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    Kanker Mulut

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    Oral cancer

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    Kanker mulut

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    Oral cancer

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    Kanker Mulut

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    Oral cancer

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    of 2

    Annals of Clinical Research and

    Trials
    Open Access Full Text Article Editorial

    Diagnostic Delay in Oral Cancer


    This article was published in the following Scient Open Access Journal:
    Annals of Clinical Research and Trials
    Received July 22, 2017; Accepted December 12, 2017; Published January 02, 2018

    Alberto Rodriguez-Archilla* Diagnostic Delay in Oral Cancer


    Faculty of Dentistry, University of Granada, Spain
    Head and neck carcinoma is the sixth most frequent malignant neoplasm in the
    world. Approximately 3% of all cancers are located in the oral cavity and oral squamous
    cell carcinoma is the most common malignant neoplasm of the mouth with more than
    90% of cases.
    However, the incidence of oral cancer is very variable depending on the geographical
    area of the world. In Southeast Asia, and particularly in India, oral cancer accounts for
    40% of all malignancies [1].
    In recent years, the incidence of oral cancer is increasing, especially in the young
    population. In contrast, the overall 5-year survival rate has not improved significantly
    being 56%. This is mainly due to the fact that 60% of oral tumors are diagnosed in
    advanced stages (III and IV stages) and to the phenomenon of “field cancerization”
    whereby oral cancers have the highest risk of development of second primary tumors.
    Although the oral cavity is an area of easy visual inspection and direct palpation that
    facilitates the examination by the professional, only 40% of oral cancers are diagnosed
    when they are localized lesions, the same proportion as colorectal cancers.
    The time of diagnosis and tumor stage have a decisive influence on the survival rate.
    Thus, for localized oral cancer lesions (stages I and II), the 5-year survival rate is 83%;
    for tumors with lymph node metastases (50% of cases), the survival rate decreases to
    42% and for tumors with distant metastases (10% of cases), the 5-year survival rate
    falls to 17% [2].
    Different etiological factors have been related to oral cancer. The main risk factors
    for oral cancer are tobacco use, alcohol consumption, the existence of potentially
    malignant disorders of the oral mucosa, and human papilloma virus (HPV) infection.
    Other related risk factors are Candida species superinfection, nutritional deficiencies,
    genetic predisposition, oral hygiene and oral health status, immunosuppression,
    chronic exposure to sun or repetitive oral mucosa trauma.
    Of all of them, the most important is the combined effect of heavy tobacco use and
    alcohol consumption that is present in more than 75% of patients with oral cancer. The
    relative risk of oral cancer among heavy smokers and drinkers is 20-fold higher than
    non-smoker or non-drinker subjects. Alcohol acts as a co-carcinogen increasing from 2
    to 4 times the carcinogenic effect of tobacco use [3].
    The increased incidence of oral cancer in young individuals from Western countries,
    especially tongue carcinoma, appears to occur due to the increased alcohol intake and
    the influence of HPV infection.
    Mouth neoplasms may show different clinical presentations. The main of them are
    non-healing ulcers, white lesions (leukoplakia), red lesions (erythroplakia), red and
    white lesions (erythroleukoplakia) or exophytic growths. These lesions are mostly
    observed on lateral borders of the tongue, floor of the mouth, buccal mucosa, gingiva,
    and soft palate.
    Diagnostic delay of oral cancer is the main factor that condition that these lesions
    are diagnosed in advanced stages and the low survival rate of them. It is estimated that
    *Corresponding author: Alberto Rodriguez-Archilla,
    Oral Medicine, Faculty of Dentistry, University of
    the average time from the time the lesion is detected until its definitive diagnosis is
    Granada, Colegio Maximo, s/n. Campus de Cartuja, made is about 6 months. This diagnostic delay can be attributed to factors related to the
    18071-Granada, Spain, E-mail: [email protected] patient and to the professional [4].

    Volume 2 • Issue 1 • 003e www.scientonline.org Ann Clin Res Trials


    Citation: Alberto Rodriguez-Archilla (2017). Diagnostic Delay in Oral Cancer

    Page 2 of 2

    Patient Delay measure to reduce the delay in the diagnosis. Additionally,


    professionals should be familiar with the biopsy, the best tool for
    Patients may ignore the presence of the lesion because, at definitive diagnosis of these lesions.
    first, oral cancer lesions are usually asymptomatic or cause no
    remarkable signs and discomfort. Symptomatology becomes There seems to be a wide consensus the need to perform
    evident when the lesions progress to more advanced stages. annual examinations for oral cancer screening for risk patients
    In other cases, the patient is aware of his lesion, and he is self- over 40 years of age, although considering new risk factors and
    medicating rather than to consult with the professional for fear increasing incidence of oral cancer in young patients, the age
    of the diagnosis. range of these periodic examinations should be expanded [7].

    Moreover, the complex anatomy of the oral cavity difficulties In conclusion, patients and the general public should have
    the self-examination by the own patient and is not useful as is in information about risk factors and behaviors related to oral
    the case of skin or breast tumors. cancer, particularly because most of them are preventable
    factors. Patients and professionals should be aware that, in the
    Other factors that may delay the diagnosis are economic early stages, oral cancer lesions are asymptomatic or with a slight
    factors, distance, or lack of specialized health services to refer the symptomatology which may delay its possible diagnosis.
    patient.
    Professionals must receive specific training to conduct
    All of this contributes to a delay in the diagnosis of the lesion complete extraoral and intraoral examinations and to perform
    and could worsen its prognosis [5]. biopsies for a correct diagnosis and early detection of oral cancer
    Professional Delay lesions.

    Sometimes the professional does not properly examine the Health providers should establish protocols for early
    oral mucosa or minimizes the severity of the lesion without detection of oral cancer with periodical oral examinations for
    taking a biopsy. Other times, when the professional decides to patients at risk and a proper management of suspicious lesions.
    take a biopsy, he incorrectly chooses the biopsy site and sends References
    a sample of non-representative tissue for the histopathological
    1. Globocan. Estimated cancer incidence, mortality and prevalence worldwide
    diagnosis. in 2012.
    Any lesion that persists for two weeks or longer after removal 2. The Oral Cancer Foundation. Oral cancer facts. 2017.
    of the possible causative agents and its treatment should be
    3. Scully C, Petti S. Overview of cancer for the healthcare team:
    biopsied or referred to a specialized health center. aetiopathogenesis and early diagnosis. Oral Oncol. 2010;46(6):402-406.
    The exhaustive examination of head, oral cavity and neck 4. Noonan B. Understanding the reasons why patients delay seeking treatment
    is critical to early detection of oral cancer. In the oral cavity, for oral cancer symptoms from a primary health care professional: an
    integrative literature review. Eur J Oncol Nurs. 2014;18(1):118-124.
    examination of both hard and soft tissues and, in the neck, a
    complete evaluation of cervical lymph nodes are mandatory [6]. 5. Güneri P, Epstein JB. Late stage diagnosis of oral cancer: components and
    possible solutions. Oral Oncol. 2014;50(12):1131-1136.
    Although most dentists performing routine oral mucosa
    6. Allen K, Farah CS. Patient perspectives of diagnostic delay for suspicious
    screenings on their patients, some lesions go unnoticed or are oral mucosal lesions. Aust Dent J. 2015;60(3):397-403.
    misdiagnosed as benign conditions. The increase of knowledge
    7. Gómez I, Warnakulasuriya S, Varela-Centelles PI, et al. Is early diagnosis of
    among dental and medical professional of potentially malignant oral cancer a feasible objective? Who is to blame for diagnostic delay? Oral
    oral disorders and oral malignant lesions will be an effective Dis. 2010;16(4):333-342.

    Copyright: © 2017 Alberto Rodriguez-Archilla. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
    permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Volume 2 • Issue 1 • 003e www.scientonline.org Ann Clin Res Trials

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