exudates and Mouth-Neoplasms

Oral cancer is common cancer in many low- and middle-income countries (LMICs) with a low five-year survival rate. It is among the four most common types of cancer in South East Asia region. In South-Central Asia, lip and oral cavity cancer is the second most common cancer according to the specific cancer types.. This scoping review intended to investigate published studies on the current prevalence and incidence of oral cancer in LMICs. The review was conducted applying the search words "Oral Cancer" and "Mouth neoplasm" as the Medical Subject Heading (MeSH) major topic and "Epidemiology" and ("prevalence" OR "incidence") as the MeSH subheading; the search was supplemented by cross-references. Included studies met the following criteria: original studies, reporting of prevalence or incidence rates, population-based studies, studies in English language and studies involving humans.. The sample sizes ranged from 486 to 101,761 with 213,572 persons included. Buccal mucosa is one of the most common sites of oral cancer, associated with the widespread exposure to chewing tobacco. The incidence is likely to rise in the region where gutkha, pan masala, pan-tobacco and various other forms of chewing tobacco are popular.. This review contributes to useful information on prevalence and incidence estimates of oral cancer in LMICs.

Topics: Alcohol Drinking; Areca; Cambodia; Developing Countries; Gingival Neoplasms; Humans; Incidence; India; Lip Neoplasms; Malaysia; Mouth Mucosa; Mouth Neoplasms; Myanmar; Palatal Neoplasms; Prevalence; Risk Factors; Smoking; Sri Lanka; Tobacco Use; Tobacco, Smokeless; Tongue Neoplasms

A variety of betel/areca nut/tobacco habits have been reviewed and categorized because of their possible causal association with oral cancer and various oral precancerous lesions and conditions, and on account of their widespread occurrence in different parts of the world. At a recent workshop in Kuala Lumpur it was recommended that "quid" be defined as "a substance, or mixture of substances, placed in the mouth or chewed and remaining in contact with the mucosa, usually containing one or both of the two basic ingredients, tobacco and/or areca nut, in raw or any manufactured or processed form." Clear delineations on contents of the quid (areca nut quid, tobacco quid, and tobacco and areca nut quid) are recommended as absolute criteria with finer subdivisions to be added if necessary. The betel quid refers to any quid wrapped in betel leaf and is therefore a specific variety of quid. The workshop proposed that quid-related lesions should be categorized conceptually into two categories: first, those that are diffusely outlined and second, those localized at the site where a quid is regularly placed. Additional or expanded criteria and guidelines were proposed to define, describe or identify lesions such as chewer's mucosa, areca nut chewer's lesion, oral submucous fibrosis and other quid-related lesions. A new clinical entity, betel-quid lichenoid lesion, was also proposed to describe an oral lichen planus-like lesion associated with the betel quid habit.

Topics: Areca; Humans; Lichen Planus, Oral; Lichenoid Eruptions; Malaysia; Mouth Diseases; Mouth Mucosa; Mouth Neoplasms; Oral Submucous Fibrosis; Plants, Medicinal; Plants, Toxic; Precancerous Conditions; Terminology as Topic; Tobacco, Smokeless

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Topics: Animals; Carcinoma, Squamous Cell; Gammaherpesvirinae; Malaysia; Mouth Neoplasms; Ursidae

Oral cancer causes a significant disease burden and financial distress, especially among disadvantaged groups. While Malaysia has achieved universal health coverage via its highly subsidized public healthcare, patient and family expenditure for treatment of oral potentially malignant disorders (OPMD) and oral cancer remains a concern in the equitability of care. This study thus aims to estimate household out-of-pocket (OOP) expenditures and the extent of catastrophic healthcare expenditure (CHE) while identifying its predictors.. This three-part study consists of a cross-sectional survey to collect sociodemographic and health utilization data of patients, a retrospective medical record abstraction to identify resources consumed, and cost modeling to simulate expenditures in two tertiary public hospitals. Loss of productivity was calculated based on absenteeism related to disease management in the hospital. OOP payments for transport, care in public healthcare facilities, and other healthcare expenditures were tallied. A CHE was defined as OOP spendings of more than 10% from total annual household income. Multivariable logistic regression was further applied to identify the association between sociodemographic factors and the incidence of CHE.. A total of 52 patients with OPMD and 52 with oral cancer were surveyed and medical records were abstracted. A Kruskal-Wallis test showed a statistically significant difference in OOP share over household income between OPMD, early- and late-stage cancer, χ2(2)=51.05, p<0.001, with the mean percentage of 9%, 22%, and 65% respectively. This study found that the prevalence of CHE in the first year of diagnosis was 86.5% for oral cancer and 19.2% for OPMD. Indian ethnicity (OR=6.24, p=0.046) and monthly income group 'less than USD 2,722' (OR=14.32, p=0.023) were shown as significant predictors for CHE.. Our study demonstrated the provision of subsidies may not be adequate to shield the more vulnerable group from CHE when they are diagnosed with OPMD and oral cancer.

Topics: Catastrophic Illness; Cross-Sectional Studies; Delivery of Health Care; Health Expenditures; Humans; Malaysia; Mouth Neoplasms; Poverty; Retrospective Studies

In Malaysia, oral cancer is very common and the reported 5-year survival of such patients is nearly 50% after treatment with surgery and radiotherapy, much lower than most of the developed countries. This study aimed to investigate the socio-demographic and clinicopathological parameters that influence the mortality rate of the patients suffering from oral squamous cell carcinoma (OSCC) in the Kelantanse population.In this retrospective study, data regarding socio-demographic, clinicopathological factors, and treatment outcome associated with OSCC were gathered from the archives of the medical records office of Hospital Universiti Sains Malaysia. For statistical analysis, simple and multiple logistic regression were performed. The significance level was set to P < .25.A total of 211 OSCC cases were registered in Hospital Universiti Sains Malaysia from January 1, 2000 to December 31, 2018. Majority of them were male (57.82%), non-smoker (54.97%), non-alcohol consumer (91.94%), and non-betel quid chewer (93.83%) Malay (60.66%) patients. The tongue was the most commonly involved part of the oral cavity (41.52%). Histologically, the majority of the cases had moderately-differentiated OSCC (52.82%). Most of the patients were diagnosed at stage IV at the time of diagnosis (61.61%). When this study was performed, the survival status of the majority of the patients was alive (68.24%).Within the analyzed socio-demographic and clinicopathological parameters, gender, alcohol consumption, T-classification, histological grading, and treatment status have been demonstrated as an independent risk factors for mortality rate in multivariate analysis. Hence, these parameters need to be taken into account for the individualized therapy management of OSCC patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Retrospective Studies; Risk Factors; Survival Analysis; Young Adult

Cancer is primarily caused by smoking, alcohol, betel quit, a series of genetic alterations, and epigenetic abnormalities in signaling pathways, which result in a variety of phenotypes that favor the development of OSCC. Oral squamous cell carcinoma (OSCC) is the most common type of oral cancer, accounting for 80-90% of all oral malignant neoplasms. Oral cancer is relatively common, and it is frequently curable when detected and treated early enough. The tumor-node-metastasis (TNM) staging system is used to determine patient prognosis; however, geographical inaccuracies frequently occur, affecting management.. To determine the additional relationship between factors discovered by searching for sociodemographic and metastasis factors, as well as treatment outcomes, which could help improve the prediction of the survival rate in cancer patients.. The statistical strategy showed R demonstrates that regression modeling outperforms an R-squared. It demonstrated that when data is partitioned into a training and testing dataset, the hybrid model technique performs better at predicting the outcome. The variable validation was determined using the well-established bootstrap-integrated MLR technique. In this case, three variables are considered: age, treatment, and distant metastases. It is important to note that three things affect the hazard ratio: age (. In this study, a hybrid approach combining bootstrapping and multiple linear regression will be developed and extensively tested. The R syntax for this methodology was designed to ensure that the researcher completely understood the illustration. In this case, a hybrid model demonstrates how this critical conclusion enables us to better understand the utility and relative contribution of the hybrid method to the outcome. The statistical technique used in this study, R, demonstrates that regression modeling outperforms R-squared values of 0.9014 and 0.00882 for the predicted mean squared error, respectively. The conclusion of the study establishes the superiority of the hybrid model technique used in the study.

Topics: Cell Survival; Humans; Linear Models; Lymphatic Metastasis; Malaysia; Mouth Neoplasms; Multivariate Analysis; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Squamous Cell Carcinoma of Head and Neck; Survival Rate

Wan Mohd Kamaluddin et al. Probiotic inhibits oral carcinogenesis: A systematic review and meta-analysis. Arch Oral Biol. 2020 Oct;118:104,855. Doi: 10.1016/j.archoralbio.2020.104855. Epub 2020 Aug 2.. The study was funded by International Islamic University Malaysia (P-RIGS18-036-0036).. Systematic review with meta-analysis.

Topics: Carcinogenesis; Humans; Malaysia; Mouth Neoplasms; Probiotics

Oral cancer has been recognized as a significant challenge to healthcare. In Malaysia, numerous patients frequently present with later stages of cancers to the highly subsidized public healthcare facilities. Such a trend contributes to a substantial social and economic burden. This study aims to determine the cost of treating oral potentially malignant disorders (OPMD) and oral cancer from a public healthcare provider's perspective. Medical records from two tertiary public hospitals were systematically abstracted to identify events and resources consumed retrospectively from August 2019 to January 2020. The cost accrued was used to estimate annual initial and maintenance costs via two different methods- inverse probability weighting (IPW) and unweighted average. A total of 86 OPMD and 148 oral cancer cases were included. The initial phase mean unadjusted cost was USD 2,861 (SD = 2,548) in OPMD and USD 38,762 (SD = 12,770) for the treatment of cancer. Further annual estimate of initial phase cost based on IPW method for OPMD, early and late-stage cancer was USD 3,561 (SD = 4,154), USD 32,530 (SD = 12,658) and USD 44,304 (SD = 16,240) respectively. Overall cost of late-stage cancer was significantly higher than early-stage by USD 11,740; 95% CI [6,853 to 16,695]; p< 0.001. Higher surgical care and personnel cost predominantly contributed to the larger expenditure. In contrast, no significant difference was identified between both cancer stages in the maintenance phase, USD 700; 95% CI [-1,142 to 2,541]; p = 0.457. A crude comparison of IPW estimate with unweighted average displayed a significant difference in the initial phase, with the latter being continuously higher across all groups. IPW method was shown to be able to use data more efficiently by adjusting cost according to survival and follow-up. While cost is not a primary consideration in treatment recommendations, our analysis demonstrates the potential economic benefit of investing in preventive medicine and early detection.

Topics: Cost of Illness; Cost-Benefit Analysis; Female; Follow-Up Studies; Hospital Costs; Hospitals, Public; Humans; Incidence; Malaysia; Male; Middle Aged; Mouth; Mouth Neoplasms; Precancerous Conditions; Retrospective Studies; Tertiary Care Centers

Dental and medical practitioners play a pivotal role in detecting early stages of oral cancers. Hence, future dental and medical practitioners need to have adequate knowledge of oral cancer. This study was conducted to assess the current level of knowledge, attitude and practices regarding oral cancer among dental and medical students of a Malaysian private university.. A cross-sectional study was conducted on third-, fourth- and final-year students of the dental and medical courses of MAHSA University, Malaysia. A total of 557 students participated in the survey. Oral cancer awareness, knowledge about risk factors, signs and symptoms of oral cancer, attitude and practices towards oral cancer were assessed using 43 questions. The questionnaire was pretested, and internal consistency, assessed using Cronbach's alpha, was acceptable (α > 0.7). The data were analysed using IBM SPSS version 21. The chi-square test was used to analyse the difference in oral cancer awareness between medical and dental students.. Among 557 participants, there were 351 (63%) medical students and 206 (37%) dental students. Based on the results obtained, dental students had a higher level of knowledge than medical students regarding oral cancer (P < 0.05). More than 90% of the dental students were able to identify smoking, alcohol consumption, betel quid chewing, human papilloma virus infection and exposure to radiation as risk factors associated with oral cancer compared to more than 50% of medical students (P < 0.05).. Through education and training, awareness amongst medical students can be reinforced, which will promote early detection of precancerous lesions and oral cancers.

Topics: Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Mouth Neoplasms; Students, Medical; Surveys and Questionnaires; Universities

The majority of oral cancer cases occur in Asia and the incidence is expected to continue to rise. Oral cancer is amenable to early detection through visual oral examination yet in many Asian countries, the disease presents at a late stage. The barriers to early detection are similar across the Asia-Pacific countries therefore, strategies to address these could be more effective if there were concerted efforts and joint resources amongst the countries. To facilitate better engagement and collaboration between stakeholders in oral cancer detection and management, the Asia-Pacific Oral Cancer Network (APOCNET) was established and the inaugural meeting was held in Kuala Lumpur on the 13th to 15th of September 2019. In this meeting, we identified the challenges faced in the early detection and management of oral cancer amongst the stakeholder countries, showcased the successful oral cancer programs in the region and identified strategic areas for collaboration. For this, notable international speakers and those from local universities and the Ministry of Health Malaysia were invited to share their experiences. The lessons learned from our neighbouring countries could lead to the implementation of similar programs that could help reduce the oral cancer burden in the region.

Topics: Asia; Humans; Malaysia; Mouth Neoplasms

To elucidate ethnic variations in the practice of oral cancer risk habits in a selected Malaysian population.. This retrospective case-control study involves 790 cases of cancers of the oral cavity and 450 controls presenting with non-malignant oral diseases, recruited from seven hospital-based centres nationwide. Data on risk habits (smoking, drinking, chewing) were obtained using a structured questionnaire via face-to-face interviews. Multiple logistic regression was used to determine association between risk habits and oral cancer risk; chi-square test was used to assess association between risk habits and ethnicity. Population attributable risks were calculated for all habits.. Except for alcohol consumption, increased risk was observed for all habits; the highest risk was for smoking + chewing + drinking (aOR 22.37 95% CI 5.06, 98.95). Significant ethnic differences were observed in the practice of habits. The most common habit among Malays was smoking (24.2%); smoking + drinking were most common among Chinese (16.8%), whereas chewing was the most prevalent among Indians (45.2%) and Indigenous people (24.8%). Cessation of chewing, smoking and drinking is estimated to reduce cancer incidence by 22.6%, 8.5% and 6.9%, respectively.. Ethnic variations in the practice of oral cancer risk habits are evident. Betel quid chewing is the biggest attributable factor for this population.

Topics: Adult; Aged; Alcohol Drinking; Areca; Case-Control Studies; China; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; India; Malaysia; Male; Middle Aged; Mouth Neoplasms; Piper betle; Retrospective Studies; Risk Factors; Smoking; Young Adult

Background: Interleukin-10 (IL10) genotypes have been closely correlated to the susceptibility for oral squamous cell\ carcinoma. More than half of oral cancers in the world occur in Asia with estimated 168,850 new cases were diagnosed\ in this geographical region alone. Considering the rising numbers of oral cancer cases in Malaysia, association of IL10\ A1082G gene polymorphism was correlated. Methodology: 41 oral squamous cell carcinoma (OSCC) cases and 48\ healthy controls of comparable age, gender, and with habits like smoking, alcohol consumption and betel quid chewing\ were selected. In this case-control study, samples were collected from the Oral Cancer Research and Coordinating\ Centre (OCRCC), Faculty of Dentistry, University of Malaya, Malaysia. Genotyping conditions were evaluated by\ polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). The PCR products were subjected\ to digestion by MnlI enzyme (NEB, UK) to screen for the IL10 A-1082G. Digested DNA products were analyzed by\ electrophoresis on 4% (w/v) agarose gel, stained with ethidium bromide and imaged under UV illumination. Chi-square\ test and Fisher’s Exact test were used in statistical analysis. Results: AG genotypes were present in 81.3% and 86.0% of\ healthy control and OSCC cases respectively (OR=0.468, 95% CI=0.133-1.653). No significant association was found\ between IL10 A1082G polymorphism with risk habits, clinico-pathological parameters and 5-years overall survival.\ The findings also show no significant correlation between the IL10 genotype and features of OSCC within the case\ group as measured by tumor size, lymph node involvement, stage, invasive front, grading, depth, pattern of invasion.\ Conclusion: This study suggests that functional polymorphism AG of IL10 A1082G may have no influence with OSCC\ susceptibility. However, further investigation with larger sample sizes can be conducted to provide additional evidence\ to support the lack of association of IL10 A1082G polymorphism in oral cancer.

Topics: Carcinoma, Squamous Cell; Case-Control Studies; Female; Follow-Up Studies; Genetic Predisposition to Disease; Genotype; Humans; Interleukin-10; Lymphatic Metastasis; Malaysia; Male; Middle Aged; Mouth Neoplasms; Polymorphism, Single Nucleotide; Prevalence; Prognosis; Survival Rate

Previous studies found that ethnicity influences oral cancer patients' survival; however, most studies were limited to certain ethnic groups particularly from the West, thus of limited relevance to Asians where the disease is most prevalent. We investigated the relationship between ethnicity and patient survival in multi-racial Malaysia. 5-year survival rate was 40.9%. No statistically significant difference was observed in survival between Malays, Chinese, Indians and Indigenous peoples (45.7%, 44.0%, 41.3%, 27.7% respectively). Increased tumor size, lymph node involvement and advanced tumor were predictive of poor survival. We conclude that ethnicity has no effect on survival or its prognostic indicators.

Topics: Adult; Aged; Cohort Studies; Ethnicity; Female; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Prognosis; Survival Rate; Tumor Burden

Betel quid chewing has been a major risk factor for oral cancer (OC) in southern China. This study aimed to analyze the scientific publications on the relationship between betel quid chewing and OC and construct a model to quantitatively and qualitatively evaluate pertinent publications from 1998 to 2017.. The publications from 1998 to 2017 were retrieved from the Web of Science Core Collection database. Microsoft Excel, Thomson Data Analyzer, VOSviewer, and CiteSpace software were used to analyze the publication outcomes, journals, countries/regions, institutions, authors, research areas, and research frontiers.. A total of 788 publications on the relationship between betel quid chewing and OC published until October 25, 2017, were identified. The top 4 related journals were Journal of Oral Pathology Medicine, Oral Oncology, Plos One, and International Journal of Cancer. The top five countries engaged in related research included China, India, the United States, the United Kingdom, and Malaysia. The corresponding disciplines, such as oncology, oral surgery, pathology, environmental and occupational health, and toxicology, were mainly concentrated in three disciplines. The subject terms squamous cell carcinoma, OC, betel quid, expression, oral submucous fibrosis, India, and p53 ranked first among research hotspots. The burst terms squamous cell carcinoma, OC, betel quid, and expression ranked first in research frontiers.. Research in this area emphasized hotspots such as squamous cell carcinoma, OC, oral submucosal fibrosis, betel quid, and tobacco. The annual number of publications steadily decreased from 1998 to 2017, with a lack of a systematic study from interdisciplinary perspectives, inadequate pertinent journals, limited regions with the practice of betel quid chewing, and insufficient participation of researchers, which indicate that as the prevalence of OC increases, particularly in China, research in this area warrants further expansion.

Topics: Areca; Bibliometrics; China; Humans; Malaysia; Mouth Neoplasms; Risk Factors; United Kingdom

Background: The aim of this study was to explore reasons for delayed health-seeking for late stage oral cancer\ patients. Methods: Semi-structured in-depth interviews were conducted with 35 oral cancer patients with TNM stage\ III to IV disease, who were treated at six tertiary regional centres managing oral cancer throughout Malaysia. Interviews\ were audio-recorded, transcribed verbatim, coded using NVivo (version 10.0) qualitative software and analysed\ using framework analysis. Results: Participants interpreted their early symptoms as a minor condition and did not\ consider it as requiring immediate attention. Four types of coping strategies causing delayed help-seeking emerged:\ 1) self-remedy 2) self-medication 3) seeking traditional healers and 4) consulting general medical practitioners (GPs)\ instead of dentists. Socio-economic factors, cultural beliefs and religious practices have some influence on diagnostic\ delay. Conclusion: Low levels of public knowledge and awareness regarding early signs and symptoms of oral cancer\ as well as GPs’ misdiagnosis of early lesions results in delayed diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Awareness; Delayed Diagnosis; Developing Countries; Female; General Practitioners; Health Behavior; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Patient Acceptance of Health Care; Qualitative Research; Referral and Consultation

This study aimed to assess changes in oral cancer patients' health-related quality of life (HRQOL) and the impact of disease stage on HRQOL scores. HRQOL data were collected from seven hospital-based centres using the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4.0 instrument. The independent samples t-test, χ

Topics: Aged; Developing Countries; Female; Humans; Interviews as Topic; Longitudinal Studies; Malaysia; Male; Middle Aged; Mouth Neoplasms; Neoplasm Staging; Quality of Life; Risk Factors

Private dental practitioners constitute approximately 40% of all registered dentists in Malaysia, and this group affords an avenue for prevention and early detection of oral cancer. However, such activities are still limited. This study investigated the feasibility of incorporating opportunistic screening of oral cancer in the private dental setting.. Dentists were recruited through two main dental associations in Malaysia and attended a 1-day training session on recognizing abnormalities within the oral cavity. Following the training, the dentists conducted screening and provided risk habits cessation advice at their respective clinics for 6 months. The impact of the program was evaluated by determining the number of patients who were screened and/or provided with risk habits cessation advice.. Twenty-six dentists took part in the program and conducted opportunistic screening on a total of 2603 individuals. On average, they screened about 23.0% of their patients and 5.1% were given risk habits cessation advice. Notably, dentists who had lower patient load were more likely to conduct opportunistic screening.. While the participating private dentists state that they have a role in performing opportunistic screening and providing risk habits cessation advice, these activities are still not a priority area in the private clinics, strongly suggesting that strategies to motivate dentists in this setting are urgently needed.

Topics: Adult; Developing Countries; Early Detection of Cancer; Education, Dental, Continuing; Female; Humans; Malaysia; Male; Mass Screening; Middle Aged; Mouth Neoplasms; Practice Patterns, Dentists'; Risk Assessment

This study includes the direct sequencing of cornulin (CRNN) gene to elucidate the possible mechanism of CRNN downregulation and explore the genetic imbalances at 1q21.3 across oral squamous cell carcinoma (OSCC) samples.. In mutation screening of CRNN gene, gDNA from OSCC tissues were extracted, amplified, and followed by direct sequencing. OSCC samples were also subjected to fragment analysis on CRNN gene to investigate its microsatellite instability (MSI) and loss of heterozygosity (LOH). Immunohistochemistry was performed to validate CRNN downregulation in OSCC samples.. No pathogenic mutation was found in CRNN gene, while high frequency of allelic imbalances was found at 1q21.3 region. MSI was found more frequent (25.3 %) than LOH (9.3 %). Approximately 22.6 % of cases had high MSI which reflects higher probability of inactivation of DNA mismatch repair genes. MSI showed significant association with no betel quid chewing (p = 0.003) and tongue subsite (p = 0.026). LOH was associated with ethnicity (p = 0.008) and advanced staging (p = 0.039). The LOH at 1q21.3 was identified to be as an independent prognostic marker in OSCC (HRR = 7.15 (95 % CI, 1.41-36.25), p = 0.018). Downregulation of CRNN was found among MSI-positive OSCCs and was associated with poor prognosis (p = 0.044).. This study showed a significant correlation between LOH/MSI at 1q21.3 with clinical outcomes and that downregulation of CRNN gene could be considered as a prognostic marker of OSCC.. Insights of the downregulation mode of CRNN gene lays the basis of drug development on this gene as well as revealing its prognostic value.

Topics: Carcinoma, Squamous Cell; Down-Regulation; Genomic Instability; Humans; Immunohistochemistry; Loss of Heterozygosity; Malaysia; Membrane Proteins; Microsatellite Instability; Mouth Neoplasms; Neoplasm Proteins; Polymerase Chain Reaction; Prognosis

The feasibility of using the Patients Concerns Inventory (PCI) to identify oral cancer patient concerns during consultation in oral and maxillofacial specialist clinics in Malaysia was assessed. A cross-sectional study was conducted using a consecutive clinical sampling technique of all new and follow-up oral cancer patients. Surgeons and counter staff were also recruited. Two-thirds of patients were elderly, 63.9% female, 55.6% Indian, 63.9% of lower-level education, and half had the lowest level household income. Patient status was mostly post-treatment (87.5%) and most were at cancer stage III/IV (63.9%); 59.7% had surgery. Patients took an average 5.9 min (95% CI 5.1-6.7 min) to complete the PCI. Physical domain appeared highest (94.4%); social/family relationship issues (4.2%) were lowest. Significant associations included patient age-personal function (P=0.02); patient education level-emotional status (P=0.05) and social/family relationship issues (P=0.04), and patient TNM staging-personal function (P=0.03). The patients' mean feasibility score for the PCI was 5.3 (95% CI 5.1-5.5) out of 6. Patients (93.1%) and surgeons (90%) found the PCI to be feasible. Only 57.1% of counter staff agreed on the use of the PCI during patient registration. Overall, the PCI was considered feasible, thus favouring its future use in routine oral cancer patient management.

Topics: Aged; Checklist; Cross-Sectional Studies; Feasibility Studies; Female; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Needs Assessment; Neoplasm Staging; Quality of Life

Dentists are typically the first professionals who are approached to treat ailments within the oral cavity. Therefore they should be well-equipped in detecting suspicious lesions during routine clinical practice. This study determined the levels of knowledge on early signs and risk factors associated with oral cancer and identified which factors influenced dentist participation in prevention and early detection of oral cancer.. A survey on dentists' knowledge and their practices in prevention and early detection of oral cancer was conducted using a 26-item self-administered questionnaire.. A response rate of 41.7% was achieved. The level of knowledge on early signs and risk habits associated with oral cancer was high and the majority reported to have conducted opportunistic screening and advised patients on risk habit cessation. Factors that influenced the dentist in practising prevention and early detection of oral cancer were continuous education on oral cancer, age, nature of practice and recent graduation. Notably, dentists were receptive to further training in the area of oral cancer detection and cessation of risk habits. Taken together, the study demonstrated that the dental clinic is a good avenue to conduct programs on opportunistic screening, and continuous education in these areas is necessary to adequately equip dentists in running these programs. Further, this study also highlighted knowledge deficits and practice shortcomings which will help in planning and developing programs that further encourage better participation of dentists in prevention and early detection of oral cancer.

Topics: Adult; Aged; Aged, 80 and over; Dentists; Directive Counseling; Early Detection of Cancer; Education, Dental, Continuing; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Professional Role; Risk Factors; Surveys and Questionnaires

Lymphoma is a malignant neoplasm of lymphoid tissue classified into Hodgkin's and non-Hodgkin's types. It mostly affects lymph nodes although a considerable proportion of Non-Hodgkin's cases occur in extranodal sites.. Selected cases diagnosed as non-Hodgkin's lymphoma (NHL) during the period of 1980 to 2012 were retrieved from the archives of the Oral Pathology Diagnostic Laboratory, Faculty of Dentistry, University of Malaya. The sections from the formalin-fixed paraffin embedded tissue blocks were stained with H and E as well as with LCA, CD20, and CD3.. The mean age was 41.6 years with a male: female ratio of 1.3:1. Out of the forty two cases, nineteen were Malays, eighteen were Chinese, followed by Indians (3) and Indonesians (2). The most common site of involvement was the mandible (22.2%), followed by the maxilla and palate (19.4% each). Most of the lesions presented as a painless progressive swelling. Only thirty six cases were further subdivided into B or T cell types. The majority were B-cell type (26 cases), of these 6 cases were Burkitt's lymphomas. Only ten cases were T-cell lymphoma, with three cases of NK/T-cell lymphoma.. In this series of 42 patients diagnosed as extranodal non-Hodgkin's lymphoma, the lesions appeared as painless swellings, mostly in men with the mandible as the most frequent site of involvement. Majority were B-cell lymphomas with Malays and Chinese being equally affected whereas lymphomas were rare in the Indian ethnicity. T-cell lymphomas were found to be common in the Chinese ethnic group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Burkitt Lymphoma; Child; Child, Preschool; Cyclophosphamide; Doxorubicin; Female; Humans; Lymphoma, B-Cell; Lymphoma, T-Cell; Malaysia; Male; Mandible; Maxilla; Middle Aged; Mouth Neoplasms; Palate; Prednisone; Retrospective Studies; Vincristine; Young Adult

A comparative cross-sectional study involving oral cancer patients and healthy individuals was designed to investigate associations between retinol, α-tocopherol and β-carotene with the risk of oral cancer.. This study included a total of 240 matched cases and controls where subjects were selected from the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS). Retinol, α-tocopherol and β-carotene levels and intake were examined by high-performance liquid chromatography (HPLC) and food frequency questionnaire (FFQ) respectively.. It was found that results from the two methods applied did not correlate, so that further analysis was done using the HPLC method utilising blood serum. Serum levels of retinol and α-tocopherol among cases (0.177±0.081, 1.649±1.670μg/ml) were significantly lower than in controls (0.264±0.137, 3.225±2.054μg/ml) (p<0.005). Although serum level of β-carotene among cases (0.106±0.159 μg/ml) were lower compared to controls (0.134±0.131μg/ml), statistical significance was not observed. Logistic regression analysis showed that high serum level of retinol (OR=0.501, 95% CI=0.254-0.992, p<0.05) and α-tocopherol (OR=0.184, 95% CI=0.091-0.370, p<0.05) was significantly related to lower risk of oral cancer, whereas no relationship was observed between β-carotene and oral cancer risk.. High serum levels of retinol and α-tocopherol confer protection against oral cancer risk.

Topics: Adult; Aged; Aged, 80 and over; alpha-Tocopherol; Carcinoma, Squamous Cell; Case-Control Studies; Chromatography, High Pressure Liquid; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Neoplasm Staging; Prognosis; Risk Factors; Vitamin A; Vitamins; Young Adult

This study aimed to determine the association between tobacco consumption (kretek) and betel quid chewing with oral cancer risk.. A total of 81 cases of oral cancers were matched with 162 controls in this hospital-based study. Information on sociodemographic characteristics and details of risk habits (duration, frequency and type of tobacco consumption and betel quid chewing) were collected. Association between smoking and betel quid chewing with oral cancer were analysed using conditional logistic regression.. Slightly more than half of the cases (55.6%) were smokers where 88.9% of them smoked kretek. After adjusting for confounders, smokers have two fold increased risk, while the risk for kretek consumers and those smoking for more than 10 years was increased to almost three-fold. Prevalence of betel quid chewing among cases and controls was low (7.4% and 1.9% respectively). Chewing of at least one quid per day, and quid combination of betel leaf, areca nut, lime and tobacco conferred a 5-6 fold increased risk.. Smoking is positively associated with oral cancer risk. A similar direct association was also seen among betel quid chewers.

Topics: Adult; Age Distribution; Aged; Areca; Case-Control Studies; Female; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Nicotiana; Prevalence; Reference Values; Risk Assessment; Sex Distribution; Smoking; Survival Analysis; Tobacco, Smokeless; Young Adult

To assess oral cancer awareness, its associated factors and related sources of information among a selected group of Malaysians.. A cross-sectional survey was conducted on all Malaysian ethnic groups aged ≥15 years old at eight strategically chosen shopping malls within a two week time period. Data were analysed using chi-square tests and multiple logistic regression. Significance level was set at α<0.05.. Most (84.2%) respondents had heard of oral cancer. Smoking was the most (92.4%) recognized high risk habit. Similar levels of awareness were seen for unhealed ulcers (57.3%) and red/white patches (58.0%) as signs of oral cancer. Age, gender, ethnicity, marital status, education, occupation and income were significantly associated with oral cancer awareness (p<0.05).. There was a general lack of awareness regarding the risk habits, early signs and symptoms, and the benefits of detecting this disease at an early stage. Mass media and health campaigns were the main sources of information about oral cancer. In our Malaysian population, gender and age were significantly associated with the awareness of early signs and symptoms and prevention of oral cancer, respectively.

Topics: Adult; Age Factors; Aged; Attitude to Health; Awareness; Cross-Sectional Studies; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Marital Status; Middle Aged; Mouth Neoplasms; Prognosis; Risk Factors; Smoking; Socioeconomic Factors; Surveys and Questionnaires; Young Adult

Identification of diagnostic markers for early detection and development of novel and therapeutic agents for effective patient management are the main motivation for cancer research. Biological specimens from large cohort and case-control studies which are crucial in providing successful research outcomes are often the limiting factor that hinders research efforts, especially in developing countries. Therefore, the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS) were established to systematically collect large number of samples with comprehensive sociodemographic, clinicopathological, management strategies, quality of life and associated patient follow-up data to facilitate oral cancer research in Malaysia. The MOCDTBS also promotes sharing among researchers and the development of a multidisciplinary research team. The following article aims to describe the process of setting-up and managing the MOCDTBS.

Topics: Databases as Topic; Developing Countries; Humans; Interdisciplinary Communication; Malaysia; Mouth Neoplasms; Tissue Banks

Early detection of oral potentially malignant epithelial lesions (PMELs) is aimed at improving survival rates as carcinogenesis is a multistep process and prevention is possible if these lesions are detected at an early and reversible stage of the disease. A prospective clinical study aimed at determining the prevalence of bilateral 'mirror-image' oral PMELs was carried out. Sample consisted of 32 (53.3%) Indians, 23 (38.3%) Chinese, 4 (6.7%) Malays and one (1.7%) Nepalese. All had histopathological confirmation of their primary existing PMEL as inclusion criteria. A total of 70 primary lesions were detected. The most common PMEL found was oral lichen planus. Of these, 28 (46.7%) patients exhibited bilateral 'mirror-image' lesions (n = 42) either synchronously (n = 32/42) or metachronously (n = 10/42). The remaining 32 (53.3%) patients had normal-looking contralateral mucosa. Present findings suggest that patients presenting with oral PMELs are at greater risk of developing a second lesion, most probably in the contralateral 'mirror-image' site.

Topics: Cell Transformation, Neoplastic; Diagnosis, Differential; Early Diagnosis; Ethnicity; Female; Humans; Lichen Planus, Oral; Malaysia; Male; Mass Screening; Mouth Mucosa; Mouth Neoplasms; Precancerous Conditions; Prevalence; Prospective Studies

This study aimed to assess the level of knowledge of oral cancer and its associated factors among university students in Malaysia.. A cross sectional study was conducted among 200 university students in Malaysia. A self administered questionnaire was used to collect data. It included questions on socio- demographic data, awareness and knowledge of oral cancer.. Mean age of the respondents was 21.5 ± 2.5 and the age ranged from 18 to 27 years. The majority of the respondents were aware of oral cancer (92.0%) and recognized the followings as signs and symptoms of oral cancer: ulcer and oral bleeding (71.0%), followed by swelling (61.5%). A satisfactory knowledge was observed on the following risk factors; smoking (95.5%), poor oral hygiene (90.5%), family history (90.0%), alcohol (84.5%) and poor fitting dentures (83.0%). However, unsatisfactory knowledge was observed about hot/spicy food (46.5%), obesity (36.0%), old age (31.5%), dietary factor (29.0%) and smokeless tobacco (25.5%). Knowledge of oral cancer was associated significantly with age (p<0.01), year of study (p<0.01) and course of study (p<0.01).. Instead of satisfactory awareness and knowledge of oral cancer and its clinical presentations, inadequate knowledge was observed about its risk factors. There is a need to introduce oral cancer education among university students.

Topics: Adolescent; Adult; Awareness; Cross-Sectional Studies; Educational Status; Female; Health Education; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Mouth Neoplasms; Prognosis; Risk Factors; Students; Surveys and Questionnaires; Universities; Young Adult

The role of diet in cancer risk has mainly been investigated based on intake of individual food items. However, food consumption is made up of a combination of various food items. This study aims to determine the association of dietary patterns with oral cancer risk.. A total of 306 matched cases and controls were recruited in this study. Data on dietary intake were obtained using food frequency questionnaire (FFQ). Factor analysis (FA) was performed to identify dietary patterns based on the intake of nine major food groups, resulting in four factors/components being retained. The odds ratio (OR) was computed for each component using conditional logistic regression.. The first pattern labelled as 'modern' was loaded with processed foods and snacks, whereas the second pattern termed as 'prudent' was characterized by intake of fruits and vegetables. The third pattern labelled as 'traditional' consisted of beverages and starches, while the fourth pattern termed as 'combination' was loaded with intakes of dairy, fermented/salted and meat/by-products. A significant reduced risk was found for 'prudent' (OR 0.53, 95% CI = 0.28-0.98), whereas an increased risk was found for both 'combination' (OR 2.43, 95% CI = 1.33-4.45) and 'traditional' (OR 2.32, 95% CI = 1.23-4.25) patterns. However, after adjusting for risk habits of tobacco smoking, alcohol consumption and betel quid chewing, only 'combination' (aOR 2.99, 95% CI = 1.55-5.75) and 'traditional' (aOR 2.08, 95% CI = 1.09-3.97) patterns remained significant.. Consumption in the highest tertile of 'traditional' and 'combination' patterns may induce twice and thrice the risk of oral cancer, respectively.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alcohol Drinking; Areca; Case-Control Studies; Diet; Diet Surveys; Factor Analysis, Statistical; Female; Humans; Logistic Models; Malaysia; Male; Middle Aged; Mouth Neoplasms; Odds Ratio; Risk Factors; Smoking; Young Adult

Less than 50% of oral cancer cases are diagnosed at early stages of the disease and this is in part due to poor awareness and lack of knowledge on the signs and symptoms of oral cancer. This study sought to measure the baseline awareness of oral cancer in Malaysia and aimed to increase public awareness and knowledge of oral cancer using a mass media campaign.. Baseline awareness and impact of the campaign was measured using self-administered questionnaires sent via email to individuals. The campaign was aired on two national television channels and the reach was monitored through an independent programme monitoring system.. 78.2% of respondents had heard of oral cancer, and this increased significantly after the campaign. However, the ability to recognize signs and symptoms remains unchanged. We found that the level of awareness differed between the distinct ethnic subgroups and the reach of the campaign was not uniform across all ethnicities.. This substantial study to measure the oral cancer awareness in Malaysia provides important baseline data for the planning of public health policies. Despite encouraging evidence that a mass media campaign could increase the awareness of oral cancer, further research is required to address the acceptability, comprehensiveness and effectiveness. Furthermore, different campaign approaches may be required for specific ethnic groups in a multi-ethnic country such as Malaysia.

Topics: Adolescent; Adult; Child; Child, Preschool; Cultural Diversity; Early Detection of Cancer; Female; Health Education; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Program Evaluation; Surveys and Questionnaires; Television; Young Adult

The impact of ablative oral cancer surgery was studied, with particular reference to recurrence and nodal metastasis, to assess survival probability and prognostic indicators and to elucidate if ethnicity influences the survival of patients.. Patients who underwent major ablative surgery of the head and neck region with neck dissection were identified and clinical records were assessed. Inclusion criteria were stage I-IV oral and oropharyngeal malignancies necessitating resection with or without radiotherapy from 2004 to 2009. All individuals had a pre-operative assessment prior to the surgery. The post operative assessment period ranged from 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves.. 87 patients (males:38%; females:62%) were included in this study, with an age range of 21-85 years. Some 78% underwent neck dissections while 63% had surgery and radiotherapy. Nodal recurrence was detected in 5.7% while 20.5% had primary site recurrence within the study period. Kaplan-Meier survival analysis revealed that the median survival time was 57 months. One year overall survival (OS) rate was 72.7% and three year overall survival rate dropped to 61.5%. On OS analysis, the log-rank test showed a significant difference of survival between Malay and Chinese patients (Bonferroni correction p=0.033). Recurrence-free survival (RFS) analysis revealed that 25% of the patients have reached the event of recurrence at 46 months. One year RFS rate was 85.2% and the three year survival rate was 76.1%. In the RFS analysis, the log-rank test showed a significant difference in the event of recurrence and nodal metastasis (p<0.001).. Conservative neck is effective, in conjunction with postoperative radiotherapy, for control of neck metastases. Ethnicity appears to influence the survival of the patients, but a prospective trial is required to validate this.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Lymphatic Metastasis; Malaysia; Male; Middle Aged; Mouth Neoplasms; Neck Dissection; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Retrospective Studies; Salivary Gland Neoplasms; Survival Rate; Young Adult

The purpose of this study was to evaluate the role of HPV and p53 polymorphisms in oral squamous cell carcinomas (OSCC) affecting Malaysian population.. We analysed frozen samples from 105 OSCC as well as 105 oral specimens derived from healthy individuals. PCR assays targeting two regions of the virus were used. PCR amplification for the analysis of p53 codon 72 arginine/proline alleles was carried out in a separate reaction.. HPV DNA was detected in 51.4% OSCC samples, while 24.8% controls were found to be HPV positive. HPV was found to be significantly associated with OSCC (P < 0.001, OR = 4.3 after adjustment for habits) when compared to controls. High-risk HPV was found to be significantly associated with OSCC cases (P < 0.05). Demographic profiles of age, gender, race and habits were not associated with HPV presence in cases and controls. However, significantly less HPV positivity was seen in poorly differentiated compared to well-differentiated OSCCs. No significant association was found between HPV positivity and p53 polymorphisms in cases and control groups. Additionally, we found no association of codon 72 polymorphism with oral cancer.. This study indicates that high-risk HPV infection is one of the contributing factors for OSCCs. HPV 16 was the predominant type found in Malaysian patients with OSCC. Further, we did not find any association between p53 codon 72 polymorphism and HPV infection or between the p53 polymorphism and the risk of oral cancer.

Topics: Adult; Aged; Alphapapillomavirus; Arginine; Carcinoma, Squamous Cell; Case-Control Studies; DNA, Viral; Female; Humans; Logistic Models; Malaysia; Male; Middle Aged; Mouth Neoplasms; Odds Ratio; Papillomavirus Infections; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Proline; Retrospective Studies; Risk Assessment; Risk Factors; Tumor Suppressor Protein p53; Tumor Virus Infections

Loss of heterozygosity (LOH) and microsatellite instability (MSI) have been documented as important events in oral squamous cell carcinoma (OSCC). Five microsatellite markers D3S192, D3S966, D3S647, D3S1228 and D3S659 were selected on chromosome 3p because of high frequency of alterations reported in head and neck squamous cell carcinoma and the involvement of von Hippel Lindau (VHL) at 3p25-26 and the fragile histidine triad (FHIT) at 3p14.2 genes proven in many tumour types. A total of 50 archival tissue samples of OSCC and corresponding normal samples were analyzed for LOH and MSI status. The overall LOH for the markers selected on 3p was 56 out of 189 informative cases (29.6%). The most frequent LOH was identified for the marker D3S966 which was 18/42 (42.8%) of informative cases suggesting the presence of putative tumour suppressor genes (TSGs) in this loci. In this study, high frequency of microsatellite instability was found in D3S966 which was 28.6% of informative cases; this reveals the possibility of mutations of MMR genes in this region. Frequent microsatellite alterations (MA) were observed in 3 markers D3S966 (71.4%), D3S1228 (56.7%) and D3S192 (41.0%). There was no significant association between LOH with gender, tumour stages and differentiation grades. However, there was a significant association between tumour stage and differentiation grades with MSI status in OSCC in Malaysian population with p values of 0.002 and 0.035, respectively. There was also a significant association between MA and differentiation grades (p=0.041).

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Genes, Tumor Suppressor; Humans; Loss of Heterozygosity; Malaysia; Male; Microsatellite Instability; Microsatellite Repeats; Middle Aged; Mouth Neoplasms

To assess the cross-sectional construct validity of the Malay-translated and cross-culturally adapted FACT-H&N (v 4.0) for discriminative use in a sample of Malaysian oral cancer patients. A cross-sectional study of adults newly diagnosed with oral cancer. HRQOL data were collected using the FACT-H&N (v 4.0), a global question and a supplementary set of eight questions ('MAQ') obtained earlier in pilot work. Of the 76 participants (61.8% female; 23.7% younger than 50), most (96.1%) had oral squamous cell carcinoma; two-thirds were in Stages III or IV. At baseline, patients' mean FACT summary (FACT-G, FACT-H&N, FACT-H&N TOI, and FHNSI) and subscale (pwb, swb, ewb, fwb, and hnsc) scores were towards the higher end of the range. Equal proportions (36.8%) rated their overall HRQOL as 'good' or 'average'; fewer than one-quarter rated it as 'poor', and only two as 'very good'. All six FACT summary and most subscales had moderate-to-good internal consistency. For all summary scales, those with 'very poor/poor' self-rated HRQOL differed significantly from the 'good/very good' group. All FACT summary scales correlated strongly (r>0.75). Summary scales showed convergent validity (r>0.90) but little discriminant validity. The discriminant validity of the FHNSI improved with the addition of the MAQ. The FACT-H&N summary scales and most subscales demonstrated acceptable cross-sectional construct validity, reliability and discriminative ability, and thus appear appropriate for further use among Malaysian oral cancer patients.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Carcinoma, Squamous Cell; Cross-Cultural Comparison; Cross-Sectional Studies; Diagnostic Self Evaluation; Discriminant Analysis; Female; Health Status; Humans; Language; Malaysia; Male; Middle Aged; Mouth Neoplasms; Quality of Life; Reproducibility of Results; Surveys and Questionnaires; Translations; Young Adult

Oral squamous cell carcinoma (OSCC) has high local recurrence, partly caused by the lack of clear margin identification on surgical removal of cancerous tissues. Direct visualization by immunostaining and fluorescent in situ hybridization (FISH) in tissue sections gives more definite information about genetic damage at margins with appropriately selected biomarkers.. To determine the usefulness of immunohistochemical techniques and FISH of the tumour suppressor TP 53 gene to identify microinvasion in marginal tissue sections and to relate the possible correlation between protein expression and genetic aberrations in OSCC cases in Malaysia.. Immunohistochemistry and FISH of TP 53 genes were applied on 26 OSCC formalin fixed paraffin embed (FFEP) blocks selected from two oral cancer referral centers in Malaysia.. For p53 protein immunohistochemistry, 96% of the 26 OSCC studied showed positive immunostaining at the excision margins. In FISH assay, 48.9±9.7% of the cancerous cells were monoploid for p53 probe signals, 41.0±9.5 % were diploid, and 10.2±7.8 % were polyploid. A correlation between p53 immunostaining and TP53 gene aberrations was noted (p< 0.05).. Immunohistochemical analysis of p53 protein expression and FISH of TP53 gene could be applied as screening tool for microinvasion of OSCC.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Squamous Cell; Humans; Immunohistochemistry; In Situ Hybridization, Fluorescence; Malaysia; Middle Aged; Mouth Mucosa; Mouth Neoplasms; Neoplasm Invasiveness; Tumor Suppressor Protein p53

The incidence of oral cancer is high for those of Indian ethnic origin in Malaysia. Various clinical and pathological data are usually used in oral cancer prognosis. However, due to time, cost and tissue limitations, the number of prognosis variables need to be reduced. In this research, we demonstrated the use of feature selection methods to select a subset of variables that is highly predictive of oral cancer prognosis. The objective is to reduce the number of input variables, thus to identify the key clinicopathologic (input) variables of oral cancer prognosis based on the data collected in the Malaysian scenario. Two feature selection methods, genetic algorithm (wrapper approach) and Pearson's correlation coefficient (filter approach) were implemented and compared with single-input models and a full-input model. The results showed that the reduced models with feature selection method are able to produce more accurate prognosis results than the full-input model and single-input model, with the Pearson's correlation coefficient achieving the most promising results.

Topics: Algorithms; Biomarkers, Tumor; Humans; Malaysia; Models, Theoretical; Mouth Neoplasms; Prognosis

This study was performed to determine oral cancer survival among Malay patients in Hospital Universiti Sains Malaysia (HUSM), Kelantan.. The medical records of 118 Malay patients with oral cancer admitted in HUSM from 1st January 1986 to 31st December 2005 were reviewed. Data collected include socio-demographic background, high-risk habits practiced, clinical and histological characteristics, and treatment profile of the patients. Survival status and duration were determined by active validation until 31st December 2006. Data entry and analysis were accomplished using SPSS version 12.0. The Kaplan-Meier method was used to perform survival estimates while the log-rank test and the Cox proportional hazards regression model were employed to perform univariate analysis and multivariable analysis of the variables, respectively.. The overall five-year survival rate of Malay patients with oral cancer was 18.0%, with a median survival time of 9 months. Significant factors that influenced survival of the patients were age, sex, tumour site, TNM stage, histological type, and treatment received.. Survival of oral cancer patients in HUSM was very low. Being elderly, male, presenting with an advanced stage at diagnosis, and not having treatment all contributed to poor survival.

Topics: Carcinoma, Squamous Cell; Female; Hospitals, University; Humans; Malaysia; Male; Medical Records; Middle Aged; Mouth Neoplasms; Neoplasm Staging; Survival Rate; Treatment Outcome

The MDM2 SNP309 has been associated with increased expression of the protein which could suppress p53 function, and has been shown to modulate risk to cancer. We have previously shown that overexpression of MDM2 is a common event in oral cancers. In the present study, we determined the association between the MDM2 SNP309 polymorphism and oral cancer in 207 oral cancer patients and 116 normal subjects. We genotyped the MDM2 SNP309 by PCR-RFLP. Logistic regression was adapted to calculate odds ratios for MDM2 SNP309 polymorphism from univariate and multivariable adjusted models. Our results suggest that MDM2 SNP309 does not confer increased risk to oral cancer (OR=1.55, 95% CI=0.77-3.11). However, the GG/TG genotype was associated with later disease onset in women above 55 years of age. Collectively, our data suggests that MDM2 SNP309 may modulate the risk to oral cancer and is a modifier of the age at oral cancer onset in women above the age of 55 years.

Topics: Age of Onset; Aged; Carcinoma, Squamous Cell; Case-Control Studies; Female; Genetic Predisposition to Disease; Humans; Logistic Models; Malaysia; Male; Middle Aged; Mouth Neoplasms; Odds Ratio; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Polymorphism, Single Nucleotide; Proto-Oncogene Proteins c-mdm2; Risk Factors

Oral squamous cell carcinoma (OSCC) is a world health problem and is associated with exposure to different risk factors. In the west, smoking and alcohol consumption are considered to be the main risk factors whilst in India and southeast Asia, betel quid (BQ) chewing is predominant. In this study, we compared the gene expression patterns of oral cancers associated with BQ chewing to those caused by smoking using Affymetrix microarrays. We found that 281 genes were differentially expressed between OSCC and normal oral mucosa regardless of aetiological factors including MMP1, PLAU, MAGE-D4, GNA12, IFITM3 and NMU. Further, we identified 168 genes that were differentially expressed between the BQ and smoking groups including CXCL-9, TMPRSS2, CA12 and RNF24. The expression of these genes was validated using qPCR using independent tissue samples. The results demonstrate that whilst common genes/pathways contribute to the development of oral cancer, there are also other gene expression changes that are specific to certain risk factors. The findings suggest that different carcinogens activate or inhibit specific pathways during cancer development and progression. These unique gene expression profiles should be taken into consideration when developing biomarkers for future use in prognostic or therapeutic applications.

Topics: Adult; Aged; Aged, 80 and over; Areca; Carcinoma, Squamous Cell; Female; Gene Expression Profiling; Gene Expression Regulation, Neoplastic; Humans; Malaysia; Male; Microarray Analysis; Middle Aged; Mouth Neoplasms; Polymerase Chain Reaction; Risk Factors; Smoking

The objective of this study was to identify the characteristics of oral cancer among Malay patients in Hospital Universiti Sains Malaysia (HUSM), Kelantan.. A retrospective record review was conducted from August to December 2006 in HUSM. Of 133 patients with oral cancer diagnosed from 1986 to 2005, 118 were Malay. Data on socio-demographic background, high-risk habits practiced, clinical and histological characteristics, and treatment profile of the patients were obtained.. Malay patients with oral cancer were predominantly elderly, aged 60 years old and above (51.7%) at the time of diagnosis, with a mean age of 58.1 years (SD 16.81). Most patients were males (64.4%) and the majority of them were married (83.9%). More than half (58.5%) had been smokers, and of those who smoked, 89.9% were males. Some had a betel quid chewing habit (22.9%) but none ever consumed alcohol. The majority of the patients (77.1%) were diagnosed at stage IV. The tongue was the most usual site involved (37.3%) and squamous cell carcinoma was the most common histological type seen (75.4%).. The prevalence of oral cancer among Malay patients in HUSM is high (88.7%). It is predominantly found in elderly males and the majority of cases present at advanced stage.

Topics: Adult; Age Factors; Aged; Female; Hospitals, University; Humans; Lymphatic Metastasis; Malaysia; Male; Middle Aged; Mouth Neoplasms; Neoplasm Staging; Prevalence; Retrospective Studies; Risk Factors; Sex Factors

Inactivation of the retinoblastoma (pRB) pathway is a common event in oral squamous cell carcinoma particularly through the aberrant expression of the components within this pathway. This study examines the alterations of molecules within the pRB pathway by looking at the presence of homozygous deletions in p16(INK4A) and the expression patterns of pRB, cyclin D1 and CDK4, as well as the presence of human papillomavirus (HPV) in our samples. In our study, 5/20 samples demonstrated deletions of p16(INK4A) exon 1alpha. pRB overexpression was found in 20/20 samples, the expression was mainly observed in all layers of the epithelia, particularly in the basal layer where cells are actively dividing and aberrant pRB expression was found in 12/20 samples. Cyclin D1 and CDK4 overexpression was detected in 6/20 and 2/20 samples respectively in comparison to hyperplasias where both proteins were either not expressed or expressed at minimal levels (<10%). Strikingly, HPV was found to be present in all of our samples, suggesting that HPV plays a significant role in driving oral carcinogenesis. Notably, 17/20 of our samples showed more than one alteration in the pRB pathway, however, we did not find any significant relationship between the presence of HPV, homozygous deletion of p16(INK4A) and overexpression of pRB, cyclin D1 and CDK4. Collectively, this data demonstrates that alterations in the pRB pathway are a common event and involve the aberration of more than one molecule within the pathway. Furthermore, the involvement of HPV in all our samples suggests that HPV infection may play an important role in oral carcinogenesis.

Topics: Carcinoma, Squamous Cell; Cell Transformation, Neoplastic; Cyclin D1; Cyclin-Dependent Kinase 4; Cyclin-Dependent Kinase Inhibitor p16; Exons; Female; Gene Deletion; Homozygote; Humans; Immunohistochemistry; Malaysia; Male; Mouth Neoplasms; Papillomaviridae; Papillomavirus Infections; Retinoblastoma Protein; Tumor Suppressor Proteins

Some oral verrucal lesions may constitute parts of the clinicopathological spectrum of proliferative verrucous leukoplakia (PVL). Because of its idiopathic yet sinister nature, it is possible that PVL may exist in other populations. The aim of this study was to review the clinicopathological features of persistent, multifocal, oral verrucal lesions in Malaysian population.. Patients with multifocal oral verrucal lesions were selected from surgical and histopathological records.. Nine patients of diverse ethnicity with 43 biopsies were reviewed. The mean age at the presentation was 62 years. The most frequent sites affected were gum, sulci, cheek and tongue. Indulgence in risk habits was reported in about 70% of patients. Four cases developed multifocal carcinoma from multifocal leukoplakia.. In retrospect, none of the cases fulfilled the original PVL criteria, although three cases were suggestive of PVL. Nevertheless, these findings do not necessarily preclude the existence of PVL as a clinicopathological entity in Malaysian population.

Topics: Adult; Age Factors; Aged; Carcinoma, Squamous Cell; Carcinoma, Verrucous; Cell Transformation, Neoplastic; Ethnicity; Female; Gingival Neoplasms; Humans; Leukoplakia, Oral; Malaysia; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Mouth Neoplasms; Risk Factors; Tongue Neoplasms; Warts

This is a study to describe the health beliefs related to oral cancer (OC) in a high-risk group in Malaysia, a predominantly Indian community living in an agricultural setting called an estate. The study population was a convenient sample of 112 adults, above 20 years of age, attending oral cancer screening in two estates. The subjects consisted of 106 (94.6%) Indians and six (5.4%) Malays. Using the Health Belief Model, the perceptions of susceptibility to OC, its severity, and the benefits of and barriers to preventive actions, as well as beliefs underlying OC aetiology were investigated. About half of the subjects (n=57, 50.9%) felt susceptible to oral cancer. A majority of subjects (n=93, 83.0%) felt that oral cancer is a severe disease. Thirty four people (30.4%) perceived OC as a preventable disease, while 56 (50%) did not, and the remaining 22 (19.6%) did not know if OC was preventable or not. The majority of subjects (84.8%) believed that modifications to the betel quid habit could be beneficial. The information solicited can be used as a starting point to design health-education activities aimed at this group in particular and the population in general.

Topics: Adult; Aged; Aged, 80 and over; Areca; Culture; Female; Follow-Up Studies; Health Education; Health Knowledge, Attitudes, Practice; Humans; India; Malaysia; Male; Middle Aged; Mouth Neoplasms

The delay in the diagnosis of oral cancer has been variously reported as being contributed by the clinicians, patients or both. The purpose of this study was to evaluate the referral pattern of 65 patients eventually diagnosed as having oral squamous cell carcinoma. The results showed that 50% of the patients delayed seeking professional help for more than 3 months after being aware of the lesion. The majority of the patients consulted medical practitioners as the first source of help. The mean clinicians' and patients' delay were 10.3 weeks and 28.9 weeks respectively. Dental practitioners showed a tendency to refer more advanced lesions compared to the medical practitioners. The findings raise the concern that lack of patients' awareness, misdiagnosis by clinicians and late detection by dental practitioners prevail thus calling for urgent measures towards early detection of the disease.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Dentistry; Diagnostic Errors; Family Practice; Female; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Patient Acceptance of Health Care; Referral and Consultation; Risk Factors; Time Factors

The prevalence of oral mucosal lesions in Malaysia was determined by examining a representative sample of 11,707 subjects aged 25 years and above throughout the 14 states over a period of 5 months during 1993/1994. A two-stage stratified random sampling was undertaken. A predetermined number of enumeration blocks, the smallest population unit in the census publication, was selected from each state. With the selected enumeration block, a systematic sample of living quarters was chosen with a random start. The survey instrument included a questionnaire on sociodemographic characteristics and a clinical examination. The clinical examination was carried out by 16 specially trained dental public health officers and the diagnosis calibrated with a final concordance rate of 92%. The age in the sample ranged from 25 to 115 years with a mean of 44.5+/-14.0. The sample comprised 40.2% males and 59.8% females; 55.8% were Malays, 29.4% Chinese, 10.0% Indians and 1.2% other ethnic groups. Oral mucosal lesions were detected in 1131 (9.7%) subjects, 5 (0.04%) had oral cancer, 165 (1.4%) had lesions or conditions that may be precancerous (leukoplakia, erythroplakia, submucous fibrosis and lichen planus) and 187 (1.6%) had betel chewer's mucosa. The prevalence of oral precancer was highest amongst Indians (4.0%) and other Bumiputras (the indigenous people of Sabah and Sarawak) (2.5%) while the lowest prevalence was amongst the Chinese (0.5%).

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Areca; China; Demography; Erythroplasia; Ethnicity; Female; Humans; India; Lichen Planus, Oral; Malaysia; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Mouth Neoplasms; Oral Submucous Fibrosis; Plants, Medicinal; Precancerous Conditions; Prevalence; Sex Factors; Socioeconomic Factors; Surveys and Questionnaires

We reviewed biopsy records for 37 cases of oral histoplasmosis for patient characteristics, clinical features, and histopathologic findings. These represented cases diagnosed in the Division of Stomatology, Institute for Medical Research, Kuala Lumpur between July 1967 and October 1994. All were male patients who ranged in age from 11 to 79 years (mean age, 56.7 years). There were 40.6% Malays, 37.8% Chinese, 18.9% Indians, and 2.7% other races. Five patients with mouth lesions as the initial presenting lesions were proven to be cases of disseminated histoplasmosis. In the remaining cases apart from the biopsy-proven oral histoplasmosis lesions, the extent of the disease elsewhere was unknown. The majority of these lesions involved the gingiva, tongue, and palate in decreasing order of frequency. The most frequent presenting symptom was oral mucosal ulceration. Squamous cell carcinoma and tuberculosis were the two most common clinical differential diagnoses. Our present findings compare favorably with published reports from other regions.

Topics: Adolescent; Adult; Carcinoma, Squamous Cell; Child; Diagnosis, Differential; Ethnicity; Histoplasmosis; Humans; Malaysia; Male; Mouth Diseases; Mouth Neoplasms; Tuberculosis, Oral

At the Faculties of Dentistry in Chiang Mai, Thailand (CM), and Kuala Lumpur, Malaysia (KL), 234 and 233 consecutive out-patients of mean ages 33.8 and 31.0 yr, respectively, were examined for the presence of oral mucosal lesions. Tobacco in some form was regularly used by 31.7% and 27.5% of the study populations in CM and KL, respectively. Cigarette smoking was the predominant habit. In CM three persons chewed betel quids and nine smoked banana leaf cigars daily. In addition, there were 24 habitual chewers of tea leaves (miang). In KL six persons chewed betel quids daily. In CM and KL three cases each (1.3%) of tobacco-associated leukoplakias were found. In KL an additional idiopathic leukoplakia was registered. One and three cases of betel related lesions were found in CM and KL, respectively. One case of a squamous cell carcinoma was found in a 45-yr-old Indian woman in KL who had been chewing betel with tobacco daily for many years. High prevalence figures were found for lichen planus, 3.8% in CM and 2.1% in KL, and an extremely high one, 48.3%, in CM for episodes of aphthous ulcers experienced during the last 2 yr. Comparatively low prevalence figures were found for herpes labialis. As could be expected melanin pigmentation was prevalent while only low figures were encountered for denture-related lesions and amalgam tattoos.

Topics: Adult; Areca; Female; Humans; Malaysia; Male; Mouth Diseases; Mouth Mucosa; Mouth Neoplasms; Plants, Medicinal; Plants, Toxic; Prevalence; Smoking; Tea; Thailand; Tobacco, Smokeless

The association between cigarette smoking and the prevalence of oral mucosal lesions was examined in 495 Malaysian army personnel. No associations between cigarette smoking and recurrent aphthous ulcerations, pre-leukoplakia and frictional keratosis could be obtained in this study. Positive associations were found between cigarette smoking and leukoedema as well as denture stomatitis. There was a negative association between cigarette smoking and the presence of coated tongue.

Topics: Adult; Cross-Sectional Studies; Humans; Malaysia; Male; Middle Aged; Military Personnel; Mouth Diseases; Mouth Neoplasms; Precancerous Conditions; Smoking

Topics: Adult; Aged; Aged, 80 and over; Alcohol Drinking; Areca; Carcinoma, Squamous Cell; Female; Habits; Humans; Malaysia; Male; Middle Aged; Mouth; Mouth Neoplasms; Plants, Medicinal; Smoking

Topics: Areca; Arecoline; Humans; Malaysia; Mouth Neoplasms; Plants, Medicinal; Precancerous Conditions; Risk

The prevalence rate of 749 cases of oral squamous cell carcinomas (SCC) recorded between 1978-1984 was studied. Results showed that the Indians formed the dominant group (63.8%) followed by the Malays (19.6%) and Chinese (16.6%). The peak incidences were generally located between the sixth and eighth decades. Only in the Chinese group a male preponderance was noted. In the Indians, the buccal mucosa was the most prevalent site; in the Malays and Chinese males, the gingiva and alveolus; and the Chinese female, the tongue. In all three groups, the well-differentiated SCC was the commonest type and the poorly differentiated least common.

Topics: Adult; Age Factors; Aged; Carcinoma, Squamous Cell; China; Female; Humans; India; Malaysia; Male; Middle Aged; Mouth Mucosa; Mouth Neoplasms; Sex Factors

Three epidemiological surveys have been carried out in Malaysia since 1971. All showed a high level of caries prevalence. Ninety per cent of school children between the ages of 6 and 18 suffered from dental caries, with a DMFT of approximately 3 and a dft of approximately 2. Ninety-five per cent of the adult population had caries experience, with the mean DMFT being 13.2. Approximately 55 per cent of children showed the presence of gingivitis with the mean number of inflamed gingival units per child ranging from 1.9 to 2.8, while 72.4 per cent of adults had some form of periodontal disease with 29 per cent having pockets deeper than 3 mm. The OHI-S score for adults was 2.2 and 81 per cent used toothbrushes to clean their teeth. A further 5.1 per cent used twigs and fingers with powdered charcoal or salt. One-third of the child population needed orthodontic treatment, with 0.3 per cent examined in peninsular Malaysia having cleft lip or palate or both. In the adult population 10.4 per cent of those examined required some form of orthodontic treatment. Twenty per cent of the children in the survey were in need of dentures; 54.7 per cent of the adults were either in need of dentures or were wearing dentures. Of these 25 per cent had complete dentures. The smoking habit was most commonly associated with pre-cancerous/cancerous lesions with alcohol consumption a close competitor; 114 adults, that is 1.3 per cent of those examined, suffer from leukoplakia but only one case of oral cancer was detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Child; Child Health Services; Dental Caries; Dental Health Services; Education; Health Services; Humans; Jaw, Edentulous; Jaw, Edentulous, Partially; Malaysia; Middle Aged; Mouth Neoplasms; Oral Health; Oral Hygiene; Periodontal Diseases; Population

Topics: Adolescent; Adult; Aged; Carcinoma, Squamous Cell; Child; Female; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Racial Groups

Topics: Adult; Aged; Carcinoma, Papillary; Female; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Middle Aged; Mouth Neoplasms; Precancerous Conditions

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Mouth Neoplasms

Topics: Adult; Aged; Alveolar Process; Carcinoma, Squamous Cell; Female; Gingival Neoplasms; Humans; Jaw Neoplasms; Lip Neoplasms; Malaysia; Male; Middle Aged; Mouth Floor; Mouth Neoplasms; Palatal Neoplasms; Tongue Neoplasms

Topics: Adult; Aged; Carcinoma, Squamous Cell; China; Female; Gingival Neoplasms; Humans; India; Malaysia; Male; Middle Aged; Mouth Neoplasms; Racial Groups; Sex Factors; Tongue Neoplasms

Topics: Adolescent; Adult; Age Factors; Areca; Ethnicity; Female; Habits; Humans; Leukoplakia, Oral; Malaysia; Male; Middle Aged; Mouth Neoplasms; Nuts; Palatal Neoplasms; Plants, Medicinal; Precancerous Conditions; Sex Factors; Smoking

Topics: Adult; Age Factors; Aged; Carcinoma, Squamous Cell; Cheek; China; Ethnicity; Female; Gingival Neoplasms; Humans; Malaysia; Middle Aged; Mouth Neoplasms; Palatal Neoplasms; Sex Factors; Tongue Neoplasms

Topics: Adenoma, Pleomorphic; Adolescent; Adult; Age Factors; Aged; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Child; Choriocarcinoma; Female; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Nasopharyngeal Neoplasms; Palatal Neoplasms; Pregnancy; Racial Groups; Tongue Neoplasms

Topics: Adolescent; Adult; Aged; Esophageal and Gastric Varices; Esophageal Neoplasms; Esophageal Stenosis; Esophagoplasty; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Pharyngeal Neoplasms; Surgical Procedures, Operative

Topics: Cheek; Ethnicity; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Neck Dissection

Changes in the buccal mucosa of 296 Indian and Malay betel-nut chewers in Perak, West Malaysia, were studied clinically. 167 out of 212 Indian subjects incorporated tobacco in their quids, while 45 out of 84 Malay subjects incorporated. "Gambir". The Indians appeared to show a higher proportion of mucosal changes, particularly when tobacco was used. "Gambir" did not appear to be potent in the production of mucosal changes. Comparison with studies in other parts of the world suggested comparable findings with respect to both tobacco and non-tobacco chewing samples, and there would appear to be some evidence that tobacco-containing quids are likely to produce a higher proportion of mucosal changes as compared to non-tobacco-containing quids. An attempt to demonstrate a dose-effect relationship by dividing the subjects into "slight" and "heavy" chewers did not yield significant differences between these two categories in each of the groups.

Topics: Adult; Aged; Areca; Ethnicity; Female; Habits; Humans; India; Leukoplakia; Leukoplakia, Oral; Malaysia; Male; Middle Aged; Mouth Neoplasms; Nicotiana; Plants, Medicinal; Plants, Toxic; Sex Factors

Topics: Female; Humans; Malaysia; Male; Mouth Neoplasms

Topics: Age Factors; Alcoholic Beverages; Areca; Asian People; Culture; Female; Humans; Keratosis; Leukoplakia; Malaysia; Male; Mouth Neoplasms; Plants, Medicinal; Sex Factors; Smoking; Socioeconomic Factors; White People

Topics: Asian People; Cheek; Choriocarcinoma; Female; Humans; Malaysia; Male; Mouth Neoplasms; Nasopharyngeal Neoplasms; Neoplasms; Pregnancy

Topics: Areca; Humans; Malaysia; Mouth Neoplasms; Neoplasms