Second primary cancers in patients with carcinoma of the lip

The occurrence of second primary cancers in patients with lip cancer was evaluated in order to test certain etiologic hypotheses. All cases of lip cancer reported to the Finnish Cancer Registry in 1953-74 (3303 men, 320 women) were followed up for a second (or third) primary cancer through the files of the Registry either to death or to 31 December 1974 (a total of 25 510 person-years). The expected numbers of cases were calculated on the basis of the incidence rates specific for sex, age, time and residence (urban or rural) in Finland. A higher than expected risk of cancer was found among both urban and rural male lip cancer patients; among women the observed number of new primary cancers did not differ from that expected. A significant excess risk among males was noted for cancers of the lung and larynx (rural patients) and for non-melanomatous skin cancer in locations other than the head and neck (urban patients). The association of cancers of the lip, lung and larynx found earlier on a geographic level supports the hypothesis that tobacco smoking is a common risk factor in these cancers. The differences in the relative risks between urban and rural patients, however, suggest that the risk factors in lip cancer in urban areas might be partially different from those prevalent in the rural population. The results do not support the hypothesis that sunlight is an important risk factor in lip cancer.     

Cancers of the lip and oropharynx in different social and occupational groups in Finland

Social status and occupation-specific risks of cancers of the lip, tongue, mouth and pharynx were studied in a nationwide series of 2369 men and 809 women diagnosed in Finland in 1971–1985 and recorded in the files of the Finnish Cancer Registry. Codes for social status (four classes) and occupation (336 categories) were drawn from the files of the 1970 Population Census. The standardised incidence rates (SIR) were defined as the ratios of observed and expected numbers of cases, the expected ones being based on the sex, age, site and calendar period-specific incidence rates in the Finnish population. The SIR of lip cancer in the lowest social class was five times that of the highest one, thus indicating the effects of social class differences in smoking habits. The effect of outdoor work on the development of lip cancer was also strongly supported by this study. The social class-adjusted SIR for fishermen was 2.7 (95% C.I. 1.3–5.0), for forestry managers 2.2 (1.2–3.6), for timber workers 1.9 (1.2-2.9) and for farmers 1.8 (1.2-2.6). For cancers of the oral cavity and pharynx there was no clear correlation with social class. However, the SIR for these cancers among farmers was significantly reduced. The occupation-specific SIRs pointed more to alcohol than smoking aetiology. In the case of cancer of the tongue, no aetiological clues whatsoever could be found. The role of direct occupational factors in the aetiology of any of these cancers seemed to be minimal.     

Is the incidence of oral and pharyngeal cancer increasing in Finland? An epidemiological study of 17 383 cases in 1953–1999

OBJECTIVE: The aim of this study was to describe the occurrence of oral and pharyngeal cancer in Finland over the last half century. MATERIALS AND METHODS: The study included all lip, oral and pharyngeal cancer cases diagnosed in Finland and reported to the nation-wide Finnish Cancer Registry between 1953 and 1999. RESULTS: The study comprised 17,383 new cancer cases: 11,666 in males and 5717 in females. Of these, 83% were squamous cell carcinomas. By the end of the study, 1999, the mean age at diagnosis had increased to 63 years for males and 67 for females. The age-adjusted incidence of oral and pharyngeal cancer decreased in males from 12.5 per 10(5) to 8.4 per 10(5) while it increased in females from 3.0 per 10(5) to 3.9 per 10(5). This was because of a decrease in lip cancer incidence in males, while the incidence of tongue, mouth and salivary gland cancers increased in both genders. The annual number of new oral cancer cases increased, however, in both genders. CONCLUSION: The incidence of lip cancer decreased in males, probably because of a decrease in smoking and in outdoor work. The incidence of intra-oral cancers increased in both genders, possibly because of increased alcohol consumption.     

Oral cancer in Australia: 1983-1996

BACKGROUND: The aims of this study were to identify differences in oral cancer incidence and mortality between sexes, age groups, oral sites and Australian States and Territories and recent trends in oral cancer incidence, mortality and age-profile over time. METHODS: Data were obtained from the Australian Institute for Health and Welfare and were age-standardized to the Australian 1991 Population Standard. Differences and trends were assessed with the Wilcoxon matched-pairs signed-ranks test and the Spearman correlation test, respectively. RESULTS: In Australia in 1996, there were 2173 new oral cancers and 400 deaths due to oral cancer, the majority of oral cancers were in the 60+ age group, oral cancer affected men more than women (>2:1), lip cancer accounted for more than 50 per cent of oral cancers and the oral cancer mortality-to-incidence (M:I) ratio was greatest in ACT and NSW and least in QLD and SA. From 1983 to 1996, the annual incidence of lip cancer increased while the M:I ratio of lip cancer decreased. The annual incidence of cervical cancer decreased whereas the annual incidence of intra-oral cancer remained constant. The M:I ratio of cervical cancer was consistently lower than the M:I ratio of intra-oral cancer. CONCLUSIONS: Reducing exposure to environmental carcinogens, increasing public awareness and population screening may reduce the incidence and mortality of oral cancer in Australia.     

Oral cancer in South Australia—incidence and case survival

A bstract — South Australian cancer registry data for the 1977–80 period indicated that 3.2 per cent of malignant neoplasms occurred in the mouth, over half of them on the lip. The male to female incidence ratio was 3.3:1 for all oral cancers and 6.3:1 for lip cases. The incidence of lip cancer was higher in country areas than in metropolitan Adelaide, and lower for migrants from England and Ireland than among other South Australians. Approximately 85 per cent of oral cancers were squamous cell carcinomas, with mucoepidermoid carcinomas being the next most prevalent type, constituting about four per cent of all cases and 29 per cent of salivary gland tumours. The four-year survival rate was 69 per cent for all oral cancers, and 84 per cent for lip cases, compared with 41 per cent for all other cancers combined.     

Lip cancer in Northern Finland: changing incidence and clinical characteristics

A population-based survey was conducted in 35 municipalities in Northern Finland to assess the incidence of lip cancer as well as the patient and tumour characteristics in cases diagnosed between 1983 and 1997. A total of 96 new patients emerged. The age-standardised incidence (per 100,000 years) of lip cancer in men decreased from 4.8 in 1983-1987 to 1.4 in 1993-1997. The incidences in women were 0.30 to 0.36, respectively. The median age of the patients increased from 66 to 73 years through the years. Overall, 90% of the patients had at least one of the known risk factors, namely rural domicile, outdoor occupation or smoking. The median duration of symptoms also remained the same, as did the median size and location of the tumour at diagnosis. In contrast, spread to regional lymph nodes became rare during the period.     

Oral cancer and precancer as diseases of the aged

Some cancers, especially sarcomas, favor younger age groups, whereas others, particularly carcinomas, are most likely to develop in older age groups. The relative frequency, mortality and morbidity rates are defined using lip and tongue cancer as examples. The paper demonstrates how oral cancer rates increase with age. For tongue cancer there is a worsening of the prognosis with advancing age. The synergistic effect of tobacco and alcohol and its relation to age is also dealt with. For leukoplakia there is also a higher rate with increasing age, although there is a shift towards younger ages when compared with oral cancer. Tobacco, age and leukoplakia are also discussed. The increased cancer and precancer rate in older people may be due to age changes in the oral mucosa making it more vulnerable to the action of carcinogens.     

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.     

Oral cancer at a Tasmanian tertiary referral clinic, the Royal Hobart Hospital 1996-2002

Background : The Holman Clinic at the Royal Hobart Hospital includes a multi-disciplinary head and neck clinic which functions as a tertiary referral centre for Southern Tasmania and involves Ear Nose and Throat surgeons, Oral and Maxillofacial Surgeons, Plastic and Reconstructive Surgeons, Radiation Oncologists and Medical Oncologists.
Methods : The aim of this study was to examine retrospectively the number, gender distribution, age, site of lesion, histology, mortality and treatment modalities of the oral cancers referred to the Holman clinic at the Royal Hobart Hospital. The medical histories and a database of the Holman clinic were used as the sources of data for this study. A total of 101 patients were treated for oral cancer in the Holman clinic at the Royal Hobart Hospital from 1996 to 2002. There were 64 males and 37 females.
Results : The distribution of anatomical sites of the oral cancers in this study was as follows: 36 oral tongue lesions, 17 floor of mouth, 13 lip, five retromolar trigone, five mandibular alveolus, six buccal mucosa, nine palatal and 10 minor and major salivary gland cancers. The most common site of oral cancer was the tongue (35.6 per cent), followed by the floor of mouth (16.8 per cent) and lip (12.9 per cent).
Conclusions : The majority of oral cancers were squamous cell carcinoma, except for the salivary gland cancers. The incidence of squamous cell carcinoma was between 67 and 100 per cent, depending upon the site involved. The trends found in this study are similar to those previously documented over the past 20 years.     

The epidemiology of lip cancer: a review of global incidence and aetiology

Lip cancer (140 ICD-9) is a form of oral cancer that has a distinctive global epidemiology. This review summarises global incidence rates for male and female lip cancer with the aid of cancer atlases. High male lip cancer rates are reported for regions of North America (12.7 per 100 000 per annum), Europe (12.0 per 100 000 per annum) and Oceania (13.5 per 100 000 per annum), while it is virtually unknown in parts of Asia. Factors commonly cited as important in the aetiology of lip cancer include solar radiation, tobacco smoking and viruses. An attempt is made to summarise the evidence for factors that may be important in lip carcinogenesis. While incidence rates are generally stable or falling among males worldwide, they are rising in many female populations. The aetiology of the disease is far from established and much information regarding its pathogenesis is based on anecdotal rather than case-controlled epidemiological evidence. The epidemiology of lip cancer supports the proposal that the lip should be considered as a distinct cancer site, rather than being included with other forms of intraoral cancer.     

Multiple primary tumours following head and neck cancer in southern England during 1961–98

BACKGROUND: Successful initial treatment of oral and oro-phayngeal cancer has led to the emergence of second primary tumours (SPTs). Population data are meagre. METHODS: Occurrence of multiple primary cancers following a malignancy in a head and neck site was computed using data from a population-based cancer registry covering a population of 14 million. RESULTS: Among 59,958 subjects reported to the registry, 5.5% males and 3.6% females developed a second primary cancer. At the sites studied, a total of 2771 second primary cancers were found, compared with an expected number of 2341. The standardised incidence ratio (SIR) for contracting a new primary cancer was 1.14 (95% CI=1.09-1.19) for men and 1.34 (95% CI=1.24-1.44) for women. There was a significantly increased risk for a second cancer in most of the upper aerodigestive tract sites that are generally regarded as tobacco associated, with an SIR for subsequent oral cancer of 5.56 in men and 15.31 in women. Subjects first detected with a pharyngeal cancer experienced the highest SIR for a subsequent tumour. Excluding tobacco-associated sites, the risk of a subsequent cancer was not significantly raised in either sex (SIR 0.87 (95% CI 0.81-0.93) for men; SIR 0.99 (95% CI 0.90-1.09) for women). CONCLUSIONS: The relative risk for multiple primary cancer was higher in younger subjects, those detected with a head and neck cancer during the 1990s as compared with earlier decades of the study, and among patients who received radiotherapy for their first tumour. By 20 years from the time of the first head and neck cancer, we estimate that approximately 30% of male patients and 20% of female patients will have developed an SPT.     

Oral cancer over four decades: epidemiology,trends, histology,and survival by anatomical sites

J Oral Pathol Med (2010) 39 : 299–305 Background: Oral cancer is one of the few life‐threatening oral diseases. The subtypes and different sites of oral cancer has different etiology epidemiology and survival rate. Prevalence of the various anatomical oral sites provided potential baseline for improvement of clinical approach. Methods: Incidence and survival rates were derived from the Israel National Cancer Registry and included all registered data between 1970 and 2006. Oral cancer included the lips, tongue, buccal mucosa, gums, vestibulum, floor of the mouth, and palate. Results: Most prevalent oral cancer subtype was squamous cell carcinoma (SCC) among men above the age of 55 years. Females had a higher incidence of SCC in lateral border of tongue, gums and buccal mucosa. Lymphoma and sarcoma were the most prevalent under the age of 20. Melanomas and metastatic disease revealed the lowest survival rate, while invasive or infiltrating basal cell carcinoma in the lips had the highest rate. The highest oral survival rate was for the lip, and the lowest was for the tongue and gums. Conclusions: Early detection of oral cancer is important for all the medical health team. Decrease in lip carcinoma may be a result of occupational or awareness changes and should be studied. Non‐epithelial tumors under the age of 20 should be considered as a differential diagnosis. A basic oral examination should be included in all routine medical examinations, with emphasis on high‐risk patients and high‐risk oral sites.     

Familial risk in oral and pharyngeal cancer

We examined the relationship between a family history of cancer and risk of roal and pharyngeal cancer using epidemiological data from a large case-control investigation of these tumours. 487 (45.7%) of the cases and 485 (41.0%) of the controls reported cancer in a parent or a sibling. After controlling for age, race, sex, study location, respondent status and smoking and alcohol use, the OR associated with any cancer in the family was 1.1 [95% confidence interval (CI) 0.9–1.3]. Risks were non-significantly elevated among those with a history of cancers arising from the oral cavity/pharynx (OR = 1.2, 95% CI 0.7–2.3), oesophagus/larynx (OR = 1.6, 95% CI 0.7–3.8) and lung (OR = 1.2, 95% CI 0.8–1.8), with the excess risk primarily among those for whom a male relative, particularly a brother, was affected with these smoking-related cancers. In addition, an elevated risk of oral/pharynx cancer was found among those whose sisters developed other cancers (OR = 1.6, 95% CI 1.1–2.2). Subsite analyses revealed stronger elevated risks of smoking-related cancers in relatives of pharyngeal cancer cases (OR = 1.7, 95% CI 1.1–2.8) than of oral cancer patients. The data indicate that there is at most a weak familial aggregation of oral/pharynx cancers. Furthermore, since the excess familial risk of oral/pharynx cancer was associated with smoking-related cancers among male but not female relatives, it seems likely that environmental factors (notably smoking and drinking) contribute to the familial tendency observed in this study. The results underscore the need to collect risk profile information on relatives in future studies to disentangle genetic from environmental determinants.     

Insights from studies with oral cleft genes suggest associations between WNT-pathway genes and risk of oral cancer

Oral squamous cell carcinoma (OSCC) accounts for more than 90% of the malignant neoplasms that arise in the mucosa of the upper aerodigestive tract. Recent studies of cleft lip/palate have shown the association of genes involved in cancer. WNT pathway genes have been associated with several types of cancer and recently with cleft lip/palate. To investigate if genes associated with cleft lip/palate were also associated with oral cancer, we genotyped 188 individuals with OSCC and 225 control individuals for markers in AXIN2, AXIN1, GSK3β, WNT3A, WNT5A, WNT8A, WNT11, WNT3, and WNT9B. Statistical analysis was performed with PLINK 1.06 software to test for differences in allele frequencies of each polymorphism between cases and controls. We found association of SNPs in GSK3B (p = 0.0008) and WNT11 (p = 0.03) with OSCC. We also found overtransmission of GSK3B haplotypes in OSCC cases. Expression analyses showed up-regulation of WNT3A, GSK3B, and AXIN1 and down-regulation of WNT11 in OSCC in comparison with control tissues (P < 0.001). Additional studies should focus on the identification of potentially functional variants in these genes as contributors to human clefting and oral cancer.     

The unequal burden related to the risk of oral cancer in the different regions of the Kingdom of Saudi Arabia

OBJECTIVES: To estimate the burden and risk of oral cancer in Saudi Arabia and highlight differences between regions. METHODS: Using the National Cancer Registry Saudi Arabia, data was collated on numbers of cases of oral cancer (1996-1998) by site, age group, gender and region, plus relative frequencies of all cancer cases. Using Globocan, age-standardised rate (ASR) of oral cancer in Saudi Arabia was compared with five other neighbouring countries in the region. RESULTS: A total of 208 lip, mouth and tongue cancers for men and 209 for women were reported to the registry during this period. ASR of oral cancer was 1.81/100,000 for males and 2.13/100,000 for females. It was ranked 15th most common cancer for males and 11th for females, with a ratio of 1:1 and median age at diagnosis of 62 years. Very wide regional disparities in the incidence of oral cancer were found, with an almost thirty-fold difference in ASR between the regions with the lowest and highest rates. Jizan Region had the highest ASR (6.2/100,000 for males and 9.82/100,000 for females). Here oral cancer was ranked 2nd for males and 1st for females, with a ratio of 0.73:1 and the median age at diagnosis for females was lower. The third highest ASR (4.48/100,000) was found in females in Najran. In these two high incidence regions oral cancer was commonly reported on the gingiva. CONCLUSIONS: Overall the burden and risk of oral cancer in Saudi Arabia are not large. However, cancer of the oral cavity is a significant public health problem for the residents of Jizan and the women of Najran. Saudi females in both these regions have a higher burden of oral cancer.     

老年唇癌患者颈部淋巴转移的临床分析

目的：研究不同手术范围的颈淋巴清扫术在老年人唇癌治疗中的临床意义。方法：回顾分析81例老年唇癌患者术后颁部淋巴中淋巴转移的病理检出率，结合病员的年龄、性别、原发部位、细胞分化和临床分期，探讨唇癌患者颈淋巴清扫的合理术式。结果：唇癌的转移率不高，位于Ⅰ区的肿大淋巴结多为炎性肿大而非癌性转移，临床分期和唇癌部位与颈部淋巴转移密切相父。结论：多数唇癌患者无须做颈部淋巴处理但需术后严密观察，舌骨上颈淋巴清扫术应规范并慎用，肩胛舌骨肌上淋巴清扫术适合多数有颈部转移的唇癌患者。     

口腔癌的预防

口腔癌是头颈部较常见的恶性肿瘤之一,其发生与多种内、外因素有关,包括吸烟、饮酒、病毒感染、营养不良、饮食习惯和局部刺激等,其中尤以吸烟、饮酒的危险性最大。尽管采用手术、放疗、化疗、生物治疗等治疗口腔癌取得了长足进展,但口腔癌的5年生存率仍然徘徊在64%左右,晚期患者的预后更差。因此,要提高口腔癌患者的生存率和生存质量,必须坚定不移地贯彻执行＂预防为主＂的卫生工作方针,力争做到早期发现、早期诊断和早期治疗。作者就目前口腔癌三级预防的相关问题进行了讨论。     

The role of the dental team in preventing and diagnosing cancer: 2. Oral cancer risk factors

Oral cancer is among the ten most common cancers world-wide, and is especially seen in disadvantaged older males. Cancer arises as a consequence of DNA mutations causing multiple molecular genetic events in many chromosomes and genes, leading to cell dysregulation. Tobacco and alcohol use are extremely important in oral mutagenesis. Environmental factors such as infective agents and genetic factors are implicated in a minority of patients. CLINICAL RELEVANCE: Dental staff can advise on lifestyle changes for the prevention of potentially malignant oral disease and thereby protect their patients, staff, colleagues, families and acquaintances, having the opportunity to make an impact on improving the survival rate and morbidity of oral cancer by detecting both potentially malignant and malignant oral lesions.     

Oral cancer knowledge,risk factors and characteristics of subjects in a large oral cancer screening program

BACKGROUND: Screening people who are at high risk of developing oral cancers is a promising tool for decreasing morbidity and mortality attributable to this cancer. METHODS: A consortium led by the New York University College of Dentistry conducted a three-day oral cancer screening during June 1999. As part of the screening intake, the authors conducted a survey to assess the sociodemographic characteristics, level of knowledge of risk factors and predictors of oral cancer awareness among the subjects. The authors performed bivariate and multivariate analyses using two indicators of oral cancer awareness as dependent variables. RESULTS: The 803 subjects were racially and ethnically diverse, 66 percent were 40 years of age or older, 43 percent had a history of smoking, and 9 percent were likely to have had a history of alcohol abuse. Race/ethnicity, education level and knowledge of risk factors for oral cancer were predictors of awareness of an oral cancer examination, whereas only knowledge and possible history of alcohol abuse were predictors of having a history of examinations. CONCLUSIONS: This screening program attracted a diverse sample of people at high risk of developing oral cancer due to smoking and likely history of alcohol abuse. Consistent with other national and international studies, the authors found a lack of knowledge of the risk factors associated with oral cancer and a low rate of histories of oral cancer examinations among the subjects. CLINICAL IMPLICATIONS: Oral cancer screening programs represent potential opportunities not only for early detection of oral cancer but to raise awareness and educate the public about the disease.