Cáncer oral: etiología, lesiones precancerosas y tratamiento / Oral cancer: etiology, precancerous lesions and treatment

Introducción: el cáncer oral es una de las neoplasias malignas más comunes en el mundo, sin embargo, a pesar de las herramientas diagnósticas actuales, existe un alto grado de morbilidad y mortalidad debido al diagnóstico tardío y a la falta de conciencia por parte de la población sobre el consumo de tabaco, alcohol, entre otras sustancias. Objetivo: el objetivo de la presente revisión es brindar información actual sobre las lesiones precancerosas, etiología, diagnóstico y tratamiento del cáncer oral. Material y métodos: se realizó una búsqueda bibliográfica en cinco bases de datos digitales sobre artículos revisados por pares desde el 2015 hasta la actualidad. Conclusión: el cáncer oral es una patología frecuente que causa graves consecuencias y secuelas en las personas que lo padecen, un conocimiento amplio de las lesiones premalignas junto con el diagnóstico temprano por parte del profesional y una mayor conciencia sobre los factores de riesgo, juegan un papel fundamental para prevenir la presencia y desarrollo de esta patología (AU)

Introduction: oral cancer is one of the most common malignant neoplasms in the world, despite the current diagnostic tools, there is a high degree of morbidity and mortality due to late diagnosis and lack of awareness of the population on the consumption of tobacco, alcohol, among other substances. Objective: the objective of this review is to provide present information of the precancerous lesions, etiology, diagnosis and treatment of oral cancer. Material and methods: a bibliographic search was carried out in five digital databases on peerreviewed articles from 2015 to the present. Conclusion: oral cancer is a frequent pathology that can cause serious consequences and sequelae in people who suffer it, an extensive knowledge of premalignant lesions among with an early diagnosis by the professional and a greater awareness of risk factors, play a fundamental role to prevent the establishment and/or progression of this pathology (AU)

Oral squamous cell carcinomas: state of the field and emerging directions / 国际口腔科学杂志·英文版

Oral squamous cell carcinoma (OSCC) develops on the mucosal epithelium of the oral cavity. It accounts for approximately 90% of oral malignancies and impairs appearance, pronunciation, swallowing, and flavor perception. In 2020, 377,713 OSCC cases were reported globally. According to the Global Cancer Observatory (GCO), the incidence of OSCC will rise by approximately 40% by 2040, accompanied by a growth in mortality. Persistent exposure to various risk factors, including tobacco, alcohol, betel quid (BQ), and human papillomavirus (HPV), will lead to the development of oral potentially malignant disorders (OPMDs), which are oral mucosal lesions with an increased risk of developing into OSCC. Complex and multifactorial, the oncogenesis process involves genetic alteration, epigenetic modification, and a dysregulated tumor microenvironment. Although various therapeutic interventions, such as chemotherapy, radiation, immunotherapy, and nanomedicine, have been proposed to prevent or treat OSCC and OPMDs, understanding the mechanism of malignancies will facilitate the identification of therapeutic and prognostic factors, thereby improving the efficacy of treatment for OSCC patients. This review summarizes the mechanisms involved in OSCC. Moreover, the current therapeutic interventions and prognostic methods for OSCC and OPMDs are discussed to facilitate comprehension and provide several prospective outlooks for the fields.

Pro-and Anti-inflammatory Biomarkers as Potential Prognosis Markers in Oral Squamous Cell Carcinoma / Biomarcadores Pro y Antiinflamatorios como Posibles Marcadores de Pronóstico en el Carcinoma Oral de Células Escamosas

ABSTRACT: The most widely used method to classify prognostic factors in cancers today is TNM. However, Oral Squamous Cell Carcinoma (OSCC) often demonstrates different behaviors in relation to aggressiveness and therapeutic response at the same TNM stage. So, in such cases biomarkers can be used to identify the biological diversity of these tumors more reliably, leading to better therapeutic strategies and disease management. The presence of inflammatory immune cells in the tumor microenvironment can have pro or antitumor effects and the investigation of the expression of inflammatory markers in OSSC can be usefulto design immunotherapeutic interventions. The Transforming Growth Factor alpha is a potent stimulator of cell migration that acts on cell proliferation, invasion and metastasis of cancer, as well as immune suppression and angiogenesis. Inflammatory cytokines, such as Interferon-gamma, mediate macrophage differentiation. Macrophages are an important component of the OSCC microenvironment. The greater amount of tumor-associated macrophages, especially the M2 phenotype, may be associated with a more aggressive biological behavior of the OSCC and, consequently, with reduced survival.

RESUMEN: El método más utilizado para clasificar los factores de pronóstico en los cánceres en la actualidad es TNM. Sin embargo, el carcinoma oral de células escamosas (COCE) a menudo muestra diferentes comportamientos en relación con la agresividad y la respuesta terapéutica en la misma etapa TNM. Entonces, en tales casos, los biomarcadores pueden usarse para identificar la diversidad biológica de estos tumores de manera más confiable, lo que lleva a mejores estrategias terapéuticas y manejo de la enfermedad. La presencia de células inmunes inflamatorias en el microambiente tumoral puede tener efectos pro o antitumorales y la investigación de la expresión de marcadores inflamatorios en COCE puede ser útil para diseñar intervenciones inmunoterapéuticas. El factor de crecimiento transformante α es un potente estimulador de la migración celular que actúa sobre la proliferación celular, la invasión y metástasis del cáncer, así como la inmunosupresión y la angiogénesis. Las citocinas inflamatorias, como el IFN-γ, median en la diferenciación de macrófagos. Los macrófagos son un componente importante del microambiente COCE. La mayor cantidad de macrófagos asociados a tumores, especialmente el fenotipo M2, puede estar asociada a un comportamiento biológico más agresivo del COCE y, en consecuencia, a una menor supervivencia.

Malignant neoplasms of the oral cavity and oropharynx treated in Brazil: what do hospital cancer records reveal? / Neoplasias malignas da cavidade oral e orofaringe tratadas no Brasil: o que revelam os registros hospitalares de câncer?

Abstract Introduction: Head and neck cancer has an impact on the global burden of diseases, representing an important cause of morbidity and mortality in Brazil, as well as worldwide. Objective: To learn and describe the clinical, epidemiological and care configuration provided to patients with cancer of the oral cavity and oropharynx recorded in Brazil, diagnosed from 2007 to 2016. Methods: This is a cross-sectional study, carried out using secondary hospital-based data, using the indirect documentation technique. Results: There were 52,799 hospital records of oral cavity cancer and 34,516 cases of oropharyngeal cancer in the assessed period. There was a predominance of male patients, aged 50-59 years, mostly Caucasians, and with a low level of schooling. Throughout the period there was a significant reduction in the positive history of alcohol and tobacco consumption, except for alcoholic beverages in oral cavity cancer. Most patients were diagnosed at an advanced stage of the disease (III or IV). Most patients with oral cavity cancer had no evidence of the disease on follow-up, while most patients with oropharyngeal cancer died. The first most frequent treatment offered to patients with oral cavity cancer was surgery, while for patients with oropharyngeal cancer it chemoradiotherapy predominated. Conclusion: Despite the fact that, in general, there was a reduction in the records of patient alcohol and tobacco consumption, the increase in the number of medical consultations, the predominantly late diagnosis and the patients' low level of schooling indicate the need for health education, primary prevention and early diagnosis of cancer of the oral cavity and oropharynx.

Resumo Introdução: O câncer de cabeça e pescoço impacta a carga global de doenças, representa importante causa de morbimortalidade no Brasil e no mundo. Objetivo: Conhecer e descrever a compleição clínica, epidemiológica e assistencial dos atendimentos a pacientes com câncer de cavidade oral e orofaringe registrados no Brasil, diagnosticados de 2007 a 2016. Método: Estudo transversal, feito a partir de dados secundários de base hospitalar, por meio de técnica de documentação indireta. Resultados: Houve 52.799 registros hospitalares de câncer de cavidade oral e 34.516 casos de câncer de orofaringe no período considerado. Predominaram pacientes do sexo masculino, da faixa etária de 50-59 anos, predominantemente branca, e de baixo nível de escolaridade. Ao longo do período houve redução expressiva do histórico positivo de consumo de bebida alcoólica e tabaco, exceto para bebida alcoólica no câncer de cavidade oral. A maioria dos pacientes foi diagnosticada em estágio avançado da doença (III ou IV). A maior parte dos pacientes de câncer de cavidade oral apresentava-se sem evidência da doença, enquanto que grande parte dos pacientes com câncer de orofaringe evoluiu a óbito. O primeiro tratamento mais frequente oferecido aos pacientes com câncer de cavidade oral foi cirurgia, enquanto para os pacientes com câncer de orofaringe foi a quimioradioterapia. Conclusão: Apesar de se observar, de maneira geral, redução dos registros do consumo de bebida e tabaco, o aumento do número de atendimentos, o diagnóstico tardio predominante e o baixo nível de escolaridade dos pacientes apontam para a necessidade da educação em saúde, de prevenção primária e do diagnóstico precoce do câncer de cavidade oral e orofaringe.

Carcinogénesis Oral y Epigenética / Oral Carcinogenesis and Epigenetics

A pesar de que los procesos epigenéticos son estudiados ampliamente de forma general, no se habían relacionado, hasta ahora, a las alteraciones genéticas más tradicionales asociadas en la etiopatogenia del cáncer oral. La visión de carcinogénesis tradicional y la de la epigenética convergen en las mismas vías moleculares involucradas en el desarrollo del cáncer, potenciándose durante el proceso de carcinogénesis oral. A continuación se realizará una revisón de las siguientes vías moleculares VEGF-C /VEGFR; HB-EGF /EGFR; Wnt /B-catenina y las ciclinas, desde un punto de vista genético y epigenético para establecer su conexión durante el proceso de carcinogénesis oral.

Although epigenetic processes are widely studied, no one has related them to the classical genetic processes in oral cancer etiopathogenesis. The traditional carcinogenesis and epigenetic views converge in the same molecular pathways involved in cancer development, enhancing this process. This review will approach the VEGF-C/VEGFR, HB-EGF/EGFR, Wnt /B-catenin, and cyclins molecular pathways from the genetic and epigenetic views to establish their connection during the oral cancer process.

Displasia fibrosa monostótica simulando proceso neoformativo intraoral en una paciente con sida. Primer caso reportado en esta población / MONOSTOTIC FIBROUS DYSPLASIA SIMULATING A NEOPROLIFERATIVE INTRAORAL NEOPLASM IN A FEMALE WITH AIDS. FIRST CASE REPORTED IN THIS POPULATION

Objetivo: Los pacientes con enfermedad por el virus de la inmunodeficiencia humana suelen presentar lesiones orales, hasta en un 50% de los casos con diagnóstico de sida. La displasia fibrosa es una lesión intra-ósea caracterizada por una alteración del crecimiento y diferenciación de los osteoblastos debida a una mutación genética. Clínicamente se caracteriza por presentar una tumoración de lento crecimiento con dolor, deformidad ósea y, en ocasiones, fracturas ante traumas mínimos. Caso clínico: Se presenta una paciente con sida y tuberculosis diseminada que desarrolló una lesión ósea tumoral , con compromiso de paladar y encía superior derecha, cuyo diagnóstico histopatológico fue de displasia fibrosa de paladar óseo y maxilar superior. Conclusión: La displasia fibrosa debe incluirse en el diagnóstico diferencial de las lesiones tumorales orales de los pacientes con enfermedad VIH/sida.

Aim: Patients with human immunodeficiency virus infection usually have oral lesions, including up to 50% of patients diagnosed with AIDS. Fibrous dysplasia is an intra-bone lesion, characterized by an alteration of the growth and differentiation of osteoblastes produced by a genetic mutation. Clinically it is characterized by presenting a tumor of slow growth with pain, bone deformity and sometimes fractures to minimal trauma. Clinical case: Here we describe a patient with AIDS and disseminated tuberculosis who developed a large tumor lesion that involve the hard palate and the maxilla. Final histopathological diagnosis was of fibrous dysplasia involving the hard palate and the upper maxilla. Conclusion: fibrous dysplasia should be included in the differential diagnosis of intraoral tumor lesions in HIV/AIDS patients.

Prevalence of Lip and Tongue Squamous Cell Carcinoma (Scc) at a Pathological Anatomy Service in Northeast Brazil / Prevalencia del Carcinoma de Celulas Escamosas en Labios y Lengua (SCC) en un Servicio de Anatomía Patológica en el Noreste Brasil

The aim of this work was to trace an epidemiological and clinical profile of oral squamous cell carcinoma (SCC) cases diagnosed as lip and tongue SCC from June 2001 to 2018 at a pathology anatomy service located in Northeastern Brazil. Age, sex, duration, location, growth type, staining, metastasis, etiologic agents and lesion size data were obtained fr om patient clinical files and histopathological reports. A total of 124 cases were recorded, with tongue SCC being the most preval ent. The common characteristics of both assessed SCCs included higher frequency in men, mean age of 60 years old, evidence mostly of exophytic lesions and maximum size of 4 cm, predominantly diagnosed after a maximum of 1 year of appearance. Regarding divergent findings, lip SCC occurred mostly in the lower portion of the lip, presenting a predominantly leukoplastic color, with regular smoking habits and sunlight identified as the main etiological agents, and no strong relation to metastasis. On the other hand, tongue SCC mostly exhibiting predominantly erythroleukoplastic staining, with a greater relationship to alcohol - associated smoking and regular smoking habits. The highest percentage of patients with metastasis presented tongue SCC. Although lip and tongue SCC display a male preference, an increasing amount of female involvement has been noted over the years, due to the adoption of deleterious habits such as smoking and alcoholism. Tongue SCC presented a greater relationship with metastasis and clinical leukoeritroplastic evidence. This greater aggressiveness could be related to the unfavorable locat ion of these lesions in relation to lip SCC, sometimes making it difficult to identify in their early development stages.

El objetivo de este trabajo fue rastrear un perfil epidemiológico y clínico de los casos de carcinoma oral de células escamosas (CCE) diagnosticados como CCE de labios y lengua entre junio de 2001 y 2018 en un servicio de anatomía patológica ubicado en el Noreste de Brasil. Los datos de edad, sexo, duración, ubicación, tipo de crecimiento, tinción, metástasis, agentes etiológicos y tamaño de la lesión se obtuvieron de los archivos clínicos de los pacientes y los informes histopatológicos. Se revisaron un total de 124 casos, siendo el CCE de lengua el más prevalente. Las características comunes de ambos CCE evaluados incluyeron mayor frecuencia en hombres, edad promedio de 60 años, evidencia mayoritariamente de lesiones exofíticas y tamaño máximo de 4 cm, diagnosticado predominantemente después de un máximo de 1 año de aparición. En cuanto a los hallazgos divergentes, el CCE labial se presentó mayoritariamente en la porción inferior del labio, presentando un color predominantemente leucoplásico, con el hábito de fumar habitualmente y la luz solar identificados como los principales agentes etiológicos, sin una fuerte relación con las metástasis. Por otro lado, el CEC de la lengua presenta en su mayoría tinción predominantemente eritroleucoplásica, con una mayor relación con el tabaquismo asociado con el alcohol y con los hábitos habituales de tabaquismo. El mayor porcentaje de pacientes con metástasis presentó CCE de lengua. Aunque el CCE de labios y lengua muestra una preferencia en hombres, se ha observado una cantidad cada vez mayor prevalencia en mujeres a lo largo de los años, debido a la adopción de hábitos nocivos como el tabaquismo y el alcoholismo. El CCE de lengua presentó una mayor relación con la metástasis y la evidencia clínica leucoeritroplásica. Esta mayor agresividad podría estar relacionada con la ubicación desfavorable de estas lesiones en relación al CCE labial, dificultando en ocasiones su identificación en sus primeras etapas de desarrollo.

Avaliação da fala pré-tratamento e pós-tratamento fonoaudiológico associado ao biofeedback ultrassonográfico de língua e de prótese bucomaxilofacial no câncer de cavidade oral / Evaluation of speech before and after speech therapy associated with ultrasound biofeedback of tongue and bucomaxillofacial prosthesis in oral cavity cancer

RESUMO As próteses bucomaxilofaciais (PBMF) têm como objetivo a reabilitação oral de pacientes com mutilações decorrentes de cirurgias de câncer de boca. Como parte dessa reabilitação oral, a terapia fonoaudiológica associada ao biofeedback ultrassonográfico da língua possibilita melhor precisão da produção de fala. O presente estudo teve por objetivo caracterizar a produção de fala de um indivíduo com histórico de múltiplas cirurgias oncológicas que levaram à glossectomia total, com auxílio de um dispositivo individualizado de acrílico, idealizado a partir da parceria Odonto-Fonoaudiologia da instituição e confeccionado por especialista em PBMF e terapia fonoaudiológica, utilizando o biofeedback visual com ultrassonografia. O indivíduo era homem, 45 anos, professor aposentado com histórico de carcinoma epidermóide de língua com episódios de recidiva. Como tratamento oncológico, foram realizadas diversas cirurgias associadas à radioterapia, ao longo de sete anos. O tratamento oncológico culminou com a glossectomia total e instalação de osteorradionecrose de mandíbula. O tratamento desta sequela da radioterapia também exigiu múltiplas abordagens cirúrgicas, com perda de grande parte da mandíbula, levando ao severo comprometimento das funções de deglutição e fala. Durante o atendimento multiprofissional da equipe Odonto-Fonoaudiologia de um hospital universitário, foi idealizada a confecção de um dispositivo individualizado de acrílico, objetivando melhorar a inteligibilidade da fala do paciente. Tal dispositivo foi confeccionado por dentista especialista em PBMF e ajustado em conjunto com a equipe de Fonoaudiologia. Com o dispositivo de acrílico adaptado, o indivíduo iniciou a terapia fonoaudiológica associada ao biofeedback, por meio da ultrassonografia de língua, com o objetivo de promover o refinamento da produção de fala dos fones fricativos [s] e [∫]. Ao comparar a avaliação pré-terapia e pós-terapia, foi possível identificar, após a análise das falas por juízes, melhora quanto à Porcentagem de Consoantes Corretas, de moderadamente severa para levemente moderada, bem como a inteligibilidade de fala, de insuficiente para regular. O dispositivo individualizado com a terapia fonoaudiológica associada ao biofeedback produziram resultados de fala satisfatórios, considerando-se a gravidade do caso e o elevado grau de mutilação do paciente.

ABSTRACT The oral maxillofacial prostheses (PBMF) aim the oral rehabilitation of patients with mutilations resulting from oral cancer surgery. The oral rehabilitation was composed of speech therapy associated with ultrasound biofeedback of the tongue, which allows better precision in speech production. The present study aims to characterize the speech production of an individual with a history of multiple oncological surgeries with total glossectomy with the aid of an individualized acrylic device, designed based on the partnership between Dentistry and Speech Therapy and made by a prosthetic dentist, undergoing therapy and speech therapy with visual biofeedback by ultrasound. The individual is a 45-year-old man, retired teacher with a history of tongue squamous cell carcinoma with episodes of recurrence. The cancer treatment was performed by several surgeries associated with radiotherapy over seven years. This treatment resulted in total glossectomy and the presence of osteoradionecrosis (ORN) of the mandible. The sequel to radiotherapy also required multiple surgical approaches with loss of a large part of the jaw, causing severe impairment of swallowing and speech functions. During the multidisciplinary care provided by the Dentistry and Speech Therapy team at a university hospital. The creation of an individualized acrylic device was conceived, aiming to improve the speech intelligibility of the patient. This device was made by a prosthetic dentist and adjusted together with the Speech Therapy team. With the adapted acrylic device, the individual started speech therapy associated with biofeedback by means of tongue ultrasound with the aim of promoting the refinement of the speech production of the fricative headphones [s] and [∫]. When comparing the pre-therapy and post-therapy assessment (after the analysis of the speeches by judges) it was possible to identify an improvement in the Percentage of Consonants Correct (PCC) from moderately-severe to slightly-moderate, as well as speech intelligibility from insufficient to regulate. The individualized device with speech therapy associated with biofeedback produced satisfactory speech results, considering the severity of the case and the high degree of mutilation of the patient.

Extensive malignant melanoma of the oral cavity: a rare occurrence

Primary malignant melanoma of the oral cavity is a rare tumor in clinical practice. Extensive malignant melanomas are still very rare in the literature. Patients with malignant melanoma of oral cavity are often diagnosed at the advanced stage of the disease due to their painless and nonspecific radiological findings. Histopathology is the gold standard for the final diagnosis and staging of the tumor. Surgery followed by radiotherapy is the standard treatment offered to patients with malignant melanoma. Here we present a rare case of extensive malignant melanoma of oral cavity which was successfully managed by surgical excision followed by adjuvant radiotherapy.

Progress in application of near-infrared fluorescence imaging in the diagnosis and treatment of oral cancer / 中南大学学报(医学版)

The preliminary screening of oral cancer mostly depends on the experience of clinicians, The surgical margin of tumor is mostly based on physical examination and preoperative imaging examination. It lacks real-time and objective intraoperative evaluation methods. Indocyanine green (ICG), as a safe and pollution-free organic fluorescent pigments, combined with near-infrared fluorescence imaging can be applied in the screening of early oral cancer, the determination of tumor resection margins, sentinel lymph node biopsy, cervical lymph node dissection, targeted chemotherapy, and other aspects. Near-infrared fluorescence imaging may become a key link in the early diagnosis and accurate treatment for oral cancer in the future.

Peripheral T-cell lymphoma not otherwise specified with oral manifestation: a case report / Linfoma periférico de células T no especificado con manifestación oral: reporte de caso

Peripheral T-Cell Lymphoma Not Otherwise Specified it is a rare type of Non-Hodgkin t-cells malignant tumor whose oral manifestations are difficult to diagnose. A case of a 48-year-old male with a hemi-maxillary lesion histological and immunohistochemically compatible with Peripheral T-Cell Lymphoma not otherwise specified is presented. A case of a 48-year-old male with a hemi-maxillary lesion histological and immunohistochemically compatible with Peripheral T-Cell Lymphoma not otherwise specified is presented. The patient treatment consisted of chemotherapy, but after the second cycle, died from immunosuppressive complications. Early stage diagnosis of oral lesions is imperative to avoid aggressive treatment and low overall survival rate of such pathologies.

Introducción: El linfoma periférico de células T no especificado es un tipo raro de tumor maligno no Hodgkin de células T cuyas manifestaciones orales son difíciles de diagnosticar. Se presenta el caso de un varón de 48 años con lesión hemimaxilar histológica e inmunohistoquímicamente compatible con linfoma periférico de células T no especificado. El tratamiento del paciente consistió en quimioterapia, pero después del segundo ciclo, falleció por complicaciones inmunosupresoras. El diagnóstico temprano de las lesiones orales es imperativo para evitar un tratamiento agresivo y la baja tasa de supervivencia.

Oral Squamous Cell Carcinoma Associated with Arsenic Exposure: A Case Series from Argentina / Carcinoma Oral de Células Escamosas Asociado con la Exposición al Arsénico: Una Serie de Casos de Argentina

ABSTRACT: Many areas of South America are directly affected by Arsenic (As) contaminated groundwater. A high percentage of the water samples taken in multiple areas of Argentina had As concentrations above the WHO level recommended guidelines. This condition was previously associated with an increased risk of chronic diseases, including different cancers. Long-term As exposure was proposed as a risk factor for Oral Squamous Cell Carcinoma (OSCC). The aim of this study is to present a series cases of Argentine patients diagnosed with OSCC who have consumed water contaminated with As for more than 10 years. Clinical data were obtained from the archive of Clinical Records Histories of the Oral Medicine Department of the Dentistry School, Universidad Nacional de Córdoba and Universidad Católica de Córdoba, Argentina. 15 cases of OSCC were included. The male: female sex ratio was 2:1. The average age was 66 years (31-89 years). Regarding location, the gum or edentulous alveolar ridge was the most prevalent site (6/15; 40 %), followed by the tongue margin. The average years of exposure to arsenical waters were 24 years (13 - 40 years of exposure). The majority of the presented cases were non drinkers non smokers. 60 % of the tumors were diagnosed at advanced stages. the epidemiological studies carried out in As-contaminated areas that address oral cancer should always incorporate the record of variables related to As exposure. Patients who live or lived at As-contaminated areas must be regularly followed up for early diagnosis of potentially malignant or malignant lesions. The high frequency of gum cancer among these cases, should raise awareness of periodontic specialists to perform a careful and thorough periodontal examination.

RESUMEN: Muchas regiones de América del Sur están directamente afectadas por aguas subterráneas contaminadas con arsénico (As). Un alto porcentaje de las muestras de agua tomadas en múltiples áreas de Argentina tenían concentraciones de As superiores al nivel aprobado por la OMS. Esta condición se asociaba previamente con un mayor riesgo de enfermedades crónicas, incluidos diferentes tipos de cáncer. La exposición a largo plazo se propuso como un factor de riesgo para el carcinoma oral de células escamosas (OSCC). El objetivo de este estudio es presentar una serie de casos de pacientes diagnosticados con OSCC que han consumido agua contaminada con As durante más de 10 años. Se obtuvieron datos clínicos del archivo de Historias de registros clínicos del Departamento de Medicina Oral de la Facultad de Odontología, Universidad Nacional de Córdoba y Universidad Católica de Córdoba, Argentina. Se incluyeron 15 casos de OSCC. La relación de género masculino: femenino fue de 2: 1. La edad promedio fue de 66 años (31-89 años). En cuanto a la ubicación, la encía o la cresta alveolar edéntula fue el sitio más frecuente (6/15; 40 %), seguido del borde de la lengua. El promedio de años de exposición a las aguas arsenicales fue de 24 años (13 - 40 años de exposición). La mayoría de los casos presentados fueron de pacientes no bebedores y no fumadores. El 60 % de los tumores fueron diagnosticados en etapas avanzadas. Los estudios epidemiológicos realizados en áreas contaminadas con As que abordan el cáncer oral siempre deben incorporar el registro de variables relacionadas con la exposición a As. Se debe hacer un seguimiento continuo de los pacientes que viven o que vivieron en áreas contaminadas con As para el diagnóstico temprano de lesiones potencialmente malignas. La alta frecuencia de cáncer de encías en estos casos, debe concienciar a los especialistas en periodoncia para que realicen un examen periodontal cuidadoso y completo.

Anti-micro rna-221 a promising genetic therapy of oral squamous cell carcinoma (scc-25)

Abstract Micro-RNA-221(miR-221) is one of oncogenic miRNAs that plays a vital role in the development and progression of oral cancers. The aim of this study is to introduce a new gene therapy for oral squamous cell carcinoma by blocking the expression of oncogenic miR-221 by its inhibitor. The present work was performed on squamous cell carcinoma cell line SCC-25 and anti-miR-221 was delivered to the cells using an ultrasound micro bubbles. Assessment of the effect of miR-221 inhibitor on SCC-25 cells was done using MTT assay, cell cycle analysis and apoptosis detection. In addition, reverse transcription-polymerase chain reaction was also used to detect the expression -miR-221 and its target genes. Using ANOVA, statistical analysis of the results showed significant inhibition of cell viability with and induction of cell apoptosis of SCC-25 cell line after transfection. Moreover, the expression of miR-221, Epidermal growth factor receptor (EGFR) and CDKNIB/p27 were downregulated without significant difference. Transfection of SCC-25 by inhibitor of miR-221 resulting in blockage of its expression leading to arresting of tumor growth. These results proved the effective role of micro-RNA inhibitors as novel therapeutic agent for oral cancers.

Resumo Micro-RNA-221 (miR-221) é um dos miRNAs oncogênicos que desempenham um papel vital no desenvolvimento e progressão de carcinomas orais. O objetivo deste estudo é apresentar uma nova terapia gênica para o carcinoma epidermóide oral por meio do bloqueio da expressão do miR-221 oncogênico por seu inibidor. O presente trabalho foi realizado na linhagem de células de carcinoma de células escamosas SCC-25 e o anti-miR-221 foi administrado às células usando micro-bolhas de ultrassom. A avaliação do efeito do inibidor miR-221 em células SCC-25 foi feita usando ensaio de MTT, análise do ciclo celular e detecção de apoptose. Além disso, a reação em cadeia da polimerase com transcrição reversa também foi usada para detectar a expressão -miR-221 e seus genes-alvo. Usando ANOVA, a análise estatística dos resultados mostrou inibição significativa da viabilidade celular e indução da apoptose celular da linhagem celular SCC-25 após a transfecção. Além disso, a expressão de miR-221, receptor do fator de crescimento epidérmico (EGFR) e CDKNIB/p27 foram regulados para baixo sem diferença significativa. A transfecção de SCC-25 por inibidor de miR-221 resultou no bloqueio de sua expressão, levando à interrupção do crescimento do tumor. Esses resultados comprovaram o papel eficaz dos inibidores de micro-RNA como novo agente terapêutico para carcinomas orais.

Abordagem dos cirurgiões-dentistas da Estratégia Saúde da Família sobre o câncer bucal / Analysis of the dental surgeon approach of the Familt Health Strategy on the oral cancer

Objetivo: este estudo busca analisar a atuação dos cirurgiões-dentistas da rede pública de saúde acerca do câncer bucal. Método: trata-se de um estudo transversal no qual foram entrevistados 217 dentistas. A coleta de dados foi realizada por meio de um questionário estruturado, enviado via e-mail, pelo Conselho Regional de Odontologia do Rio Grande do Norte. Resultados: um terço dos profissionais relatou ser capaz de realizar biópsias e citologia esfoliativa, mas apenas 15,2% das unidades de saúde possuíam condições materiais para fazê-las. Cerca de 85% dos cirurgiões-dentistas possuíam o conhecimento básico sobre o câncer bucal e 66,8% realizavam ações educativas-preventivas. Conclusão: embora a maioria dos cirurgiões-dentistas tivessem conhecimento adequado para realizar o diagnóstico bucal, a maioria não era capaz de realizar procedimentos cirúrgicos com finalidade diagnóstica. A realização desse exame durante a atenção primária é perfeitamente possível, por necessitar de baixa complexidade de equipamentos, e sua eficácia no diagnóstico permite a detecção precoce e o início do tratamento em estágios iniciais da doença, podendo reduzir as taxas de mortalidade por câncer bucal.(AU)

Objective: this study sought to analyze the performance of dental surgeons in the public health network regarding oral cancer. Method: this is a cross-sectional study in which 217 dentists were interviewed. Data collection was conducted through a structured questionnaire sent via e-mail, by the Regional Council of Dentistry of Rio Grande do Norte. Results: one third of the professionals reported being able to perform biopsies and exfoliative cytology, but only 15.2% of the Health Units had material conditions to carry them out. About 85% of dental surgeons had basic knowledge about oral cancer, and 66.8% performed educational- preventive actions. Conclusion: although most dental surgeons had adequate knowledge to perform the oral diagnosis, most of them were not able to perform surgical procedures for diagnostic purposes. The performance of this exam in primary care is perfectly possible because it requires low equipment complexity, and its effectiveness in diagnosis allows for early detection and initiation of treatment in the early stages of the disease, which can reduce oral cancer mortality rates.(AU)

Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus / 华西口腔医学杂志

Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.

Sclerotherapy of benign oral vascular lesions with non-diluted ethanolamine oleate / Escleroterapia de lesiones vasculares orales benignas con oleato de etanolamina no diluido

Benign oral vascular lesions are anomalies characterized by the blood vessels proliferation or malformation and the treatment with the sclerosing agent ethanolamine oleate acts irrigating the vessel producing a sterile inflammatory response. The objective of this study was to report and discuss the results from treatment of benign oral vascular lesions with non-diluted ethanolamine oleate through the analysis of clinical records. The sample was composed by the selection of twenty-six patients (12 male and 14 female), with oral vascular malformations. All lesions were treated with intralesional injections of undiluted ethanolamine oleate. These patients attended in Oral Medicine outpatient clinic of the Federal University of Paraná between the years of 2011 to 2015. The average age was 60.65 years, with a higher prevalence for women. The majority of the individuals had one lesion and its location was mostly in the lower lip. The main complaint was about a physical discomfort. The lesions had the average size of 6.52 mm and received a median number of 2.32 applications. Only one patient reported feeling pain in the postoperative week. In most cases the resolution of the lesion was considered partial. Follow-up was obtained up to one month after the end of treatment. The sclerotherapy with undiluted ethanolamine oleate shows acceptable results in the treatment of small benign oral vascular lesions with a few minor side effects.

Las lesiones vasculares orales benignas son anomalías caracterizadas por la proliferación o malformación de los vasos sanguíneos y el tratamiento con el agente esclerosante etanolamina oleato actúa irrigando el vaso produciendo una respuesta inflamatoria estéril. El objetivo de este estudio fue informar y discutir los resultados del tratamiento de lesiones vasculares orales benignas con oleato de etanolamina no diluido a través del análisis de historias clínicas. La muestra estuvo compuesta por la selección de veintiséis pacientes (12 hombres y 14 mujeres), con malformaciones vasculares orales. Todas las lesiones fueron tratadas con inyecciones intralesionales de oleato de etanolamina sin diluir. Estos pacientes acudieron a la clínica ambulatoria de Medicina Oral de la Universidad Federal de Paraná entre los años 2011 a 2015. La edad promedio fue de 60,65 años, con una mayor prevalencia para las mujeres. La mayoría de los individuos tenían una lesión y su ubicación era principalmente en el labio inferior. La queja principal era sobre una molestia física. Las lesiones tenían un tamaño promedio de 6,52 mm y recibieron una mediana de 2,32 aplicaciones. Solo un paciente informó haber sentido dolor en la semana postoperatoria. En la mayoría de los casos, la resolución de la lesión se consideró parcial. El seguimiento se obtuvo hasta un mes después del final del tratamiento. La escleroterapia con oleato de etanolamina sin diluir muestra resultados aceptables en el tratamiento de pequeñas lesiones vasculares orales benignas con algunos efectos secundarios menores.

Necessidades humanas de cuidado no homem em tratamento cirúrgico oncológico: implicações para a enfermagem / Necesidades humanas de cuidado en el hombre en tratamiento cirúrgico oncológico: implicaciones para la enfermería / The human care needs for men undergoing oncological surgical treatment: implications towards the nursing profession

Objective: The study's goal has been to identify the basic human needs of men undergoing oncologic surgical treatment and its implications for nursing care. Methods: It is a descriptive study with a qualitative approach. The scenario is the Nursing Consultation Ambulatory, INCA-RJ. The participants were 25 men bearing mouth neoplasm under exclusively surgical treatment. Study approved by the Research Ethics Committee under the CAAE No. 52647116430015274. Data collection was carried out through a semi-structured interview. The Bardin's thematic content analysis was used. Results: Three thematic categories emerged, as follows: the human needs for health care of the physical body; the human needs for social health care and the human needs for spiritual health care. Conclusion: The human needs affected by organic imbalances point to the importance of planning a care service that provides an effective result to human health necessities

Objetivo: Identificar as necessidades humanas básicos da saúde do homem em tratamento cirúrgico oncológico e suas implicações para o cuidado de enfermagem. Método: Estudo descritivo, qualitativo. Cenário ambulatório de Consulta de Enfermagem, INCA-RJ. Participantes foram 25 homens com neoplasia de boca em tratamento exclusivamente cirúrgico. Após aprovação do CEP n°52647116430015274. A coleta de dados foi à entrevista semiestruturada. Utilizou-se a análise temática de conteúdo de Bardin. Resultados: Emergiram três categorias temáticas: as necessidades humanas de cuidado à saúde do corpo físico; as necessidades humanas de cuidado a saúde social e as necessidades humanas de cuidado a saúde espiritual. Conclusão: Deste modo, as necessidades humanas afetadas com desequilíbrios orgânicos, aponta a importância de planejar um cuidado que proporcione resultado efetivo às necessidades à saúde do homem

Objetivo: Identificar las necesidades humanas básicas de la salud del hombre en tratamiento quirúrgico oncológico y sus implicaciones para el cuidado de enfermería. Método: Estudio descriptivo, cualitativo. Escenario ambulatorio de Consulta de Enfermería, INCA-RJ. Los participantes fueron 25 hombres con neoplasia de boca en tratamiento exclusivamente quirúrgico. Tras la aprobación del CEP n ° 52647116430015274. La recolección de datos fue a la entrevista semiestructurada. Se utilizó el análisis temático de contenido de Bardin. Resultados: emergieron tres categorías temáticas: las necesidades humanas de cuidado de la salud del cuerpo físico; Las necesidades humanas de cuidado de la salud social y las necesidades humanas de cuidado de la salud espiritual. Conclusión: De este modo, las necesidades humanas afectadas con desequilibrios orgánicos, apunta la importancia de planificar un cuidado que proporcione resultado efectivo a las necesidades de la salud del hombre

Determination of Factors Associated with Critical Weight Loss in Oral Cavity Carcinoma Patients: A Retrospective Cohort Study

Abstract Introduction Critical weight loss is defined as an unintentional weight loss of ≥ 5% at 1 month or ≥ 10% at 6 months from the start of treatment. Critical weight loss leads to deterioration of the immune function and reduced tolerance to treatment (surgery ± radiochemotherapy) as well as increased complication rates. Objective Critical weight loss, defined as a weight loss of ≥ 5% after 1 month or ≥ 10% after 6 months from the start of treatment, is not uncommon in head and neck cancer patients. We aimed to assess the factors associated with critical weight loss during the treatment of oral cavity squamous cell carcinoma patients. Methods A retrospective cohort study was performed at the Aga Khan University Hospital, in Karachi, Pakistan, on 125 patients. Patients receiving adjuvant therapy were considered exposed, and the outcome was critical weight loss. Results The mean age of presentation was 46.9 ± 12.8 years in patients undergoing surgery and adjuvant therapy, with 119 (79.3%) of them being male and 31 (20.7%) female. One hundred and twelve patients (81.3%) developed critical weight loss at 6 months from the start of treatment, and the only significant variable associated with critical weight loss was the stage of the disease (p= 0.03). Conclusion A large proportion of patients with oral cancer developed critical weight loss requiring a need for intervention. The overall stage of the disease is a significant predictor of critical weight loss in patients undergoing treatment.

Frecuencia de Lesiones y Condiciones Orales en Pacientes Mayores de 18 Años en una Clínica de Atención Primaria en México / Frequency of Lesions and Oral Conditions in Patients Older than 18 Years in a Primary Care Clinic in Mexico

RESUMEN: La patología oral es el área de la odontología que se especializa en el diagnóstico y tratamiento de enfermedades orales. Se realizó un estudio transversal, en el cual fueron incluidos pacientes mayores de 18 años que acudieron a una clínica de atención primaria del departamento de estomatología de la universidad Autónoma de Ciudad Juárez, en México y a los cuales independientemente del motivo de consulta se les realizo historia clínica y exploración intraoral detallada. Fueron examinados 650 pacientes (424 mujeres y 226 hombres) con un rango de edad de 18 a 89 años (media=42.27). Las lesiones más frecuentes fueron la queratosis friccional (30,46 %) e hiperplasia fibrosa (6,92 %), la melanosis fisiológica (42,92 %) y los gránulos de Fordyce (36,46 %) fueron las condiciones más identificadas. En las lesiones de la mucosa oral que identificamos estuvo presente el factor traumático de manera crónica, es importante que el odontólogo este familiarizado con las lesiones más frecuentes, con su etiología, características clínicas y tratamiento de cada una de ellas.

ABSTRACT: Oral pathology it's the branch of medicine that focuses on the diagnosis and treatment of oral diseases. A cross-sectional study was carried out in which patients older than 18 years was included, that were attended in the primary care clinic at the stomatology department of the Autonomous University of Ciudad Juárez, in Mexico, and regardless of the reason for consultation the clinical history and intraoral examination was done We examined 650 patients (424 women and 226 men) with an age range of 18 to 89 years (mean=42.27). The most frequent oral lesion was the frictional keratosis (30.46 %), fibrous hyperplasia (6.92 %), physiological melanosis (42.92 %), and fordyce granules (36.46 %). In the oral mucosal lesions identified was present a chronic traumatic factor, it is important that the dental staff knows about the most frequent injuries, their etiology, clinical characteristics and treatment of each one.