Aproximadamente 3% das neoplasias malignas são originadas da cavidade bucal e representadas na maioria pelo carcinoma espinocelular (CEC). Estudos tem demostrado variações nas características clínico-epidemiológicas do CEC de boca de acordo com área geográfica da população estudada. A compreensão das características de uma população específica é importante por muitas razões, incluindo a compreensão da extensão do problema, fatores relacionados com seu desenvolvimento, seu diagnóstico e prognóstico. No entanto, poucos estudos têm sido relatados sobre essa lesão na população Uruguaia. O objetivo deste estudo foi avaliar o perfil demográfico, os aspectos clínicos e terapêuticos, assim como, os fatores prognósticos dos carcinomas espinocelulares de boca (CECB) diagnosticados em serviços públicos no Uruguai. Foram selecionados todos os prontuários médicos de pacientes com diagnóstico histopatológico de carcinoma espinocelular de boca primário atendidos no período de Janeiro 2000 a Dezembro de 2010 em Hospitais Públicos de Uruguai. Os prontuários foram avaliados manualmente e foram coletadas informações quanto aos dados demográficos, fatores de risco, características clínicas do tumor, tratamento e evolução. Foi confeccionado um banco de dados com as informações coletadas nos prontuários. A análise descritiva de todas as variáveis foi realizada e a existência de associação entre as variáveis independentes e os desfechos (estadiamento clínico e evolução) foi avaliada através do teste Qui-quadrado de Pearson e o teste de Fisher, o nível de significância estabelecido foi de 5%. Dentre os 200 prontuários de pacientes analisados, 79.4% eram homens com distribuição homem:mulher de 3.8:1. A média de idade foi de 60,75 anos. A análise univariada mostrou que o estadiamento clínico tem associação significativa com o tabagismo (p = 0,04), quantidade de tabaco (p = 0,018), aspecto clínico (p = 0,009), tamanho do tumor (p = 0,001) e metástases regionais (p = 0,001). Os homens portadores de CEC foram associados com o consumo de tabaco e álcool. O prognóstico desfavorável dos CECB (óbito) foi significativamente relacionado com aspecto clínico (p = 0,02), tamanho (p = 0,001), metástases regionais (p = 0,016), estadiamento clínico (p = 0,002) e tratamento (p = 0,001). A maioria dos pacientes com CECB que evoluiram a óbito (pior prognóstico), exibiram úlcera (93,9%), tamanhos avançados - T3/T4 (90,2%), metástases regionais (66%), foram classificadas no estágio III/IV (94,1%) e receberam tratamento não cirúrgico ou paliativos. Conclui-se que no Uruguai o diagnóstico do CECB é tardio e associado a baixas taxas de sobrevida. Medidas educativas e preventivas para a população assim como, investimentos em estratégias para melhorar o diagnóstico precoce devem ser uma meta neste país. / Nearly 3% of malignant neoplasms originate from the oral cavity and are mostly represented by squamous cell carcinoma (SCC). Studies have demonstrated variations in clinical and epidemiological features of oral SCC according to geographical area of the study population. Understanding the characteristics of a specific population is important for many reasons, including the comprehension of the extent of the problem, factors associated with their development, diagnosis and prognosis. However, few studies have been developed in Uruguayan population about this lesion. The aims of the present study were to evaluate the demographic, clinical and therapeutic features, as well as, the predictive factors of poor prognosis in patients with primary OSCC evaluated during a period of 10-years in public health services in Uruguay. Medical records of patients with histological diagnosis of primary OSCC treated between January 2000 and December 2010 in Uruguayan Public Hospitals were selected. Information regarding demographics, risk factors, clinical features, treatment and outcome was collected. A descriptive analysis was performed, and the existence of association between independent variables and outcomes (clinical stage and evolution) was assessed using the Pearson Chi-Square test and Fisher's test. Out of a total of 200 patients with OSCC, 79.4% were men with 3.8:1 male:female ratio. The mean age was 60.75 years. Univariate analysis showed that clinical stage have significant association with smoking (p=0,04), amount of tobacco (p=0.018), clinical aspect (p=0.009), tumor size (p=0.001) and regional metastasis (p=0.001). OSCC male patients were associated with tobacco and alcohol comsumption. Worse overall survival (poor prognosis) was significant associated with clinical aspect (p=0.02), size (p=0.001), regional metastasis (p=0.016), clinical stage (p=0.002) and treatment (p=0.001). The majority of OSCC patients with worse overall survival presented oral ulcer (93.9%), T3/T4 tumor size (90.2%), regional metastasis (66%), were classified at stage III/IV (94.1%) and received nonsurgical or palliatives treatment. We conclude that in Uruguay the diagnosis of OSCC is late associated to low survival rate. Educational and preventive measures for the population and investment in strategies to improve early diagnosis should be a goal in this country.

Orientador: Marcio Ajudarte Lopes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-10T15:19:18Z (GMT). No. of bitstreams: 1 Pinto_LucielmaSalmitoSoares_D.pdf: 2009810 bytes, checksum: e857bd28ac572f1423b462c29e7a2583 (MD5) Previous issue date: 2008 / Resumo: O carcinoma espinocelular (CEC) bucal recorre em cerca de 30% dos casos. O reconhecimento de fatores prognósticos confiáveis pode resultar na predição do comportamento tumoral e prevenção de falhas no tratamento. O objetivo deste estudo foi analisar a correlação entre as características clínicas, histopatológicas e imunohistoquímicas em casos de CEC bucal com recidiva local precoce. Desta forma, 69 casos de carcinoma bucal sem tratamento prévio para tumores de cabeça e pescoço foram selecionados, sendo que 23 apresentaram recidiva precoce e 46 sem recidiva. Informações clínicas foram obtidas dos prontuários e as características histopatológicas foram avaliadas de acordo com os sistemas de gradação de Anneroth et al. (1987) e Bryne et al. (1992). Reações imunohistoquímicas foram feitas para FAS e ErbB2. Nossos resultados mostraram uma predileção pelo gênero masculino (89,85%) com idade média de 55,5 anos. Apesar de não ser estatisticamente significante, observou-se um risco relativo de 2,62 e 2,89 para que usuários de fumo e o álcool desenvolvam recidiva local, respectivamente. Notou-se relação estatisticamente significante entre o tratamento apenas cirúrgico e o desenvolvimento de recidivas (p = 0,03). A soma dos escores de Anneroth et al. (1987) maior que 15 foi estatisticamente associada à recidiva (p = 0,03). Menor expressão de FAS e maior expressão de ErbB2 citoplasmático foram estatisticamente associadas à recidiva tumoral (p = 0,01). Estiveram associados à pior sobrevida: o uso de álcool (p = 0,0028), e piores escores obtidos nos parâmetros queratinização (p < 0,0001), padrão de invasão (p < 0,0001) e inflamação (p < 0,0001) segundo Anneroth et al. (1987). A maior expressão de FAS esteve também significativamente associada à maior sobrevida global dos pacientes (p = 0,0002). Apesar de não estatisticamente significante, FAS foi correlacionada com a queratinização (p = 0,08) e de forma significante estatisticamente, a queratinização relacionou-se com ErbB2 expresso em membrana (p = 0,0006). De acordo com os nossos resultados, sugerimos a utilização do sistema de Anneroth et al. (1987), bem como o estudo imunohistoquímico com os marcadores FAS e ErbB2 para melhor compreensão do comportamento dos CECs bucais / Abstract: Oral squamous cell carcinoma (SCC) recurs locally in about 30% of cases. The recognition of reliable factors may result in the tumor behavior prediction and prevent treatment failures. The purpose of this study was to evaluate the correlation among clinical, histopathological and immunohistochemical features in oral SCC with early local recurrence. Sixty-nine cases of oral SCC without previous treatment for head and neck tumors were selected, being: 23 cases with early local recurrence and 46 cases without recurrence. Clinical data were obtained from the medical records and the histopathological features were assessed according Anneroth¿s and Bryne¿s histological grading of malignancy. Immunohistochemical reactions for FAS and ErbB2 were performed. Our results showed a male predilection (89.85%), with a mean age of 55.5 years. Although there were no statistical differences, relative risks of 2.62 and 2.89 were observed for smokers and alcohol drinkers have local recurrence, respectively. Significant differences were observed between surgical treatment and local recurrence (p = 0.03). The sum of the Anneroth¿s histological grading degrees exceeding 15 was statistically associated to local recurrence (p = 0.03). Lower FAS and more cytoplasmic ErbB2 expression were statistically correlated to local recurrence (p = 0.01). An association between overall survival and alcohol use was observed (p = 0.0028). The parameters keratinization (p < 0.0001), mode of invasion (p < 0.0001) and lymphoplasmocytic infiltration (p < 0.0001) according Anneroth¿s histological grading were related to overall survival. More FAS expression was also associated with better overall patients survival (p = 0.0002). Although there was no statistical difference, FAS was related to keratinization (p = 0.08), similar but statistically, keratinization was associated with membrane ErbB2 expression (p = 0.0006). According our results, we suggest the use of Anneroth¿s histological grading system as well as the immunohistochemical markers FAS and ErbB2, for best comprehension of OSCC¿s behavior / Doutorado / Estomatologia / Doutor em Estomatopatologia

Aproximadamente 3% das neoplasias malignas são originadas da cavidade bucal e representadas na maioria pelo carcinoma espinocelular (CEC). Estudos tem demostrado variações nas características clínico-epidemiológicas do CEC de boca de acordo com área geográfica da população estudada. A compreensão das características de uma população específica é importante por muitas razões, incluindo a compreensão da extensão do problema, fatores relacionados com seu desenvolvimento, seu diagnóstico e prognóstico. No entanto, poucos estudos têm sido relatados sobre essa lesão na população Uruguaia. O objetivo deste estudo foi avaliar o perfil demográfico, os aspectos clínicos e terapêuticos, assim como, os fatores prognósticos dos carcinomas espinocelulares de boca (CECB) diagnosticados em serviços públicos no Uruguai. Foram selecionados todos os prontuários médicos de pacientes com diagnóstico histopatológico de carcinoma espinocelular de boca primário atendidos no período de Janeiro 2000 a Dezembro de 2010 em Hospitais Públicos de Uruguai. Os prontuários foram avaliados manualmente e foram coletadas informações quanto aos dados demográficos, fatores de risco, características clínicas do tumor, tratamento e evolução. Foi confeccionado um banco de dados com as informações coletadas nos prontuários. A análise descritiva de todas as variáveis foi realizada e a existência de associação entre as variáveis independentes e os desfechos (estadiamento clínico e evolução) foi avaliada através do teste Qui-quadrado de Pearson e o teste de Fisher, o nível de significância estabelecido foi de 5%. Dentre os 200 prontuários de pacientes analisados, 79.4% eram homens com distribuição homem:mulher de 3.8:1. A média de idade foi de 60,75 anos. A análise univariada mostrou que o estadiamento clínico tem associação significativa com o tabagismo (p = 0,04), quantidade de tabaco (p = 0,018), aspecto clínico (p = 0,009), tamanho do tumor (p = 0,001) e metástases regionais (p = 0,001). Os homens portadores de CEC foram associados com o consumo de tabaco e álcool. O prognóstico desfavorável dos CECB (óbito) foi significativamente relacionado com aspecto clínico (p = 0,02), tamanho (p = 0,001), metástases regionais (p = 0,016), estadiamento clínico (p = 0,002) e tratamento (p = 0,001). A maioria dos pacientes com CECB que evoluiram a óbito (pior prognóstico), exibiram úlcera (93,9%), tamanhos avançados - T3/T4 (90,2%), metástases regionais (66%), foram classificadas no estágio III/IV (94,1%) e receberam tratamento não cirúrgico ou paliativos. Conclui-se que no Uruguai o diagnóstico do CECB é tardio e associado a baixas taxas de sobrevida. Medidas educativas e preventivas para a população assim como, investimentos em estratégias para melhorar o diagnóstico precoce devem ser uma meta neste país. / Nearly 3% of malignant neoplasms originate from the oral cavity and are mostly represented by squamous cell carcinoma (SCC). Studies have demonstrated variations in clinical and epidemiological features of oral SCC according to geographical area of the study population. Understanding the characteristics of a specific population is important for many reasons, including the comprehension of the extent of the problem, factors associated with their development, diagnosis and prognosis. However, few studies have been developed in Uruguayan population about this lesion. The aims of the present study were to evaluate the demographic, clinical and therapeutic features, as well as, the predictive factors of poor prognosis in patients with primary OSCC evaluated during a period of 10-years in public health services in Uruguay. Medical records of patients with histological diagnosis of primary OSCC treated between January 2000 and December 2010 in Uruguayan Public Hospitals were selected. Information regarding demographics, risk factors, clinical features, treatment and outcome was collected. A descriptive analysis was performed, and the existence of association between independent variables and outcomes (clinical stage and evolution) was assessed using the Pearson Chi-Square test and Fisher's test. Out of a total of 200 patients with OSCC, 79.4% were men with 3.8:1 male:female ratio. The mean age was 60.75 years. Univariate analysis showed that clinical stage have significant association with smoking (p=0,04), amount of tobacco (p=0.018), clinical aspect (p=0.009), tumor size (p=0.001) and regional metastasis (p=0.001). OSCC male patients were associated with tobacco and alcohol comsumption. Worse overall survival (poor prognosis) was significant associated with clinical aspect (p=0.02), size (p=0.001), regional metastasis (p=0.016), clinical stage (p=0.002) and treatment (p=0.001). The majority of OSCC patients with worse overall survival presented oral ulcer (93.9%), T3/T4 tumor size (90.2%), regional metastasis (66%), were classified at stage III/IV (94.1%) and received nonsurgical or palliatives treatment. We conclude that in Uruguay the diagnosis of OSCC is late associated to low survival rate. Educational and preventive measures for the population and investment in strategies to improve early diagnosis should be a goal in this country.

O Carcinoma espinocelular (CEC) é o mais comum das neoplasias malignas da cavidade oral. Corresponde a cerca de 70 a 90% dos cânceres orais. Há aproximadamente 200.000 novos casos por ano no mundo. No Brasil são estimados cerca de 14.120 novos casos de câncer oral por ano. A literatura atual tem demonstrado uma alteração do perfil clínico do paciente portador de CEC em relação às quatro décadas passadas. Avaliamos os dados clínicos disponíveis de 665 pacientes diagnosticados com CEC da cavidade oral atendidos na Disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo entre os anos de 1970 a 2009. As variáveis estudadas foram: idade, gênero, etnia e sitio primário do tumor. Os dados foram analisados estatisticamente entre as décadas. Os dados gerais encontrados revelaram que dos 665 casos analisados, 512 (76,99%) eram homens e 143 (21,50%) mulheres, sendo 538 (80,9%) leucodermas, 98 (14,74%) melanodermas, 15 (2,26%) feodermas e 14 (2,11%) xantodermas.Os sítios mais acometidos foram, o assoalho bucal com 150 (22,56%) casos, seguido pela língua com 142 (21,35%), mandíbula 88 (13,23%), palato 72 (10,83%), lábios 62 (9,32%), rebordo e fundo de sulco 31 (4,66%), outros (trígono retromolar, , mucosa jugal e tonsilas) com 94 (14,14%) e 26 (3,91%) sem dados. A idade média geral encontrada foi de 56,81 anos, sendo que nos homens foi de 55,88 anos e nas mulheres de 60,07 anos. Quanto ao gênero, na década de 70, os homens representavam 86% dos casos e na última década 74%, passando de uma relação de 5,93 H/M para 3,32 H/M, resultando em uma redução de 44% na relação homem / mulher. Quando se compara a idade entre as quatro décadas, observamos um aumento das idades médias, de 55,1 anos na primeira década para 60,07 anos na quarta década, porém sem relevância estatística. Pacientes leucodermas foram os mais acometidos na primeira década com 87,56% dos casos e na última com 76,55%, enquanto os melanodermas responderam por 6,47% dos casos na década de 70 e por 19,91% na última década. Não foi possível encontrar alterações significativas do perfil clínico dos pacientes com CEC entre as décadas analisadas. / Squamous cell carcinoma (SCC) is the most common malignancy of the oral cavity, accounting for up to 90% of oral cancers and, in Brazil, there are approximately 14,120 new cases of oral cancer per year. Current literature has shown a change in the clinical profile of patients with SCC in relation to the past four decades. We evaluated the clinical data of 665 patients diagnosed with SCC of the oral cavity treated at the Department of Stomatology Clinic, School of Dentistry, University of São Paulo between 1970 and 2009. The variables studied were age, gender, ethnicity, and primary tumor site. Data were statistically analyzed between the decades. The data revealed that out of 665 cases, 512 (76.99%) were men and 143 (21.50%) women. In the 70\'s, men accounted for 86% of cases and 74% in the last decade, with a ratio of 5.93 Male / Female to 3.32 M / F, a 44% reduction in the male to female ratio. In this cohort, 538 (80.9%) were Caucasian, 98 (14.74%) were Melanoderm, 15 (2.26%) were Mulatto, and 14 (2.11%) were Asian. Caucasian patients were the most affected in the first decade with 87.56% of cases and the last with 76.55%, while the black patients accounted for 6.47% of cases in the 70s and 19.91% in the last decade. The most common affected site was the floor of the mouth (150; 22.56%), followed by tongue (142; 21.35%), mandible (88; 13.23%), palate (72; 10.83%), lips (62; 9.32%), alveolar ridge and fornix (31; 4.66%), or other, e.g., retromolar trigone, buccal mucosa and tonsils (94; 14.14%). Twenty-six (3.91%) cases had no data. The mean age was 56.71, 55.88 years for men and 60.07 years for women. When comparing the age of four decades, an increase of the mean ages of 55.1 years in the first decade to 60.07 years in the fourth decade, but without statistical significance. In conclusion, this study did not find significant changes in the clinical profile of patients with SCC over time.

RESUMO O objetivo deste estudo foi avaliar o conhecimento de cirurgiões dentistas inscritos em cursos de estética quanto aos fatores predisponentes e de diagnóstico do câncer bucal, a partir de um questionário previamente testado. O desenvolvimento de materiais e técnicas odontológicas e o anseio cada vez maior do ser humano em busca da beleza têm levado um número crescente de pacientes aos consultórios odontológicos. Julgamos este momento oportuno para informar a população e diagnosticar precocemente o câncer de boca. Com relação às características gerais dos 465 participantes, houve predominância de uma população jovem, com idade inferior a 39 anos, maior participação feminina e quase 1/3 formados de 10 a 20 anos. As características clínicas da ocorrência desta neoplasia não estão claras para os entrevistados, uma vez que somente metade indicou o carcinoma espinocelular como o tipo mais comum, e aproximadamente metade tem conhecimento das características do linfonodo em metástase cervical. Cerca de 20% desconhece a região da boca e a faixa etária de maior ocorrência deste tumor, e também o seu aspecto inicial. Entretanto, 75,7% reconhecem a leucoplasia como a condição mais comumente associada ao câncer bucal. Com relação aos fatores de risco, o consumo de tabaco, história familiar e consumo de álcool estão claros para quase todos os participantes, mas, em se tratando das demais condições apresentadas como fatores de risco, as dúvidas e contradições estão evidentes. Na prática clínica relacionada ao câncer de boca, observa-se que 14,2% não realizam exames para identificar lesões bucais, sendo que, destes, 80,3% não sabem como fazê-lo. Apenas 5,8% realizam procedimentos de diagnóstico, com a grande maioria considerando regular ou insuficiente seu conhecimento na área. Somente 16,6% têm confiança para realizar o diagnóstico. Mais da metade está há mais de 5 anos sem realizar um curso de atualização em câncer de boca, apesar de terem interesse em faze-lo no futuro. Concluindo, os cirurgiões dentistas ainda não apresentam conhecimento e treinamentos ideais para difundir os meios de prevenção e detecção precoce do câncer de boca. / ABSTRACT The purpose of this paper is assessing the knowledge of dentists who are registered at aesthetics courses as for predisposing and diagnosis factors of oral cancer, through a previously tested questionnaire. The development of odontological materials and techniques allied to a longing of a human being who is more and more in search of beauty, has taken an increasing number of patients to odontoligical consultation rooms. We consider this an opportune moment to inform the population and to do the early diagnosis of oral cancer. On what concerns the general characteristics of the 465 participants, there was a predominance of a young population, whose age was under 39 years, more female participation and almost 1/3 who had been graduated for 10 to 20 years. The clinical characteristics of this neoplasia occurrence are not clear for the persons interviewed, since only half of them have indicated the spinocellular carcinoma as the most common one and approximately half of them are aware of the lymph node characteristics in cervical metastasis. Around 20%, ignores the region of the mouth and the age group where this tumor occurs more frequently, and also its initial aspect. Notwithstanding, 75,7% recognizes the leucoplasia as the condition more frequently associated with oral cancer. On what concerns risk factors, the use of tobacco, family history and alcohol intake are clear for almost all the participants, but on what refers to the other conditions presented as risk factors, the doubts and contradictions are evident. On the clinical practice related to oral cancer, it is observed that 14,2% don’t do examinations for identifying buccal lesions, and among these ones, 80,3% don’t know how to do it. Only 5,8% does diagnosis procedures, and the great majority considers their knowledge in the area, regular or insufficient. Only 16,6% has enough confidence to do the diagnosis. In spite of being interested in doing courses in the future, more than half of them have not taken any upgrading course on oral cancer for more than 5 years. Concluding, the dentists still don’t present ideal knowledge and training to diffuse the means for prevention and early detection of mouth cancer.

Objetivo. Investigar o papel da dieta no câncer oral. Métodos. Este estudo utilizou dados do Município de São Paulo obtidos em um estudo multicêntrico tipo caso-controle de base hospitalar. Participaram 845 indivíduos (366 casos incidentes de câncer oral e 469 controles). Os dados de consumo alimentar foram obtidos por um questionário de freqüência alimentar (QFA). Verificou-se o risco associado ao consumo de alimentos e de grupos de alimentos definidos a priori e a posteriori, por análise fatorial, estes últimos denominados \"fatores\". O primeiro fator, rotulado como \"prudente\", caracterizou-se pelo consumo de vegetais, frutas, queijo e carne de aves. O segundo, \"tradicional\", pelo consumo de arroz e massas, feijão e carne; o terceiro fator, pelo consumo de pão, manteiga, embutidos, queijos, doces e sobremesas. O último fator, \"monótono\", associou-se negativamente ao consumo de frutas, vegetais e alimentos lácteos. Após categorização dos fatores dietéticos em tercis, foram estimados os valores da Razão de Chances e Intervalos de Confiança de 95 por cento por regressão logística múltipla não condicional. Resultados. Verificaram-se associações inversas para o consumo mais elevado de feijão e vegetais crus e para o tercil intermediário de arroz e massas; e diretas para o consumo de ovos, batata e leite. O padrão tradicional associou-se inversamente ao câncer oral, e o monótono positivamente. Nossos dados sugerem que a dieta tradicional do brasileiro, composta por arroz e feijão, além do consumo de frutas, vegetais e quantidades moderadas de carnes, pode conferir proteção para o câncer oral, independente de fatores de risco reconhecidos, como o fumo e o consumo alcoólico. / Objective: to identify dietary factors related with oral cancer in the city of São Paulo, Brazil. Methods: this study is part of a Latin American multicentre hospital based case-control. Participated 366 incident cases of oral cancer in Sao Paulo City, and 469 controls, frequency matched with cases by sex and age. The dietary data was collected by a food frequency questionnaire (FFQ). The risk associated to the intake of food and food groups, defined a priori and a posteriori, through factor analysis (so-called factors) was analyzed. The first factor, labeled \"prudent\', was characterized for the intake of vegetables, fruits, cheese and poultry. The second, \"traditional\', for the intake of rice, pasta, pulses and meat, while the third, named \"snacks\" was characterized for the intake of bread, butter, salami, cheese, cakes and desserts. The last, \"monotonous\", was associated inversely with the intake of fruits, vegetables and most of the others food items. After categorization of the food items and the scores of the factors into tertiles, the Odds Ratio and 95 per cent Confidence lnterval were calculated by unconditional multiple logistic regression. Results: The intake of rice, beans and raw vegetables was associated with lower risk, whereas eggs, potatoes and milk were associated with increased risk. The traditional pattern was inversely related with the oral cancer, while the monotonous was positively associated. Conclusions: Our data suggest that the Brazilian traditional habit of eating meals composed by rice and beans, plus moderated quantities of meat, may conter protection against the oral cancer, independent of other risk factors, as alcohol and tobacco consumption.

Oral cancer is the 6th most common cancer in the world, with a poor prognosis and frequent late-stage diagnosis, which significantly impacts survival and quality of life. The key to better control of this disease is early detection, preferably at a precancerous stage. In order to facilitate this early detection and diagnosis, it is critical to identify the factors potentially impacting on the time lag from initial detection to diagnostic biopsy. The overall goal is to develop effective strategies for early identification of oral cancers in order to achieve better control over this disease. There are 2 components in this thesis: the objectives of part I (personal interview) were 1) to develop an interview-style questionnaire, 2) to collect data from patients with high-risk oral lesions (HRL’s) and 3) to characterize the experiences of these individuals that may have impacted the time interval leading up to diagnosis. The objectives of Part II (focus group discussion) were 1) to gather feedback regarding the questionnaire developed in Part I, 2) to obtain recommendations for future planning and delivery of province-wide questionnaire and 3) as a group, to share information on patients’ experiences to diagnosis and patients’ perspectives on their interactions with health professionals (HP’s) throughout this journey. An interview-style questionnaire was developed to collect both qualitative and quantitative data on patients’ experiences. Forty patients with HRL’s diagnosed within 12 months were recruited and interviewed in the Dysplasia Clinic of the BC Oral Cancer Prevention Program. Two focus groups were conducted and feedback from participants regarding the questionnaire and patients’ experiences was recorded. Among 40 patients interviewed, 21 (53%) initially self-identified their lesions (SIG) and 19 (47%) were identified by health professional screening (PSG; 84% by dental professionals). The SIG showed higher rates of invasive SCC at diagnosis as compared to those in the PSG (76% vs. 32%, P = 0.01) and SIG took twice as long to have the initial biopsy performed as the PSG (23 ± 52 vs. 11 ± 28 months). Notably, the main symptom of patients in SIG was pain or presence of non-healing ulcers (18/21; 86%). In contrast, all lesions in PSG were asymptomatic. The mean time from detection to diagnosis was 17.5 ± 42.3 months (range: 0-240 months). Fourteen patients (35%) experienced a time lag of greater than 6 months from first detection of an oral lesion until the first diagnostic biopsy was performed. Both patient and professional factors impact on the time lag. The main contributing factors for this time lag include both patient factors (a lack of concern, fear, and a lack of oral cancer awareness) and the professional factors (lack of knowledge in differentiating high-risk lesions, delay in initiating the referral or ‘watch and wait’, and delay in scheduling of referral appointments to the specialists). Focus group results supported the format and content of the questionnaire, provided input in designing of future province-wide survey and emphasized that patients require continued post-diagnostic and treatment care. A general lack of awareness of oral cancer in general population and in HP’s in addition to a lack of screening activities have been brought forward as critical factors that result in delay to diagnosis. In conclusion, these results suggest HP’s, especially dental professionals, can play a critical role in early identification of HRL’s at an asymptomatic, pre-invasive stage through regular screening. Strategies in raising awareness of oral cancer in both the general population and among HP’s are essential for early identification of oral cancers in order to achieve better control over this disease. / Dentistry, Faculty of / Graduate

Magister Chirurgiae Dentium - MChD / Background and Aims: While a single “high quality” oral liquid based cytology (LBC) study has shown a high sensitivity and specificity for the technique in detection of oral dysplasia and malignancy, the high unit cost of this technology cannot be borne by the developing African countries. This study aims to evaluate the efficiency of an alternative cost-effective technique, Shandon PapSpin (PS) LBC in diagnosis of oral and oropharyngeal dysplasia and malignancy. Materials and Methods.We compared the diagnostic accuracy of Shandon PS LBC with that of scalpel biopsy in 69 patients. Transepithelial cytology specimens were obtained using a cervical Cytobrush. The cytology specimens were graded and scored using a novel oral cytologic grading and scoring system respectively. Results: Histological diagnosis of dysplasia or invasive squamous cell carcinoma was made in 51 of the 69 cases. Histology confirmed the cytological diagnosis of dysplasia or malignancy in 49 of the 51 cases. There were two false negative and no false positive cases. The sensitivity was 96% and the specificity 100%. The cytologic grade correlated positively with histologic grade. The best cut off value for distinguishing reactive/mildly dysplastic lesions from high 9 grade/invasive squamous cell carcinoma was determined as a cytologic score of 3, representing a sensitivity of 95% and a specificity of 96%. Conclusion: The Shandon PS LBC in association with transepithelial brush biopsy technique (TBBT) is a highly sensitive, specific and economical screening test in detection of oral and oropharyngeal dysplasia and malignancy. The proposed oral cytologic grading system correlates well with histology. The novel oral cytologic scoring system shows promise as a simple, reliable and reproducible scoring system. In addition, the liquid residual allows for immunocytochemical (Podoplanin) testing. / South Africa

Magister Scientiae - MSc / Oral cancer is characterised by marked geographical differences in frequency and site preference as reported by various studies. In South Africa, a few studies have been reported on the patterns and aetiology of oral cancer, and age standardised incidence rates (ASIR). Studies in several countries have shown an increase in oral cancer incidence among younger people. Title: Epidemiology of oral cancer in South Africa 1996-2002. Aim and Objective: The aim of this study was to determine the age standardised incidence rates (ASIR) of oral cancer by age, gender, race and site in South Africa for a consecutive period of seven years. Method: Pathology case records of oral cancer diagnosed over a seven-year period from 1996 to 2002 and reported to the National Cancer Registry (NCR) were analysed for age, sex, race, and date of diagnosis, basis of diagnosis, topography and tumour type. The data was tabulated and categorised using Microsoft Excel. The South African population size for each year of the study was estimated by linear extrapolation using the 1996 and 2001 census results. Age standardisation incidence rates against the world population were calculated by the standard direct method. Results: The total number of oral squamous cell carcinoma cases over the 7-year period was 9702. The majority of cases (34%) were on the tongue. The male to female ratio was 1:3. The age standardized incidence rates in this study was lower among African women; (0.640 per 100000 per year) and the highest was 13.40 new cases per 100000 per year (coloured males). Lip cancer was highest among both males and females of the white population. The cumulative rate of developing oral cancer was 1:83 and 1:32 for males and females respectively. / South Africa

The National Cancer Registry (NCR) of South Africa publishes pathology-based cancer incidence in the country and is the main cancer data source. The data published by the NCR have been used extensively in the development of the draft national guidelines for cancer prevention and control as well as for cancer research. The list of contributing pathology laboratories is fairly inclusive. As far as Oral Cancer is concerned, the Department of Oral Pathology, University of Limpopo, has however not submitted data to the NCR. It is therefore reasonable to assume that because of this, a large proportion of histologically diagnosed oral cancers are not reflected in the NCR. Materials and methods: Data from the National Cancer Registry and the University of Limpopo, Department of Oral Pathology for the five years 1997-2001 were combined and then filtered for sites in the oral and oropharyngeal region. Age- Standardised Incidence Rates (ASIR) and the Cumulative Lifetime Risk (LR) for males and females in the different population groups were determined. Conclusion: It is possible that the total ASIR for oral and oropharyngeal cancer has increased in South Africa. The incidence of oral and oropharyngeal cancer in individuals below the age of 45 years in South Africa is higher than the global average. / Dissertation (MChD)--University of Pretoria, 2013. / Oral Pathology and Oral Biology / unrestricted