Challenges in Early Diagnosis of Oral Cancer: Cases Series

Abstract

Oral cancer has an overall survival rate of only 50%. This prognosis is significantly improved when this disease is diagnosed and treated in its early stages. Oral cancer is usually associated with classical clinical features associated with malignancy resulting in accurate diagnosis. However, certain cases of oral cancer, especially in its early stages, can be clinically deceptive and can be misdiagnosed. There is a recent trend of changing demographics and etiology associated with oral cancer adding to the diagnostic challenges faced by the clinician. The awareness of these changing trends is needed to aid in early diagnosis of oral cancer. In this case series, we have presented three cases of patients with challenging aspects.

Candida albicans and Oral Carcinogenesis. A Brief Review

“…Some of these lesions are already described in ancient times, such as in the "Iππoκρατικó ςώµα" (Corpus Hippocraticum) and later in the manuscripts of the doctors of the Byzantine Roman Empire. Oral cancer, such as squamous cell carcinoma, in more than 50% of cases is preceded by potentially malignant lesions [2,3]. In fact, a characteristic aspect is the presence of white areas in the white and/or red patches (leukoplakia/erythroplakia) on the mucosa, which subsequently evolve into ulcers and/or a lump.…”

“…In fact, a characteristic aspect is the presence of white areas in the white and/or red patches (leukoplakia/erythroplakia) on the mucosa, which subsequently evolve into ulcers and/or a lump. The 5-year survival is less than 50% and despite the progress made in terms of early diagnosis and treatment in the last twenty years, it has not significantly improved [2,4]. Potentially malignant lesions, which the WHO defines as precancerous lesions, include leukoplakia, oral lichen planus, and also oral submucosal fibrosis (it is present in Eastern populations where it is customary to chew quid leaf) [5].…”

“…These precancerous forms for a differential diagnosis of exclusion from other oral pathologies will be based on the medical history, physical examination, and/or histological examination. In fact, for a pseudo-membranous candidiasis lesion, the main diagnostic criterion will be the clinical objective examination, and instead, for a chronic hyperplastic candidiasis, it will be the histological examination that makes the differential diagnosis from oral leukoplakia [2,6]. Instead, in North America and Europe, high risk human papillomavirus (HPV) infections are responsible for a growing percentage of oropharyngeal cancers among young people; for other infectious agents, this link is still debated (e.g., it has been reported that different species belonging to the Candida spp.…”

Knowledge, attitudes, practice and related factors of oral cancer prevention among public health nurses in Taiwan

“…The percentage of patients receiving early oral cancer treatment is relatively high, with a five‐year survival rate as high as 70%–80% and a cure rate of 80% or more (Coleman, 2012; NCI & Retrieved, 2019; Shah & Gil, 2009). Early diagnosis and identification of patients at high risk are considered essential to help ensure early treatment and to improve the response to therapy, and oral cancer patients’ prognosis and overall survival (Chakraborty, Natarajan, & Mukherjee, 2019; Homann et al., 2001; Sujir, Ahmed, Pai, Denny, & Shenoy, 2019). However, patients are often diagnosed at later stages, dropping the five‐year survival rate to less than 50%; 15%–20% of oral cancer patients develop a primary cancer in the oral cavity or nearby mucosa, increasing recurrence and distant metastases even more (Coleman, 2012; Shah & Gil, 2009).…”

Communication, Counseling and Compassionate Care

“…[ 1 ] Most cases of oral malignancies associated with smoking or smokeless tobacco/areca nut are clinically preceded by asymptomatic lesions collectively referred as oral potentially malignant disorders (OPMDs) where a significant proportion of OPMD transform to Malignancy. [ 2 3 4 ] It is the duty of the primary care physician to get actively involved in the early detection and prevention of transformation of OPMDs to oral cancer.…”