevention and early detection of these cancers and discussing strategies for change. Methods : A literature review of the following areas was conducted: epidemiology of and risk factors for oral cancers; knowledge, opinions, and practices of health care providers and the public regarding prevention, early detection, and control of oral cancers; and policies and regulations that either enhance or act as barriers to the prevention and early detection of oral cancers. Results : Overall, the public is ill-informed about risk factors for and signs and symptoms of oral cancers and relatively few US adults have had an oral cancer examination. Further, health care providers are remiss in providing oral cancer examinations and detecting early oral cancers. Conclusion : To achieve the 13 oral cancer objectives contained in "Healthy People 2000," health care providers and the public must know the risk factors for these cancers as well as their signs and symptoms. Further, health care providers need to provide oral cancer examinations routinely and competently. Equally important, the public needs to know that an examination for oral cancer is available and that they can request one routinely. Thus, a vigorous agenda that includes education, policy, and research initiatives is needed to enhance oral cancer prevention and early detection.     

Squamous cell carcinoma of the oral tissues: a comprehensive review for oral healthcare providers

North Americans in 2004 were projected to die from oral and pharyngeal cancer at a rate of 1.2 per hour. Oral healthcare providers can be instrumental in reducing the incidence of oral and pharyngeal premalignant and malignant lesions by identifying patients with high-risk behavior, educating their patients about the consequences of their high-risk behavior, and by early detection of premalignant and malignant conditions. The fact only 34% of the cancers of the oral cavity and larynx are localized at the time of diagnosis and evidence that at least one third of the patients diagnosed with an oral or pharyngeal malignancy have undergone oral cancer screening within the past three years suggests the current protocol for the early detection of pre-malignant or malignant changes appears to be deficient. To facilitate early diagnosis, oral healthcare providers must take into consideration the capriciousness of oral cancer and must be familiar with the availability and application of diagnostic modalities beyond conventional visual inspection and palpation of oral soft tissues. This article provides a comprehensive review of the disease for healthcare professionals.