Etiology and prevention of oral cancer

Oralni karcinom jedna je od 10 najčešćih neoplazmi u Europi i SAD-u, a incidencija mu je u stalnom porastu i prosječno iznosi 10/100 000 stanovnika. Učestalost mu raste s dobi, češći je u muškaraca iako incidencija u žena raste. 80 % svih oralnih karcinoma smješteno je na 20 % površine oralne sluznice, na području koje svojim izgledom podsjeća na potkovu, a smrtnost je vrlo visoka jer se u preko 45 % slučajeva dijagnosticira tek kada su već prisutne metastaze. Glavni etiološki čimbenici u nastanku oralnog karcinoma i dalje su alkohol i pušenje. U alkoholnim pićima i duhanu nalazimo brojne kancerogene koji djeluju na oralnu sluznicu i uzrokuju malignu transformaciju. Osim toga, alkoholičari i pušači često imaju neadekvatan nutritivni status i oslabljen imunološki sustava te su podložniji štetnim agensima. Posljednjih godina sve se više pažnje pridaje virusnim infekcijama u etiologiji oralnog karcinoma, ponajviše HPV-16. Dokazano je da taj virus, uz pomoć virusnih gena E6 i E7, inaktivira tumor-supresore p53 i pRb. Nadalje, kako je svaki čovjek genotipski i fenotipski svojevrsna jedinka, svi pojedinci izloženi istim rizičnim čimbenicima neće razviti oralni karcinom. Upravo ta činjenica potvrđuje nam da su u etiologiji oralnog karcinoma izrazito bitni endogeni čimbenici, genetske, epigenetske i molekularne promjene. Osim navedenog, bitni etiološki čimbenici za razvoj oralnog karcinoma su i uživanje bezdimnog duhana, prehrana manjkava voćem i povrćem, te prenkancerozna stanja i lezije. Kako bi se smanjila incidencija oralnog karcinoma, vrlo je bitno osigurati adekvatnu prevenciju, primarnu, sekundarnu i tercijarnu, s posebnim naglaskom na primarnu prevenciju i rano dijagnosticiranje.Oral cancer is one of the 10 most common neoplasm in Europe and the USA, and the incidence of it is constantly increasing, up to 10/100 000 inhabitants at the moment. The incidence increases with age and it is still more common in men, although the incidence in women is growing. 80% of all oral cancers is placed at 20% of the oral mucosa, the area that looks like a horseshoe, and the mortality rate is very high because of the fact that over 45% of cases are diagnosed when they already had metastases. Main etiological factors for oral cancer development are smoking and alcohol consumption. In those products we can find a lot of carcinogens that have negative effect on oral mucosa. Furthermore, people who smoke and drink alcohol excessively often don’t eat well and have weak immune system. Because of that they are more prone to carcinogen agents. In the past years researchers are more focused on some new aspects of oral cancer etiology, one of them is the viral infections, especially HPV-16 infection. It is known that HPV genes E6 and E7 bind to tumor-suppressor genes p53 and pRb and inactivate their effects. Due to the fact that every person is an unique individual, genetically and phenotypically, we can assure that endogenic, genetic, epigenetic and molecular aspects are extremely important in oral cancer etiology. In addition, important etiological factors for oral cancer development are also tobacco chewing, diet deficient in fruits and vegetables and precancerous conditions and lesions. It is very important to ensure adequate prevention if we want to low oral cancer incidence rates. Primary, secondary and tertiary prevention are all very important but the accent should be on primary prevention and early cancer detection