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Review of Literature 2.

1 Oral Cancer Cancer is definided as the uncontrollable growth of cells that invade and cause damage to surrounding tissue. Oral cancer appears as a growth or sore in the mouth that does not go away. Oral cancer, which includes cancers of lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat), can be life threatening if not diagnosed and treated early.[ Khandekar SP, page 156] Oral cancer starts in the mouth (oral cavity) and can interfere with the ability to breath, talk, eat, chew, or swallow. The oral cavity is easy to examine. Oral cancer that can develop in any part of the mouth, including the tongue, the gums, the palate (roof of the mouth), under the tongue, the skin lining the mouth or the lips. [Khandekar SP, 158]

2.1.1 Internal Factors of Oral Cavity Cancer a. Genetic Ethnic background is known to influence many types of cancer. For example, cancer in blacks is increasing at a faster rate than in whites. Oral and pharyngeal cancer is the fourth lending cancer site in black men and the seventh leading site of cancer in non-Hispanic whites and blacks.[ Scully C, 173] Oral cancer can occur due to genetic disease. Tumor formation as a result of genetic drift caused by etiological factors resulting in excessive cell division and uncontrolled. Gene targeted genetic changes are oncogenes, the genes that promote growth, anti-oncogenes, genes that inhibit the genes that regulate growth and apoptosis. [Scully C, 173] Most human tumors show chromosome aberrations that are usually proportional to the degree of malignancy and vary with cach tumor and patient. It is not known

whether the chromosomal abnormalities are the cause or the result of malignancy. However, identifications will surely help our understanding of causes, prevention, treatments, and prognosis of malignancies. [Scully C, 173] b. Age and Sex Of all of the factors that may contribute to the development of cancer, age is the factor that confers the highest risk. Oral cancer, like most cancers, is a disease of older age. About 95% of all oral nancers occur in persons over 40 years old, and the average age at the time of diagnosis occurs as individuals approach the age of 65. [Rodriguez T, 207] The rising incidence and mortality rates in young and middle-aged adults is incontrovertible, but there has been debate over the causes of this increase and whether their disease is inherently more aggressive than that occurring in older patients. 48, 57, 58 however, the relatively short duration of exposure to these known risk factors suggests that other factors may also be involved and there was a small sub-group of patients who had little, if any, exposure to the major risk factors. [Rodriguez T,207] In most countries around the world, oral cancer is more common in men than in women. The reported sex differences are attributable to heavier indulgence in risk habits by men and exposure to sunlight (for lip cancer) as a part of outdoor occupations. The ratio of males to females diagnosed with oral cancer, however, has declined over the decades and is now about 1.5:1 for the mouth and about 2.8:1 for cancer of oropharynx. Thus oral ratio is lower in men than in women, suggesting that some male characteristic may predisposes preferentially to oral cancer. [; 1 mei 2013, 7.42 pm] 2.1.2 Eksternal Factors of Oral Cavity Cancer a. Human Papillomavirus

HPV is the name of a group of viruses that include more than 80 different types associated with a variety of epidermal warts and skin lesions, some of which are associated with skin cancer. Low-risk HPV subtypes (eg. Type 6,11) are associated with more benign skin lesions such as warts (papillomas). High-risk subtypes (eg. Type 16,18) can cause neoplasia (abnormal cell growth) or dysplasias and are associated with the development of cervical and anal cancers.[World Health Organisation, page 64] Certain so-callrf high risk types of human papillomavirus (HPV) are recognized as important causes of cancer of the ano-genital tract, and may also be involved in the a etiology of cancers of the oral cavity and pharynx. Epidemiological and experimental evidence lend some support to this possibility. Increased risk of cancers of the oral cavity and pharynx subsequent to the occurrence common a etiologic factors.[World Health Organisation, page 64] The most dangerous aspect of human papilloma virus is its potential to causes cancer. A highly studied topic is HPVs ability to cause cervical cancer. Normal cell division is regulated by two genes, Rb and p53. Rb segregates the transcription factors necessary for progression through the cell cycle.[ Day GL, 9]

Daftar Pustaka: 1. Khandekar SP, Badgey PS, Tiwari RR. Oral cancer and some epidemiological factors: a hospital based study. Indian J Community 2006; 31(3): 157-159 2. Scully C. Oncogen, onco-supressor, carcinogenesis and oral cancer. British Dent J 1992; 173 (53) 3. Rodriguez T, Altieri A, Chatenoud L, et al. Risk factors for oral and pharyngeal cancer. Oral Oncol 2004;40 (2): 207 4. Day GL, Blat WJ Secondary primary tumors in patients with oral cancer. Cancer 1992;70:14-9

5. World Health Organisation, Human papilomavirus, IARC Monograms on the evaluation of carcinogenic risk to humand, 1995,64 6., diakses rabu 1 mei 2013, 7.42 pm