Oral cavity cancer

The oral cavity is anterioly located and unique in the variety of tissues contained in this area. Although oral cancer screening may be done on clinical examination, imaging plays a critical role in staging and determination of deep margins for either tumor resectability or radiation planning. This article discusses the relevant anatomy on magnetic resonance imaging (MRI), including the lips and gingiva, floor of mouth, and oral tongue. This is followed by a discussion of standard MRI techniques, American Joint Committee on Cancer (AJCC) classification, and relevant MRI findings with discussion and imaging examples of carcinoma in major sites, including floor of mouth, oral tongue, buccal mucosa, bony upper alveolus, hard palate, and retromolar trigone. A brief summary of newer imaging techniques for evaluation of oral cancer is also presented.     

Oral cancer proteomics

Proteomics is a novel molecular profiling technology that may significantly accelerate human cancer research. This review summarizes recent progress in oral cancer proteomics and discusses potential applications in this emerging field. With the rapid development of proteomics tools, this technology platform will be utilized to discover highly sensitive and specific protein markers for cancer diagnosis and prognosis, elucidate the molecular determinants and key signal pathways underlying the disease mechanism, identify novel therapeutic targets and assess drug efficacy and toxicity, and to monitor treatment response and the relapse of the cancer. These proteomic applications may collectively facilitate the early detection and successful treatment of this devastating disease in the future.     

Oral complications in cancer patients

Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications.     

Oral candidiasis in cancer patients

Oral candidiasis in cancer patients is an infection for which inconsistent diagnostic and therapeutic strategies currently prevail. Recent studies have shown its potential importance in the development of systemic candidiasis. A clinical and cytologic study was undertaken on 52 consecutive cancer patients admitted to our institution. Although the incidence of clinical candidiasis was low (8%), 27% of patients harbored evidence of subclinical colonization by Candida. In addition, a significant correlation was found between candidal colonization and low absolute lymphocyte counts. The significance of these findings in relation to systemic candidiasis and rationale for therapy are discussed.     

Oral morphine in chronic cancer pain

Extensive clinical experience has been obtained in the use of opiates during the last decade in special units devoted to symptom control in advanced cancer. Important contradictions have emerged with the clinical pharmacological literature on opiates calling into question its relevance to the treatment of chronic pain. Specifically in the case of morphine it is clear that: it is a very effective analgesic given orally, dosage must be individualized, parenteral use or exotic analgesic 'cocktails' are usually unnecessary, and tolerance, dependence and respiratory depression are rarely common or serious problems which prevent effective pain control provided morphine is used appropriately in accordance with its pharmacological characteristics. Heroin is a suitable alternative to morphine (particularly for intramuscular administration) if differences in milligram potency are taken into account, but has no advantages in terms of either analgesic efficacy or side effects. This paper summarizes clinical experience in the use of oral morphine for cancer pain at St. Christopher's Hospice, any data from clinical investigations which support this approach, and comments on the areas of controversy which have emerged.     

Oral candidosis in community-based patients with advanced cancer

Oral candidosis is a significant cause of morbidity in patients with advanced cancer. The objectives of the study were to determine the epidemiology, etiology, clinical features, and microbiological aspects of oral candidosis among community-based patients. The subjects were recruited from hospice day centers in England. The clinical component involved completion of a study questionnaire, assessment of performance status, clinical examination of the oral cavity, measurement of unstimulated whole salivary flow rate, measurement of stimulated whole salivary flow rate, and performance of an oral rinse. Oral swabs were taken from subjects with appearances indicative of oral candidosis. The laboratory component involved standard procedures to isolate, enumerate, and identify yeasts from the clinical specimens. Three hundred ninety patients participated in the study. Two hundred seventy-two (70%) patients had oral yeast carriage, and 51 (13%) patients had combined clinical and microbiological evidence of oral candidosis. On univariate analysis, the presence of oral candidosis was associated with poor Eastern Cooperative Oncology Group performance status, presence of a denture, usage of a systemic corticosteroid, the severity of xerostomia, a low unstimulated whole salivary flow rate, and a low stimulated whole salivary flow rate. Multivariate analysis identified poor Eastern Cooperative Oncology Group performance status, presence of a denture, usage of a systemic corticosteroid, and the severity of xerostomia as being independently associated with the presence of oral candidosis. Oral candidosis is relatively common in community-based patients with advanced cancer. Hence, such patients should be screened for oral candidosis and should also be screened for reversible factors that predispose to oral candidosis, such as poor dental hygiene and salivary gland dysfunction.     

Oral ciprofloxacin therapy for infections in cancer patients

Forty six episodes of infection in 43 cancer patients were treated with oral ciprofloxacin at a dose of 750 mg every 8 h. The overall clinical response was 85%. Patients with microbiologically proven infections had a higher response rate (90%) than patients with infections from whom no causative organism(s) could be isolated (69%). Two of three neutropenic patients responded favourably. Favourable responses were seen in a variety of infections including bacteraemia, urinary tract infection, respiratory tract infection and skin and soft-tissue infection. Resistance to ciprofloxacin developed in one isolate of Pseudomonas aeruginosa. Side effects were mild and were predominantly gastrointestinal in nature. Orally administered ciprofloxacin is safe and effective for the therapy of many serious infections in cancer patients. However, more data are required in patients who are neutropenic.     

Oral contraceptive use and risk of breast cancer

The clinical impact of the association between oral contraceptive (OC) use and breast cancer risk is important given that OCs are the most commonly prescribed contraceptive agent and that more than a quarter of a million women are diagnosed as having breast cancer in the United States annually. Substantial changes to OC formulations have been made during the past decade, and this review focuses on recent OC trends and risks and benefits. We also have a better understanding of how estrogen affects breast carcinogenesis; research on this topic is ongoing and has the goal of decreasing breast cancer incidence and mortality.     

Oral complications in Chinese cancer patients undergoing chemotherapy

In this study the oral status and mucositis-related symptoms in 94 Chinese cancer patients undergoing chemotherapy for with curative intent were examined. Data were collected by a research nurse at three stages over a period of 16 days: at the start, on day 8, and on day 16 of chemotherapy. The majority of subjects experienced a mild to moderate degree of mucositis with the highest score reported on day 8. Patients with head and neck cancer had consistently higher scores for mucositis and symptoms in most phases. Oral mucositis and symptoms were significantly and positively correlated with consumption of spicy and/or hot (temperature) food, and frequency of use of mouthwashes. Significantly higher scores were found in patients who: ate hot (temperature) food, had low tolerance for hot food and spicy foods, and were taking Chinese medicinal herbs. Careful monitoring of patient diet preferences, cancer site, and use of Chinese medicine is recommended for comprehensive oral assessment. The alleviation of oral mucositis and the associated symptoms through promotion of an appropriate food/fluid intake and more frequent use of mouthwashes should be emphasized in oral care.