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Oral Cancer

Descriptive epidemiology of oral and pharyngeal cancer over the last four decades is reviewed, with specific focus on Europe. Substantial rises in mortality rates have been observed for younger males, mostly in eastern Europe. The independent role of alcohol and tobacco and their interaction on oral carcinogenesis is discussed, since these factors account for about three quarters of oral cancers in Europe. The influence of dietary factors, and in particular of a diet poor in fresh fruit and vegetables on oral carcinogenesis, is also discussed, since diet may account for 10–15% of oral cancer cases in Europe. Finally, among other carcinogens, the possibility of human papillomavirus involvement in the aetiology of cancer of the oral cavity and pharynx is overviewed. Implications for prevention are discussed. There is as yet no evidence to support population screening for oral cancer, although the mouth is easy to examine, and the disease is common in certain parts of the world and/or subsegments of the population. Oral cancer screening programs have been carried out on several hundred thousands of individuals in developing countries (mostly India and Cuba) and several thousands in developed countries (mostly the U.S.A., U.K. and Italy). Especially in developed countries, lesions of the pharynx and larynx were also searched for. Substantial portions of individuals with suspicious lesions (around 10%), mostly leukoplakia, could be identified, but major difficulties were found in targeting highest-risk individuals and referring them to a specialised centre, when necessary. When oral inspection was repeated, relatively high incidence of oral cancer, after removal of prevalent cases, suggested a rather short sojourn time for preclinical cancer (in the order of one year). Oral cancer screening programmes would be greatly facilitated by screening tests able to anticipate the detection of a preclinical phase, compared to visual inspection, thus allowing screening intervals to be prolonged. Finally, even if dysplastic lesions of the oral cavity were better recognised and understood (e.g. as for intraepithelial lesions of the cervix uteri), surgical control of the disease would be harder than for the uterus, breast, or colon-rectum. The present investigation has examined the clinical benefits of tobramycin, polymyxin E and amphotericin therapy in the management of oral mucositis in children undergoing chemotherapy prior to bone marrow transplantation. Tobramycin, polymyxin E, and amphotericin reduced the degree of oral mucositis more than conventional therapy of diphenhydramine, Maalox, and local analgesic. While there was a statistically significant fall in the severity of the mucositis with tobramycin, polymyxin E and amphotericin, this was unlikely to be of practical benefit.

Last Updated on: May 20, 2024

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