The role of dentists in the prevention and treatment of oral cancer

Oralni karcinom zloćudni tumor je sluznice usne šupljine koji nastaje mutacijom epitelnih stanica. Najčešći uzročnici su pušenje cigareta i konzumacija alkoholnih pića. Može se razviti iz prekanceroznih lezija, među kojima su najznačajnije leukoplakija i eritroplakija. Ostale prekancerozne lezije usne šupljine su: oralni lichen planus, aktinički heilitis i submukozna fibroza. Oralni karcinom najčešće nastaje u području „potkove” koju čine: dno usne šupljine, lateralni i ventralni dijelovi jezika, lingvalni dio donjeg alveolarnog grebena, retromolarno područje te nepčani lukovi. Bolest je u početku asimptomatska te se klinički manifestira kao bijele ili crveno bijele lezije na oralnoj sluznici, ili kao ulceracije koje ne cijele duže od dva tjedna. U kasnijim fazama nastaju ulceracije s induriranimi i uzdignutim rubovima ili egzofitične tvorbe koje ispunjavaju usnu šupljinu. Često prvi znak oralnog karcinoma može biti i povećani, fiksirani i bezbolni limfni čvor u vratu što upućuje na metastazu. Oralni karcinom primarno metastazira limfogeno, a u težim slučajevima može metastazirati i hematogeno u udaljene organe. Bolest se dijagnosticira biopsijom promijenjene sluznice i patohistološkom analizom uzetog bioptata. Liječenje ovisi o lokalizaciji i uznapredovalosti tumora, limfogenim/udaljenim metastazama i općem zdravlju pacijenta. U početnim stadijima bolesti karcinom se kirurški odstranjuje, a u uznapredovalim se stadijima, uz kirurško liječenje, koristi radioterapija i/ili kemoradioterapija. Stomatolog ima značajnu ulogu u ranom otkrivanju karcinoma usne šupljine jer prvi može uočiti potencijalno „opasne” promjene na sluznici te pacijenta uputiti na daljne specijalističke pretrage. Ako se bolest otkrije na vrijeme, prognoza je bolja, liječenje je jednostavnije, a stopa preživljenja veća.Oral cancer is a malignant tumor of the oral cavity mucous membrane which is caused by the mutation of epithelial cells. The most common causes include cigarette smoking and consumption of alcoholic beverages. It can develop from precancerous lesio ns, with leukoplakia and erythroplakia being the most significant ones. Other precancerous lesions of the oral cavity include the oral lichen planus, actinic cheilitis and submucosal fibrosis. Oral cancer usually occurs in the horseshoe­shaped area of the mouth which consists of the floor of the oral cavity, the lateral and ventral parts of the tongue, the lingual part of the lower alveolar ridge, the retromolar area and the palatal arches. The disease is initially asymptomatic, and it is clinically manifested either as white or a mixture of red and white lesions on the oral mucosa, or as ulcerations that do not heal in the span of two weeks. Ulcerations with indurated and raised edges or exophytic formations that fill the oral cavity develop in the later stages. Very often, the first sign of oral cancer can be an enlarged, fixed, and painless lymph node in the neck, which is an indication of metastasis. Oral cancer primarily forms metastases in a lymphogenous manner, and in more severe cases it can also metastasize hematogenously to distant organs. The disease is diagnosed by biopsy of the changed mucous membrane and by a pathohistological analysis of the biopsy taken. Treatment depends on the localization of the tumor, its stage, the lymphogenic/distant metastases, and the general health of the patient. In the initial stages of the disease, cancer is surgically removed, and in advanced stages, radiotherapy and/or chemoradiotherapy is used in addition to the surgical treatment. The doctor of dental medicine plays an important role in early detection of oral cavity cancer, as they can spot potentially malignant changes of the mucous membrane and refer the patient to a specialist. Early detection of the disease results in a better prognosis, simpler treatment and greater survival rate