Ethanol-Induced Cell Damage Can Result in the Development of Oral Tumors

Alcohol consumption is an underestimated risk factor for the development of precancerous lesions in the oral cavity. Although alcohol is a well-accepted recreational drug, 26.4% of all lip and oral cavity cancers worldwide are related to heavy drinking. Molecular mechanisms underlying this carcinogenic effect of ethanol are still under investigation. An important damaging effect comes from the first metabolite of ethanol, being acetaldehyde. Concentrations of acetaldehyde detected in the oral cavity are relatively high due to the metabolization of ethanol by oral microbes. Acetaldehyde can directly damage the DNA by the formation of mutagenic DNA adducts and interstrand crosslinks. Additionally, ethanol is known to affect epigenetic methylation and acetylation patterns, which are important regulators of gene expression. Ethanol-induced hypomethylation can activate the expression of oncogenes which subsequently can result in malignant transformation. The recent identification of ethanol-related mutational signatures emphasizes the role of acetaldehyde in alcohol-associated carcinogenesis. However, not all signatures associated with alcohol intake also relate to acetaldehyde. This finding highlights that there might be other effects of ethanol yet to be discovered.

Factors associated with oral cavity cancers in Sub-Saharan Africa: Summary of the literature

INTRODUCTION: Oral cavity cancers are now a public health problem according to WHO epidemiological data. There are several risk factors or factors associated with cancers of the oral cavity but they vary according to geographic regions. OBJECTIVE: The objective of this study was to identify factors associated with cancers of the oral cavity in Sub-Saharan African populations through a systematic literature review. METHODOLOGY: Using the data available for the period from January 1980 to December 2019, a synthesis of the literature was carried out. The literature localization strategy included an electronic search of the MEDLINE, EMBASE and GOOGLE SCHOLAR databases from 1980 to 2019 and a manual search of the list of references of articles identified by snowballing. The data were extracted independently by two researchers on an Excel© spreadsheet. Parameters collected from each study were author, country, type of study, period of study, size, age, gender, and factors studied. RESULTS: Out of 1,318 articles found, 24 were selected. The data contained 17,290 patients including 8,229 men, i.e. a male / female sex-ratio of 0.91. Factors studied were tobacco, alcohol, diet, infection, genetics and social factors. CONCLUSION: The results reported showed that several factors are associated with the occurrence of oral cavity cancers in Sub-Saharan Africa. There is a need to conduct further studies with more structured methodologies for more convincing results.

Malignant Bowel Obstruction due to Metastatic Carcinoma of Buccal Mucosa - A Case Report

Cancers of the oral cavity are one of the most common malignancies encountered among cancer patients in India.1 There are different histological variants of oral cavity cancers, and squamous cell carcinoma (SCC) is most common among them. The main etiological factors implicated for development of oral cavity cancers are tobacco chewing and alcohol use.2 In India, carcinoma of buccal mucosa has the highest incidence among all the oral cavity cancers.3 The mean age of presentation is 50 years.4 Incidence among males is three times that of females.5 Most of the patients present in advanced stage (Stage III & IV) with majority in stage IV.6 Metastasis from oral cavity cancer takes place by detachment, invasion, proliferation and evasion through lymphatic system and blood vessels. It is regulated at various levels in the body.7 Most common sites of distant metastasis from oral cavity cancers are lungs and liver. Sometimes vertebral bone metastasis is also seen among patients. Metastasis to omentum and intra peritoneal organs other than liver is very rare.

Pleural malignant mesothelioma with metastatic deposition in the tongue

A 70-year-old man with epithelioid malignant pleural mesothelioma was referred to the maxillofacial surgery department with a painful lesion on the lateral border of his tongue which interfered with swallowing. Physical examination demonstrated a 3 cm firm, non-ulcerated mass on the left lateral tongue, histologically shown to be metastatic epithelioid mesothelioma. MRI of the neck and CT scan of the thorax, abdomen and pelvis scans also demonstrated progressive local and metastatic disease. The patient was not felt to be fit for further treatment. More than 90% of oral cavity cancers are squamous cell carcinoma. All reported cases of metastasis of malignant mesothelioma to the tongue have been of the epithelioid subtype with 10 cases reported in the literature to date. Diagnosis is important as tongue lesions can significantly impact on quality of life and synchronous tongue primaries should be ruled out. Tongue lesions may herald metastases to other extrapleural locations.

Microvascular reconstruction for head and neck cancers in high risk population: clinical outcomes and complications

Introduction Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. Methods This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. Results Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. Conclusions A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.