An Analysis of the Epidemiological and Etiological Factors of Oral Tumors of Young Adults in a Central-Eastern European Population

Abstract

The etiology of tumors in young age is not precisely known yet, but studies on the topic generally agree that in this group of patients the traditionally known behavioural risk factors (tobacco and alcohol abuse) play no or a significantly less important role. Oral squamous cell carcinoma occurring at a young age is a topic of utmost importance that is extensively and intensively researched as, while the overall incidence of oral cancer is decreasing worldwide, that of squamous cell carcinoma diagnosed in young adults is steadily increasing. The present article aims at presenting the main questions and characteristics of tumors in young adults in Central-Eastern Europe and in developed West European countries as contrasted to tumors found in middle aged and elderly patients. Factors influencing the development of oral cancer include regulatory factors of the cell cycle, the inherited vulnerability of the genetic code of certain proteins and the presence of HPV infection with an oncogenic genotype. The connections of HPV infection and genetic damages are studied intensively. It is known that the prevalence of oral HPV infections is growing with a background of potentially changing sexual habits. It is debated, however, whether smoking and alcohol consumption could have a connection to HPV associated oral cancer and whether the spread of HPV in itself could be an explanation for the growing occurrence of young-age tumors. There is no consensus in the literature as to the prognostic significance of age. Some research groups have found a better life expectancy for young patients, while other authors found a worse prognosis for these patients. It is known that the prognosis of head and neck tumors, the prevalence of HPV infections as well as genetic mutations show regional and ethnic variations. This might be explained by differences in the degree of development of a preventive system, in the quality of care and in the attitudes of young patients towards visiting a doctor. The study is made difficult by incomparable patient selection criteria as well as by the question of the intraoral localisation of tumors as an independent risk factor.

Preneoplasia and carcinogenesis of the oral cavity

“…The oral cavity can be the site of a variety of HPV-related lesions [8][9][10], some of which are microscopically and behaviorally analogous to those located in the genital tract [11]. The verruca, condylomas, and doi: 10.7243/2052-6199-3-1…”

Margins of oral leukoplakia: autofluorescence and histopathology

“…1,2 The annual transformation rate into squamous cell carcinoma (SCC) is assumed to be 1%-2.9%, 3,4 and it is strongly linked to the use of alcohol and tobacco, though it also appears without any of the known risk factors. 5 Many patients are not aware of oral leukoplakia, which commonly causes no symptoms, unlike other lesions such as oral lichen planus. 7,8 There is an argument in favour of the detection and histopathological identification of degrees of dysplasia in leukoplakia, in view of the potential for the progression of such lesions.…”

Perfil clínico-epidemiológico do Carcinoma Epidermoide Oral em pacientes adultos jovens dos 20 aos 45 anos:

“…Pesquisas e relatórios realizados nos últimos anos sugerem que o número de casos de câncer bucal está em fase de declínio, devido à menor exposição a fatores de risco, como fumo e álcool, entretanto, observa-se um crescimento significativo da prevalência do CEB em pacientes adultos jovens 7,8 . De acordo com a literatura, a faixa etária da população considerada como adultos jovens corresponde à idade entre 18 e 45 anos 9 .…”

“…Estudos relatam que o CEB em pacientes jovens tem uma progressão clínica distinta daquela que ocorre em pacientes mais velhos, acredita-se que, além do alcoolismo e do tabagismo, outros fatores, como o vírus papiloma humano (HPV), uso de maconha e deficiências nutricionais, sejam predisponentes para o desenvolvimento do CEB 8,12,13 . O CEB em pacientes jovens pode apresentar um comportamento clínico mais agressivo, com elevada incidência de metástases linfonodais e pior prognóstico 14,15 .…”