exudates and Precancerous-Conditions

Endemic goitre is a major concern in many parts of the world, including Southeast Asia. Goitrous thyroid lesion is postulated as a precursor lesion to thyroid cancer (TC). This paper reviews the prevalence rates and characteristics of TC among cases of goitrous thyroid-swelling in different parts of Malaysia and Myanmar. Recorded data from hospital-based retrospective studies of thyroid cases, whose study periods ranged from three to 11 years, were analysed. These included research findings from the author's publications as well as other published review articles of retrospective analyses. The incidence of TC varies among gender, age, race/ethnicity and histological type. There appears to be a higher rate of occurrence among females aged 21-60 years. Papillary thyroid carcinoma is the more common histological type compared to follicular cancer. This review also presents a descriptive analysis and discussion on studies conducted in other countries. Further exploration is warranted in order to uncover the possible risk factors for the rising incidence of TC.

Topics: Adult; Age Distribution; Biopsy, Needle; Cell Transformation, Neoplastic; Developing Countries; Female; Goiter, Endemic; Humans; Immunohistochemistry; Incidence; Malaysia; Male; Middle Aged; Myanmar; Precancerous Conditions; Risk Assessment; Sex Distribution; Thyroid Neoplasms; Young Adult

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

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

To identify genes associated with gastric precancerous lesions in Helicobacter pylori (H. pylori)-susceptible ethnic Malays.. Twenty-three Malay subjects with H. pylori infection and gastric precancerous lesions identified during endoscopy were included as "cases". Thirty-seven Malay subjects who were H. pylori negative and had no precancerous lesions were included as "controls". Venous blood was collected for genotyping with Affymetrix 50K Xba1 kit. Genotypes with call rates < 90% for autosomal single nucleotide polymorphisms (SNPs) were excluded. For each precancerous lesion, associated SNPs were identified from Manhattan plots, and only SNPs with a χ² P value < 0.05 and Hardy Weinberg Equilibrium P value > 0.5 was considered as significant markers.. Of the 23 H. pylori-positive subjects recruited, one sample was excluded from further analysis due to a low genotyping call rate. Of the 22 H. pylori-positive samples, atrophic gastritis only was present in 50.0%, complete intestinal metaplasia was present in 18.25%, both incomplete intestinal metaplasia and dysplasia was present in 22.7%, and dysplasia only was present in 9.1%. SNPs rs9315542 (UFM1 gene), rs6878265 (THBS4 gene), rs1042194 (CYP2C19 gene) and rs10505799 (MGST1 gene) were significantly associated with atrophic gastritis, complete intestinal metaplasia, incomplete metaplasia with foci of dysplasia and dysplasia, respectively. Allele frequencies in "cases" vs "controls" for rs9315542, rs6878265, rs1042194 and rs10505799 were 0.4 vs 0.06, 0.6 vs 0.01, 0.6 vs 0.01 and 0.5 vs 0.02, respectively.. Genetic variants possibly related to gastric precancerous lesions in ethnic Malays susceptible to H. pylori infection were identified for testing in subsequent trials.

Topics: Adult; Aged; Asian People; Case-Control Studies; Chi-Square Distribution; Female; Gastritis, Atrophic; Gastroscopy; Gene Frequency; Genetic Predisposition to Disease; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Male; Metaplasia; Middle Aged; Phenotype; Polymorphism, Single Nucleotide; Precancerous Conditions; Predictive Value of Tests; Risk Factors; Stomach Neoplasms

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

Conventional methods for writing case notes detailing the progress of oral lichen planus (OLP), a precancerous condition that requires long-term surveillance, is both time-consuming and tedious for the busy clinician.. To design and perform a simple surveillance on OLP patients based on colour-coded topography mouth maps (TMM).. Three colour-coded TMM were employed: red for OLP in high risk oral mucosal sites, yellow for cases showing improvement and green for asymptomatic lesions at each recall visit. In this preliminary study, these were applied on 30 histologically confirmed OLP individuals attending the Oral Medicine Clinic at the Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya. The sites and extent of OLP lesions were charted on either red, yellow or green TMM based on defined criteria. This surveillance evaluated OLP in relation to patientandapos;s age, race, gender, underlying systemic conditions, oral habits, initial onset of OLP, oral manifestations and presence/absence of clinically suspicious areas.. Study sample comprised 4 (13.3%) Malays, 9 (30.0%) Chinese and 17 (56.7%) Indians. Most OLP patients belong to the green TMM (n= 14, 46.6%) group followed by red (n= 11, 36.7%) and yellow (n= 5, 16.7%) groups. Of the 11 cases with red TMM, rebiopsy was performed on 4 cases but no dysplasia was detected. Any local confounding factors namely periodontal disease or faulty dental restorations were managed accordingly.. TMM is simple to use and aided the clinicians in terms of time saving and patient management. Hence, follow-up of OLP patients can be carried out more efficiently and appropriately. TMM can be used for surveillance of other oral precancerous lesions and conditions.

Topics: Biopsy; Cell Transformation, Neoplastic; China; Color; Disease Progression; Female; Humans; India; Lichen Planus, Oral; Malaysia; Male; Neoplasm Staging; Population Surveillance; Precancerous Conditions; Prognosis; Risk Factors; Surveys and Questionnaires

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

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

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

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