One Man’s Tortuous Foray Into Oral and Maxillofacial Surgery

Why not have a go at home with loved ones around? Explanations like these remind us that the respectful care of women is an integral part of future health system reform. Urban Africa is not only about empty plates. There is a rapidly expanding middle class with a taste for refined sugar, and a culture which associates large abdominal girth with higher social class. As a result we are beginning to see a rise in cases of diabetes in pregnancy. Doreen is 31 and has just had her third child.

The first was delivered normally and weighed a decent 4. The second was even bigger at 4. Big babies are the hallmark of untreated diabetes in pregnancy; the high sugar level means the baby lays down more fat around the shoulders and abdomen raising the likelihood of complications at delivery. They also get so used to the high sugar and produce so much insulin that when they are born into the world their sugar level plummets which can kill. There is no screening for diabetes in pregnancy in Uganda. We do not yet even know which screening test would be best, or even what we would do if it was picked up as management is not straightforward and beyond the present antenatal system.

As I spoke to Doreen the story of diabetes in her case was clear. This recent baby needed a Caesarean as there was not enough fluid around the baby diabetes causes both too much or too little fluid. Her baby was wrapped up in sheets beside her and I see a tiny area of the sheet flickering over and over again in a repetitive way.

I ask to see her 2-day old baby and sure enough the tiny girl was having a seizure, repetitively jerking her left arm up in the air. Doreen has no idea, and no doctor has been around that day. One junior doctor usually has to cast an eye over around 80 women and their new babies in the course of a morning. Few get a thorough check, and besides Doreen has no diagnosis. Fortunately both are discharged a few days later, but the impact of the seizures and damage to the brain may not be realised until months later.

Ruth is 43 and has travelled from a very rural farming community. She has a coy smile and has the air of a once confident person who has suffered too much hardship in her life. She came to the hospital after hearing a radio advertisement. She had been leaking urine for twenty years having developed a vesico-vaginal fistula abnormal connection between the bladder and vagina after the birth of her third child.

Since that time she withdrew from village life, and farmed alone, hiding her shame from the community. Fortunately a supportive husband stayed with her, though many are not so lucky. Ruth has had decades to contemplate her fate, has come to terms with her condition, and is now happy that something may finally be done about it — surgical repair. Opposite Ruth sits another girl, with the same condition, but at the start of her story. She is very small, and looks incredibly shy. She is only 16 years old, but as I gain her confidence she tells me her story. Her first statement says so much; her family was not able to pay for her to go to school, so she stayed at home and became pregnant, totally matter of fact about the inevitability of such a chain of events.

Again she laboured at home and got to the hospital too late. A dead baby was delivered using a suction cup in what sounded like an extremely traumatic series of events. She started leaking urine 6 weeks later, again due to injuries from a prolonged obstructed labour. She looked very vulnerable and alone, in a room full of women with totally avoidable internal injuries, victims of a world that still fails to recognise the equitable status of women in society.

Annett is a year-old lady, a bubbly character with a broad smile across her face. She had given birth to a baby boy the week before and is overjoyed. She lost her first baby at 34 weeks of pregnancy. The staff encouraged her to get to antenatal visits early in subsequent pregnancies. Annett had the confidence and educational ability to speak up at her antenatal visits and demand the basics were done. As often happens she suffered with high blood pressure again. She came into the hospital at 26 weeks and was managed with medication for another 5 weeks to give her baby the chance to mature.

At 31 weeks her condition was so severe that her baby had to be delivered, since the placenta is the cause of the blood pressure disorder. Her baby boy was taken to special care unit. On the first day Annett showed me pictures on her phone, but the next day took me to see him in the neonatal unit. Seventy similar babies were lined up, many with NG tubes in their noses, their mothers expressing milk and pushing it down the tube with a syringe. One doctor has the job of looking after all these delicate beings.

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Annett tells me all about what she does several times per day for her baby, and in immense detail. But she only got there because she had the educational and financial means to transcend the gaps in the chain, a privilege of few. Four young women, one just 19 years old, died of this high blood pressure disorder in our two weeks on the unit this year. They are morbid stories in themselves, but more frightening is the sheer number of similar stories that are told every day, even in this one hospital.

Each maternal death is detailed and the stories are hauntingly similar. Whilst total average worldwide wealth improves, the inequities both within and between nations are worsening. Sharing stories like this will not change the world, but the least one can do is advocate for those without a voice. It may at least help in appreciating the excellent standards that our National Health Service affords our women and mothers.

Finally pulling their weight. As soon as they were here they were gone. A big thanks to the surgical team, primarily coming from Great Ormand Street, for all their hard work over the last couple of weeks. Thank you for giving up your annual leave and private surgical lists and working for free. It was a busy week with two theatres performing more than 30 operations. It was a stressful couple of weeks for the patients who were watching each day as more of their friends were taken into the unknown.

A little disconcerting when you still have your scheduled op and your friends come back swollen, in pain, and dribbling a mixture of saliva and blood.. Some of the operations performed are at the forefront of surgical technicality. The techniques are far from perfected and complications do arise. The next few days are critical in the long term success of the operations.

Hiroshi Nishikawa and Anthony MacQuillan on the left — the plastics team. David Dunaway from the maxfax team on the right. It has been amazing to see some of the transformations that have occurred.

Ayesha is about 15 and been confined to the house all her life, with a clamped jaw and a non-existent self-esteem. Today she looks another person, and she seems like another person too as she sits with the other children. The graft from her arm is healthy and she is looking at a different future than she had before her a couple of weeks ago. Bekalich is about 25 and from South Sudan. She has three children including an 18 month old baby who is now in our care. In the end she went to theatre to have a forearm graft to replace her facial deformity.

The first concern was the baby. The child was malnourished and not behaving normally for an 18 month old baby. He would cry whenever he was taken from the mother, at which point she would scoop him back up into her arms and to the breast, signifying attachment issues. In the UK this behaviour would immediately be flagged as secondary to neglectful abuse.

He received no stimulation from the mother. She did not play with or talk to the child who just sat silently in her arms. The child did not crawl and made no effort to move, and there was hardly any muscle mass on the legs. The child was socially and developmentally delayed, most likely secondary to the social exclusion that her mother has suffered due to her defect. We saw this as a valuable opportunity to feed up and stimulate the baby.

Almost two weeks later and we are looking after a different child. This is due to an amazing effort by all the nurses and the patients here who has been stimulating the child around the clock. It has seemed like bullying some of the time but with positive results. As I look down the gardens I see him sitting up on his own. He is playing with a ball and moves onto his front to crawl at his own accord. I run down to get a closer look. I tickle him behind his ears and he squeezes his mouth together into a pout. We all tickle the baby a bit more and to our amazement a huge smile spreads across his face, milk teeth and all.

This is the first time the baby has ever smiled, you can imagine the elation. As you would expect we kept tickling him until he cried…. The original version of this blog then went on to outline what has happened since. I must admit that the version I originally posted probably crossed patient confidentiality boundaries. As such it has been moderated.

However the dilemma is till the same — what happens when advanced technology meets those that are not understand the basic principles of modern medicine, and how can one possibly obtain informed consent? Our data suggest that factors which alter M cell-density in the gut epithelium may be important risk factors which influence host susceptibility to orally acquired prion diseases. After exposure, the early accumulation and replication of prions within small intestinal Peyer's patches is essential for the efficient spread of disease to the brain.

To replicate within Peyer's patches, the prions must first cross the gut epithelium. M cells are specialised epithelial cells within the epithelia covering Peyer's patches that transcytose particulate antigens and microorganisms. In the specific absence of M cells in these mice, the accumulation of prions within Peyer's patches and the spread of disease to the brain was blocked, demonstrating a critical role for M cells in the initial transfer of prions across the gut epithelium in order to establish host infection.

Chronic inflammation has been implicated in carcinogenesis, with increasing evidence of its role in lung cancer. We aimed to evaluate the role of genetic polymorphisms in inflammation-related genes in the risk for development of lung cancer. Of the 23 polymorphisms, two were associated with risk for lung cancer. Survival was not influenced by genotype. This study provides further evidence that IL1B promoter polymorphisms may modulate the risk for development of lung cancer.

Oral cancer is one of the leading cancers in Thailand; southern Thai Muslims seem to have a longer delay in attending treatment for oral cancer than Buddhists in the same area. Visual screenings of high-risk populations have been suggested to be an effective prevention method. This study assessed oral cancer knowledge and belief attitudes influencing oral cancer screening in Thai Muslim high-risk groups. Twelve semi-structured in-depth interviews and the focus group discussion were conducted based on the health belief model. Stratified purposeful sampling was used to recruit the participants.

Participants lacked knowledge about oral cancer in terms of signs and symptoms and predisposing factors. This influenced misleading belief attitudes concerning susceptibility of oral cancer , barriers, and their self-efficacy to have oral cancer screening examinations. Betel quid chewing was not regarded as a risk habit but as having a protective role against the disease.

Perceived susceptibility was also seen by some to be dependent upon Allah's will. Traditional medication was mentioned as a preferred alternative to modern treatment. The latter was believed by some to be the cause of death for cancer patients. Interventions to promote oral cancer knowledge and right belief attitudes for oral cancer screening are clearly indicated. Current oral assessment scales are designed to assess the severity of oral health in cancer patients who have undergone radiotherapy or chemotherapy.

Currently, no scale is available that assesses the overall oral health situation of patients. However, this type of scale is critical for guiding nursing staff to understand the oral status of postoperative patients and for facilitating the development of patient-centered oral nursing treatments.

To develop the oral assessment scale for post-operational patients with oral cancer OASPOCa and establish its psychometric properties. The ten associated items of the OASPOCa were determined using a series of five professional council meetings and two verifications of content validity by 5 experts in the field of oral cancer care. A pilot study was conducted on 30 participants and a formal study was conducted on participants at the ICU and the oral and maxillofacial surgery ward at a medical center in southern Taiwan.

All of the participants were oral cancer patients who had been admitted to excise tumors of oral cancer. None of the participants had been treated previously for oral cancer using chemotherapy or radiotherapy. A content validity of 1. The inter-rater reliability assessment in the pilot study yielded ICCs of. This scale is a reliable tool for assessing the oral status of postoperative oral cancer patients. Matrix metalloproteinases MMPs play a critical role in inflammation and carcinogenesis, and the expression of mRNA MMP7 in oral squamous cell carcinoma tissues was higher than in the oral lichen planus or normal oral mucosa.

However, the genotypic role of MMP7 has never been examined in oral cancer. Therefore, in the current study we aimed to examine the contribution of genotypic variants in the promoter region of MMP7 AG and CT to oral cancer risk in Taiwan. In this hospital-based case-control study, patients with oral cancer and gender-and age-matched healthy controls were genotyped for MMP7 AG and CT via polymerase chain reaction-restriction fragment length polymorphism PCR-RFLP methodology.

The comparisons in allelic frequency distribution also support the findings that G allele may not be the risk determinant allele for oral cancer. There is no interaction between the genotypes of MMP7 with age, gender, smoking, alcohol or betel quid consumption on oral cancer risk.

Our results indicate that the MMP7 promoter genotypes only play an indirect role in determining the personal susceptibility to oral cancer in Taiwan. High dose rate brachytherapy for oral cancer. Brachytherapy results in better dose distribution compared with other treatments because of steep dose reduction in the surrounding normal tissues. Excellent local control rates and acceptable side effects have been demonstrated with brachytherapy as a sole treatment modality, a postoperative method, and a method of reirradiation. Low-dose-rate LDR brachytherapy has been employed worldwide for its superior outcome.

With the advent of technology, high-dose-rate HDR brachytherapy has enabled health care providers to avoid radiation exposure. This therapy has been used for treating many types of cancer such as gynecological cancer , breast cancer , and prostate cancer. However, LDR and pulsed-dose-rate interstitial brachytherapies have been mainstays for head and neck cancer. HDR brachytherapy has not become widely used in the radiotherapy community for treating head and neck cancer because of lack of experience and biological concerns. On the other hand, because HDR brachytherapy is less time-consuming, treatment can occasionally be administered on an outpatient basis.

For the convenience and safety of patients and medical staff, HDR brachytherapy should be explored. In particular, our studies have shown that superficial tumors can be treated using a non-invasive mold technique on an outpatient basis without adverse reactions. The next generation of image-guided brachytherapy using HDR has been discussed.

In conclusion, although concrete evidence is yet to be produced with a sophisticated study in a reproducible manner, HDR brachytherapy remains an important option for treatment of oral cancer. Contemporary management of cancer of the oral cavity. Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly.

Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers.

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With cancer survival rate climbing up over the past three decades, quality of life for cancer patients has become an issue of major concern. Oral health plays an important part in one's overall quality of life. However, oral health status can be severely hampered by side effects of cancer therapies including surgery, chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. Moreover, prevention and treatment of these complications are often overlooked in clinical practice.

The present paper aims at drawing health care professionals' attention to oral complications associated with cancer therapy by giving a comprehensive review. Brief comments on contemporary cancer therapies will be given first, followed by detailed description of oral complications associated with cancer therapy. Finally, a summary of preventive strategies and treatment options for common oral complications including oral mucositis, oral infections, xerostomia, and dysgeusia will be given. Challenges of the Oral Cancer Burden in India.

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Oral cancer ranks in the top three of all cancers in India, which accounts for over thirty per cent of all cancers reported in the country and oral cancer control is quickly becoming a global health priority. This paper provides a synopsis of the incidence of oral cancer in India by focusing on its measurement in cancer registries across the country. Based on the International Classification of Disease case definition adopted by the World Health Organisation, and the International Agency for Research on Cancer , this review systematically examines primary and secondary data where the incidence or prevalence of oral cancer is known to be directly reported.

Variability in age-adjusted incidence with crude incidence is projected to increase by Challenges focus on measurement of disease incidence and disease-specific risk behavior, predominantly, alcohol, and tobacco use. Future research should be aimed at improving quality of data for early detection and prevention of oral cancer. Breast cancer among young U. The associations were not further confounded by case-control differences in education, religion, breast feeding of offspring, or infertility; in oral contraceptive contraindications, indications, or complications; or in measures of breast cancer detection such as mammography or breast biopsy.

Long-term oral contraceptive use among young women or use beginning near menarche may be associated with a small excess breast cancer risk, possibly due to susceptibility to genetic damage in breast epithelial cells at ages of high breast cell proliferative activity. Future studies should investigate whether the patterns of risk we reported are present as this cohort ages. Cancer database is a systematic collection and analysis of information on various human cancers at genomic and molecular level that can be utilized to understand various steps in carcinogenesis and for therapeutic advancement in cancer field.

Oral cancer is one of the leading causes of morbidity and mortality all over the world. The current research efforts in this field are aimed at cancer etiology and therapy. Advanced genomic technologies including microarrays, proteomics, transcrpitomics, and gene sequencing development have culminated in generation of extensive data and subjection of several genes and microRNAs that are distinctively expressed and this information is stored in the form of various databases. Extensive data from various resources have brought the need for collaboration and data sharing to make effective use of this new knowledge.

The current review provides comprehensive information of various publicly accessible databases that contain information pertinent to oral squamous cell carcinoma OSCC and databases designed exclusively for OSCC. This paper also describes gene overlap in various databases, which will help researchers to reduce redundancy and focus on only those genes, which are common to more than one databases.

We hope such introduction will promote awareness and facilitate the usage of these resources in the cancer research community, and researchers can explore the molecular mechanisms involved in the development of cancer , which can help in subsequent crafting of therapeutic strategies. Oral cancer is a multifactorial disease process and involves complex interactions between gene to gene and gene to environmental factors. Interleukin 8 IL-8 , a pro-inflammatory cytokine, having angiogenic activity with elevated expression in tumor cells, is reported to play an essential role in oral cancer development.

This study was conducted with the aim to investigate the role of IL-8 -AT gene polymorphism in susceptibility , progression, and self-reporting pain in oral cancer. The single nucleotide polymorphisms of the IL-8 -AT gene were screened in patients with oral cancer and healthy controls, by polymerase chain reaction-restriction fragment length polymorphism. The results of the study demonstrated that IL-8 -AT gene polymorphism was significantly associated with susceptibility of oral cancer , whereas its correlation with clinico-pathological status or pain due to oral cancer could not be established.

The AT heterozygous OR 5. Furthermore, significantly increased values of A allele frequencies compared to T allele were observed in all patients OR 1. Tobacco chewing and smoking were also found to influence the development of oral cancer and increased the incidence of pain in oral cancer patients. The findings of this study suggest that the IL-8 -AT gene polymorphism may be associated with increased risk of oral cancer.

Implication for second primary cancer from visible oral and oropharyngeal premalignant lesions in betel-nut chewing related oral cancer. Visible oral and oropharyngeal premalignant lesions may be used to monitor for a second primary oral cancer. To control for bias, we focused on the visible oral and oropharyngeal premalignant lesions of patients with oral cancer with a positive betel-nut chewing habit. Visible oral and oropharyngeal premalignant lesions that can predict second primary oral cancers were studied.

Nine hundred ninety-seven patients with positive betel-nut chewing habits and oral cancer were enrolled in this retrospective cohort study. We analyzed the relevance of their visible oral and oropharyngeal premalignant lesion incidence and relative clinicopathological variables to the development of a second primary oral cancer.

Second primary oral cancer risk was significantly higher in patients with positive visible oral and oropharyngeal premalignant lesions P oral and oropharyngeal premalignant lesions make it a potentially valuable marker in follow-ups of patients with a positive betel-nut chewing habit with oral cancer , especially young patients with heterogeneous leukoplakia. Salivary mineral composition in patients with oral cancer. To analyse the mineral content of saliva in patients with oral cancer in order to identify possible markers that might aid the diagnosis of oral cancer.

The study group consisted of 34 patients, aged years with a diagnosis of oral cancer , including seven women and 27 men, before the start of treatment. Samples of unstimulated saliva were collected in plastic containers. The concentrations of sodium and potassium were assessed using ion selective electrodes, and the concentrations of calcium, magnesium, iron and phosphorus were assessed using colorimetric methods. Statistically significant differences between the study and control groups were found only for the concentration of sodium--higher concentrations were found in the study group.

When comparing different cancer localisations, the highest levels of salivary sodium were found in cases of cancer of the floor of the oral cavity, and the lowest levels in tongue or parotid gland cancer. The highest calcium levels were found in cancer of the floor of the oral cavity, and the lowest levels in tongue cancer. The highest levels of magnesium were found in cancer of the floor of the oral cavity, and the lowest in tongue cancer.

As regards the different histological types, higher sodium and calcium levels were found in squamous cell carcinomas than in other types. Salivary mineral content in patients with oral squamous cell carcinoma is indicative of oral dehydration; however, we found no evidence of any salivary mineral markers that would be useful for the diagnosis of oral cancer. Therapeutic strategies with oral fluoropyrimidine anticancer agent, S-1 against oral cancer. Oral cancer has been recognized as a tumor with low sensitivity to anticancer agents. However, introduction of S-1, an oral cancer agent is improving treatment outcome for patients with oral cancer.

In addition, S-1, as a main drug for oral cancer treatment in Japan can be easily available for outpatients. In fact, S-1 exerts high therapeutic effects with acceptable side effects. Moreover, combined chemotherapy with S-1 shows higher efficacy than S-1 alone, and combined chemo-radiotherapy with S-1 exerts remarkable therapeutic effects.

Furthermore, we should consider the combined therapy of S-1 and molecular targeting agents right now as these combinations were reportedly useful for oral cancer treatment. Here, we describe our findings related to S-1 that were obtained experimentally and clinically, and favorable therapeutic strategies with S-1 against oral cancer with bibliographic considerations. Mouth self-examination in a population at risk of oral cancer. Cancer of the oral cavity is a public health problem and many cases are not diagnosed until the disease has reached an advanced stage.

The aim of this study was to initiate an educational programme in self-examination for patients at risk from oral cancer. This quasi-experimental study set out to initiate an educational programme in self-examination for patients at risk from oral cancer , assessing the outcomes after three months. In individual minute face-to-face sessions, patients were given information and training in oral cancer risk factors and then verbal instructions as how to carry out oral self-examination. Three months later, patients were interviewed by telephone and asked if they had carried out self-examination independently at home.

The programme was evaluated by means of a health belief model questionnaire on perceived susceptibility 3 items , severity 8 items , benefits 4 items , barriers 8 items and efficacy 6 items. Eighty-six patients 37 females [ Logistic regression analysis indicated that patients who felt themselves subject to susceptibility OR: Toxicogenomics and Cancer Susceptibility: Advances with Next-Generation Sequencing. The aim of this review is to comprehensively summarize the recent achievements in the field of toxicogenomics and cancer research regarding genetic-environmental interactions in carcinogenesis and detection of genetic aberrations in cancer genomes by next-generation sequencing technology.

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Cancer is primarily a genetic disease in which genetic factors and environmental stimuli interact to cause genetic and epigenetic aberrations in human cells. Somatic mutations, resulting from either DNA damage induced by exposure to environmental mutagens or from spontaneous errors in DNA replication or repair are involved in the development or progression of the cancer.

Induced or spontaneous changes in the epigenome may also drive carcinogenesis. Advances in next-generation sequencing technology provide us opportunities to accurately, economically, and rapidly identify genetic variants, somatic mutations, gene expression profiles, and epigenetic alterations with single-base resolution.

Whole genome sequencing, whole exome sequencing, and RNA sequencing of paired cancer and adjacent normal tissue present a comprehensive picture of the cancer genome. These new findings should benefit public health by providing insights in understanding cancer biology, and in improving cancer diagnosis and therapy. Population genetic testing for cancer susceptibility: The current standard model for identifying carriers of high-risk mutations in cancer-susceptibility genes CSGs generally involves a process that is not amenable to population-based testing: Several studies have shown that application of these selection criteria results in a substantial proportion of mutation carriers being missed.

Population-based genetic testing has been proposed as an alternative approach to determining cancer susceptibility , and aims for a more-comprehensive detection of mutation carriers. Herein, we review the existing data on population-based genetic testing, and consider some of the barriers, pitfalls, and challenges related to the possible expansion of this approach. We consider mechanisms by which population-based genetic testing for cancer susceptibility could be delivered, and suggest how such genetic testing might be integrated into existing and emerging health-care structures.

The existing models of genetic testing including issues relating to informed consent will very likely require considerable alteration if the potential benefits of population-based genetic testing are to be fully realized. Detection of survivin mRNA in healthy oral mucosa, oral leucoplakia and oral cancer. Survivin is involved in modulation of cell death and cell division processes. Survivin expression in normal adult tissues has not been fully understood, although it is markedly lower than in cancer , where it is over-expressed. To investigate survivin expression in normal, potentially malignant and cancerous oral mucosa.

We measured survivin mRNA levels by real-time RT-PCR in specimens of oral mucosa 15 from normal mucosa, 17 from potentially malignant lesions, 17 from neoplasms. Scores were compared using Kruskal-Wallis test and post hoc according to Conover. Chi-squared test was used for dichotomous data. The median relative levels of survivin mRNA resulted six for normal mucosa, eight for potentially malignant lesions, 13 for cancers: Expression in normal mucosa and potentially lesions group showed no significant difference.

Low, but not marginal expression of survivin in normal mucosa is a new finding, and it could be explained with the higher sensibility of our methods. Survivin expression in oral potentially malignant lesions might indicate a progressive deregulation of expression paralleling oncogenesis, particularly during the first stages of process, suggesting a putative predictive role for survivin. Novel quantitative analysis of autofluorescence images for oral cancer screening.

However, its accuracy is heavily dependent on the examining physician's experience. This study was aimed toward the development of a novel quantitative analysis of autofluorescence images for oral cancer screening. Patients with either oral cancer or precancerous lesions and a control group with normal oral mucosa were enrolled in this study. The lesion in the image was chosen as the region of interest ROI.

The average intensity and heterogeneity of the ROI were calculated. A quadratic discriminant analysis QDA was utilized to compute boundaries based on sensitivity and specificity. A boundary of specificity of 0. The oral cancer and precancerous lesions could also be differentiated from normal oral mucosae with a specificity of 0. Common breast cancer susceptibility loci are associated with triple negative breast cancer. Triple negative breast cancers are an aggressive subtype of breast cancer with poor survival, but there remains little known about the etiological factors which promote its initiation and development.

Commonly inherited breast cancer risk factors identified through genome wide association studies GWAS display heterogeneity of effect among breast cancer subtypes as defined by estrogen receptor ER and progesterone receptor PR status. In the Triple Negative Breast Cancer Consortium TNBCC , 22 common breast cancer susceptibility variants were investigated in 2, Caucasian women with triple negative breast cancer and 4, healthy controls.

Together, our results provide convincing evidence of genetic susceptibility for triple negative breast cancer. Clinical implications of epigenetic regulation in oral cancer. Thus, individual genomic variants representing the genomic constitution and epigenetic alterations play a critical role in the development of oral cancer. Extensive epigenetic studies on the molecular lesions including oncogenes, tumor suppressor genes, genes associated with apoptosis, DNA damage repair have been reported.

The current review highlights epigenetic regulation with a focus on molecular biomarkers and epidrug therapy in oral cancer.

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Epigenetic regulation by hypermethylation, histone modifications and specific microRNAs are often associated with early events and advanced stages in oral cancer , and thus indicate epidrug therapy for intervention. The presence of epigenetic marks in oral lesions, cancers and tumor associated mucosa emphasizes indications as biomarkers and epidrugs with therapeutic potential for better patient management. Jack; Kim, Edward S. Patients with oral preneoplastic lesion OPL have high risk of developing oral cancer. Although certain risk factors such as smoking status and histology are known, our ability to predict oral cancer risk remains poor.

The study objective was to determine the value of gene expression profiling in predicting oral cancer development. Gene expression profile was measured in 86 of OPL patients who were enrolled in a clinical chemoprevention trial that used the incidence of oral cancer development as a prespecified endpoint. The median follow-up time was 6. Gene expression profiles were associated with oral cancer -free survival and used to develope multivariate predictive models for oral cancer prediction.

Based on the gene expression profile data, we also identified transcripts significantly associated with oral cancer risk associated genes P-value oral cancer risk. In multiple independent datasets, the expression profiles of the genes can differentiate head and neck cancer from normal mucosa. Our results show that gene expression profiles may improve the prediction of oral cancer risk in OPL patients and the significant genes identified may serve as potential targets for oral cancer chemoprevention.

To identify prostate cancer susceptibility genes, we applied a mutation screening of candidate gene approach. We screened for mutations in CHEK2 , the A total of 28 4. Sixteen of 18 unique CHEK2 mutations identified in this study were not detected among unaffected men, suggesting a. Infectious and dietary risk factors of oral cancer. In addition to the classic risk factors of oral cancer , namely alcohol and tobacco, other factors both infectious and environmental are thought to be associated with the development of oral malignancy.

Infections in the oral cavity may be an important preventable cause of cancer. Poor oral hygiene, periodontal disease, chronic candidiasis, human papilloma virus HPV and herpesvirus infections link statistically with cancer but the mechanisms involved are largely unknown.

Infections may trigger cell proliferation, inhibit apoptosis, interfere with cellular signaling mechanisms and up-regulate tumor promoters. In addition, several oral micro-organisms metabolize alcohol to carcinogenic acetaldehyde thus explaining the association between poor oral hygiene, alcohol consumption and carcinogenesis. With regards to dietary factors the Mediterranean-type fruit and vegetable rich diet has been shown to reduce the risk of oral cancer but the evidence is weak, the effect of individual food components and trace elements on carcinogenesis remains unclear at present.

Copyright Elsevier Ltd. Cancer susceptibility and reproductive trade-offs: The factors influencing cancer susceptibility and why it varies across species are major open questions in the field of cancer biology. One underexplored source of variation in cancer susceptibility may arise from trade-offs between reproductive competitiveness e. We build a model that contrasts the probabilistic onset of cancer with other, extrinsic causes of mortality and use it to predict that intense reproductive competition will lower cancer defences and increase cancer incidence.

We explore the trade-off between cancer defences and intraspecific competition across different extrinsic mortality conditions and different levels of trade-off intensity, and find the largest effect of competition on cancer in species where low extrinsic mortality combines with strong trade-offs. In such species, selection to delay cancer and selection to outcompete conspecifics are both strong, and the latter conflicts with the former. We discuss evidence for the assumed trade-off between reproductive competitiveness and cancer susceptibility.

Sexually selected traits such as ornaments or large body size require high levels of cell proliferation and appear to be associated with greater cancer susceptibility. Similar associations exist for female traits such as continuous egg-laying in domestic hens and earlier reproductive maturity. Trade-offs between reproduction and cancer defences may be instantiated by a variety of mechanisms, including higher levels of growth factors and hormones, less efficient cell-cycle control and less DNA repair, or simply a larger number of cell divisions relevant when reproductive success requires large body size or rapid reproductive cycles.

These mechanisms can affect intra- and interspecific variation in cancer susceptibility arising from rapid cell proliferation during reproductive maturation, intrasexual competition and reproduction. Lifestyle risk factors for oral cancer. The "style of life is the unique way in which individuals try to realize their fictional final goal and meet or avoid the three main tasks of life: Lifestyle refers to the way individuals live their lives and how they handle problems and interpersonal relations. Carcinogenicity is dose-dependent and magnified by multiple exposures.

Conversely, low and single exposures do not significantly increase oral cancer risk. These behaviours have common characteristics: For these reasons, effective Public Health measures aimed at preventing oral cancer and other lifestyle-related conditions. Oral Candida colonization in oral cancer patients and its relationship with traditional risk factors of oral cancer: Candida, an opportunistic fungal pathogen, has been implicated in oral and oesophageal cancers. This study aimed to examine oral Candida carriage in 52 oral cancer patients and age-, gender- and denture status-matched oral cancer -free subjects.

We assessed general health, smoking and alcohol drinking habits, use of alcohol-containing mouthwash and periodontal status community periodontal index of treatment needs. Conditional and binary logistic regressions were used to identify explanatory variables that are risk factors for oral cancer. No significant difference in the isolation profile of Candida species was found between the two groups, except C. Differences were noticed in the incidence of C. These results indicate that there is a significant association between oral cancer occurrence and Candida oral colonization and that the observed genotypic diversity of C.

The purpose of this study is to examine factors that influence the diagnostic ability of dental students with regards to oral cancer and oral potentially malignant disorders. Dental students at different levels of study were directly interviewed to examine their oral cancer knowledge and diagnostic ability using a validated and pre-tested survey instrument containing validated clinical images of oral cancer and oral potentially malignant disorders.

An oral cancer knowledge scale 0 to 31 was generated from correct responses on oral cancer general knowledge, and a diagnostic ability scale 0 to was generated from correct selections of suspicious oral lesions. Knowledge scores ranged from 0 to 27 mean Diagnostic ability scores increased with year of study and ranged from 0 to Clinical Trial Information A clinical trial is a study to answer Changing Trends in oral cancer - a global scenario.

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Oral cancer is one of the highly prevalent cancers worldwide and a leading cause of mortality in certain regions like South-Central Asia. It is a major public health problem. Late diagnosis, high mortality rates and morbidity are characteristics of the disease worldwide. For control of oral cancer an idea of the coverage of the same in the various regions is necessary. The estimated incidence, mortality and 5-year survival due to lip, oral cavity cancer in world is 3, 00, 2.

A changing trend in incidence and prevalence of oral cancer has been observed with more women and youngsters being affected by oral cancer. Metronomic chemotherapy in advanced oral cancers. To assess the feasibility of metronomic chemotherapy in the palliative care setting. To study the toxicity profile and efficacy of metronomic chemotherapy for palliation in oral cavity cancers. Retrospective analysis of prospectively collected data. Subjects receiving metronomic chemotherapy from August to January for palliation in oral cancers subjected to certain criteria were included.

The chemotherapy was continued till disease progression, intolerable side effects or patients' desire to stop. The toxicity profile was reported in accordance with common terminology criteria for adverse events CTCAE version 4. The efficacy was noted in terms of symptom control, response rates, progression free survival PFS and overall survival OS. SPSS version 16 has been utilized. Descriptive analysis has been presented. Eighteen patients with a median age of Five patients had received no previous treatment while the rest had some form of previous treatment. ECOG performance status was 1 in 14 patients and 2 in 4 patients.

Grade mucositis was seen in one patient. Clinical benefit rate was Use of metronomic chemotherapy seems promising and well tolerated in this setting. Large trials are warranted to confirm these results. Epigenetic susceptibility factors for prostate cancer with aging. Increasing age is a significant risk factor for prostate cancer.

The prostate is exposed to environmental and endogenous stress that may underlie this remarkable incidence. DNA methylation, genomic imprinting, and histone modifications are examples of epigenetic factors known to undergo change in the aging and cancerous prostate. In this review we examine the data linking epigenetic alterations in the prostate with aging to cancer development. An online search of current and past peer reviewed literature on epigenetic changes with cancer and aging was performed. Relevant articles were analyzed. Epigenetic changes are responsible for modifying expression of oncogenes and tumor suppressors.

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