Oral

# Oral Cancer: The Preventable Epidemic

## Introduction: Where Lifestyle Meets Lesions
Oral squamous cell carcinoma accounts for 90% of oral cancers, with global incidence exceeding 500,000 annually. Distinct epidemiologic patterns exist: tobacco/alcohol-related cancers in Western populations versus betel quid-associated malignancies in South/Southeast Asia. The oral cavity's accessibility facilitates early detection, yet 60% of cases present at advanced stages due to symptom neglect.

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## Causes and Risk Factors: Direct Carcinogen Exposure

### Primary Insults
- **Tobacco Products**: Smoking (10× risk), smokeless tobacco
- **Alcohol**: Synergistic with tobacco (35× increased risk)
- **Betel Quid**: Contains arecoline (IARC Group 1 carcinogen)

### Secondary Factors
- **HPV Infection**: HPV16 responsible for rising oropharyngeal cancer
- **Poor Oral Hygiene**: Chronic irritation from ill-fitting dentures
- **UV Exposure**: Lip cancer in outdoor workers

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## Prevention Strategies: From Abstinence to Vaccination

### Primary Prevention
- **Tobacco Cessation Programs**: Risk halves 5 years after quitting
- **HPV Vaccination**: Prevents HPV-related oropharyngeal cancer
- **Betel Quid Control**: Regulatory restrictions in endemic areas

### Early Detection Protocol
1. **Visual Examination**: Monthly self-checks for:
   - Erythroplakia (red patches)
   - Leukoplakia (white patches)
   - Non-healing ulcers (>2 weeks)
   
2. **Professional Screening**:
   - Annual dental examination with toluidine blue staining
   - VELscope fluorescence visualization

### High-Risk Management
- Chemoprevention with retinoids
- Photodynamic therapy for premalignant lesions