Mouth cancer in inflammatory bowel diseases

Abstract

Mouth cancer is a major health problem. Multiple risk factors for developing mouth cancer have been studied and include history of tobacco and alcohol abuse, age over 40, exposure to ultraviolet radiation, human papilloma virus infection (HPV), nutritional deficiencies, chronic irritation, and existence or oral potentially malignant lesions such as leukoplakia and lichen planus. An important risk factor for mouth cancer is chronic immunosuppression and has been extensively reported after solid organ transplantation as well as HIV-infected patients. Diagnosis of inflammatory bowel disease (IBD) is not yet considered as a risk factor for oral cancer development. However, a significant number of patients with IBD are receiving immunosuppressants and biological therapies which could represent potential oral oncogenic factors either by direct oncogenic effect or by continuous immunosuppression favoring carcinogenesis, especially in patients with HPV(+) IBD. Education on modifiable risk behaviors in patients with IBD is the cornerstone of prevention of mouth cancer. Oral screening should be performed for all patients with IBD, especially those who are about to start an immunosuppressant or a biologic.

Lichen planus and diabetes mellitus: Systematic review and meta‐analysis

“…Another issue that should be taken into account is that tobacco consumption is one of the undeniable precancerous factors in the oral cavity, and although there is not a direct relationship to oral lichen planus, it is implicated in the degenerative process of oral precancerous lesions (Giagkou, Christodoulou, & Katsanos, ; López‐Jornet, Parra‐Perez, & Pons‐Fuster, ). The malignant transformation is also related to the lesion time of evolution and the patient's age.…”

A loss-of-function polymorphism in ATG16L1 compromises therapeutic outcome in head and neck carcinoma patients

“… 150 Additionally, IBD patients are more prone to develop mouth cancer, and the mechanisms of carcinogenesis may be linked to long-lasting inflammation, immunosuppressive treatments and to their HPV status. 151 The role of ATG16L1 loss-of-function alleles has also been reported for other cancers than HNSCC. Indeed, rs2241880 has been described as a risk factor both for developing hepatocellular carcinoma in the context of cirrhosis, 152 breast cancer, 153 and gastric cancer.…”

Risk Factors and Clinical Outcomes of Head and Neck Cancer in Inflammatory Bowel Disease: A Nationwide Cohort Study

“…For these variables, results should be interpreted cautiously, as no firm conclusions can be drawn. Some authors 22,24 have suggested oral screening for all IBD patients, especially those who are starting immunosuppression. As the incidence of HNC in IBD in general is low and no well-defined premalignant lesions analogous to cervical intraepithelial neoplasia in cervical cancer have been established yet, we would recommend increased awareness for HNC in IBD rather than active screening, especially in elderly onset IBD.…”

“…Various reports advocate regular oral screening. 23,24 Currently, studies on risk factor for HNC development and HNC outcome in IBD patients are lacking. We hypothesized a worse outcome for oral cavity cancer (OCC) and pharyngeal cancer (PC) in IBD patients treated with immunosuppression in comparison with the general population.…”