**2. Preventive awareness and control care for oral cancers**

Preventive medicine acts as a unique control for oral cancers and also charges at all-time low costs to states across the world [2, 15]. In this way, many actions can be taken by health organizations, especially by the World Health Organization in the risky geographic regions of the world [28]. Prevention of oral cancer is mainly a management of those diseases, so public awareness should be the first priority for health workers (e.g., by using media to promote fast outcomes) [3, 14]. For awareness about encountering precancerous lesions [1, 22, 28], Jeihooni et al. [9] reported that 30.4% of patients had preventable oral cancer, while 50% did not, and the remaining 19.6% of patients were unclear as to whether or not oral cancer is preventable.

To prevent oral cancers, the etiological factors should be known, and measures must be taken according to those causes. Etiological factors are tobacco use, especially in individuals older than 40 years of age, alcohol consumption, betel chewing, HPV infection or carriage, dietary intakes such as salted meat consumption, poor oral hygiene, genetic predisposition, Epstein-Barr virus (EBV) infection, long-term exposure to sunlight, and immune system disease such as organ transplant recipients and HIV-infected patients, especially as it causes lip cancer [1, 3, 4, 9, 13, 14, 29, 30].

HPV-related oral cancers, especially oropharyngeal cancers, differ from other cause-related cancers as HPV-related cancers have been seen in young, non- or former tobacco users, nonalcoholic patients, and also patients with small T tumors but with nodal involvement (fortunately, their prognosis is more satisfactory than non-related HPV tumors). In addition, HPV-related tumors are well-defined borderline, more exophytic with smaller sizes and lymph node metastasis with dominant cystic features [19]. To prevent HPV-related oral cancers, vaccination against HPV should be performed to decrease the incidence of oropharyngeal SCC [31], whereas Owosho et al. [31] reported that HPV-related oropharyngeal cancer reached its highest rate in the year 2006 and has since started to decline but not at a statistically significant rate. In the literature, vaccination programs have primarily focused on HPV infection related to cervical cancer [1]. Thus, Center for Disease Control and Prevention (CDC) is recommending that the vaccination program for HPV-related oropharyngeal cancers should be carried out for children at ages 11–12 in two doses by health providers [31].

multidisciplinary approach, including oral and maxillofacial surgeons, oral and maxillofacial radiologists, ENT specialists, medical and radiological oncologists, prosthodontists, dentists, general surgeons, primary care clinicians (such as family medicine), physical therapy and rehabilitation specialists, dietitians, speech therapists, supportive care experts, and also

After radical, surgical, and other treatment modalities such as radiotherapy and chemotherapy especially in stages III and IV patients—improving a patient's quality of life is very important [7, 14, 24, 26, 27]. Besides these, if patients have more advanced surgical (and other) treatment modality, the important thing is, of course, survival. Also, the second issue is improving quality of life. In this aspect, prosthodontics, speech therapy, dental implant-supported restoration with oral and maxillofacial surgeons, and other supportive specialties such as providers like physical therapists, mental health professionals, and dietitians and applications improve

Preventive medicine acts as a unique control for oral cancers and also charges at all-time low costs to states across the world [2, 15]. In this way, many actions can be taken by health organizations, especially by the World Health Organization in the risky geographic regions of the world [28]. Prevention of oral cancer is mainly a management of those diseases, so public awareness should be the first priority for health workers (e.g., by using media to promote fast outcomes) [3, 14]. For awareness about encountering precancerous lesions [1, 22, 28], Jeihooni et al. [9] reported that 30.4% of patients had preventable oral cancer, while 50% did not, and the remaining 19.6% of patients were unclear as to whether or not oral cancer is preventable. To prevent oral cancers, the etiological factors should be known, and measures must be taken according to those causes. Etiological factors are tobacco use, especially in individuals older than 40 years of age, alcohol consumption, betel chewing, HPV infection or carriage, dietary intakes such as salted meat consumption, poor oral hygiene, genetic predisposition, Epstein-Barr virus (EBV) infection, long-term exposure to sunlight, and immune system disease such as organ transplant recipients and HIV-infected patients, especially as it causes lip cancer [1,

HPV-related oral cancers, especially oropharyngeal cancers, differ from other cause-related cancers as HPV-related cancers have been seen in young, non- or former tobacco users, nonalcoholic patients, and also patients with small T tumors but with nodal involvement (fortunately, their prognosis is more satisfactory than non-related HPV tumors). In addition, HPV-related tumors are well-defined borderline, more exophytic with smaller sizes and lymph node metastasis with dominant cystic features [19]. To prevent HPV-related oral cancers, vaccination against HPV should be performed to decrease the incidence of oropharyngeal SCC [31], whereas Owosho et al. [31] reported that HPV-related oropharyngeal cancer reached its highest rate in the year 2006 and has since started to decline but not at a statistically significant rate. In the literature, vaccination programs have primarily focused on HPV infection related

pathologists or, if possible, oral and maxillofacial pathologists [2, 24, 25].

**2. Preventive awareness and control care for oral cancers**

a patient's quality of life [2, 24].

54 Prevention, Detection and Management of Oral Cancer

3, 4, 9, 13, 14, 29, 30].

Other efforts to prevent oral cancer should be done by controlling tobacco use or reduction programs [3, 6, 7, 11, 14, 29]. Alcohol consumption should be reduced or cut off as well [3, 7, 14]. If tobacco and alcohol are used together by the same individuals, that increases the oral cancer rate and may be a dramatically worse prognosis than HPV-related cancers [3, 5, 7, 11]. Unfortunately, alcohol is related to a very risky factor for cancer occurring even in nonsmoking individuals [3, 5, 7].

On the other hand, improving especially rich vegetable and fruit diet intake awareness programs, physical activity-increasing programs in daily life, regular sexual education for adolescents, and oral hygiene education activities may be helpful for reducing oral cancer rates in the future [1, 14, 32]. Awareness programs and activities should be conducted by healthcare providers or governments worldwide, especially in more risky regions such as Southeast Asia. For example, images of early oral cancer can be placed on cigarette packages [4].

In the risky region, or those patients that have high risk, they should be encouraged to carry out self-inspection of their oral mucosa, and if they see any mouth abnormality, they are obligated to take professional advice or treatment [4]. In addition, oral hygiene education and encouragement to improve it in individuals are key factors in preventing or early detection of oral cancer [9]. Moreover, Rahmati-Najarkolaei et al. [32] reported that awareness activities with students about risky factors decreased fear of oral cancer and also changed their attitude about knowing whether they have oral cancer. Lack of public awareness about cancer-causing factors and predictors produces diagnosis of oral cancer at stages as late as III or IV [4]. Therefore, awareness may provide early diagnosing of lesions; it reduces the cost of treatment and also reduces treatment morbidity [16, 22].

To date, many strategies have experimented with community awareness in the literature, such as mass media campaigns, which have gained some success from increased public awareness [1, 3, 8]. Unfortunately, these improvements are still not enough in terms of public awareness. Nowadays, Internet-based or online connections such as social media are very popular communication tools across the whole world. For example, the online-supported education or activities for tobacco cessation counseling revealed limited success in a randomized experiment [1, 8]. Internet-based education also applied for alcohol counseling with some success gained [1]. Billboards have also not been successful in delivering improved awareness to risky populations [1]. Prevention is the main management of oral cancers, and public awareness is a key part of prevention: where, when, and how it should be done and how it is possible is not important.

#### **2.1. Look and see: precancerous mouth lesions**

Many types of oral lesions have malignant transformation potential, aptly named premalignant or precancerous lesions. Premalignant lesions are described by using clinical, pathological, histochemical, and also many other screening techniques for which lesions such as leukoplakia, lichen planus with oral and cutaneous form, erythroplakia, stomatitis nicotina, and submucous fibrosis are named or classified [3, 10, 15, 18, 22, 33–35]. In addition, there is less malign transformation potential in lesions such as discoid lupus erythematosus and also a lesser likelihood of malignant transformation in hereditary entities such as epidermolysis bullosa and dyskeratosis congenita [34]. For the lip cancer, there are precancerous lesions like xeroderma pigmentosum, radiodermatitis, and chronic cheilitis [18]. However, histological investigation has only produced knowledge about malignant transformation potential named dysplasia—and has been indicated or used as a prediction of malignant changes [34]. According to the WHO's (2005) statement, carcinoma in situ has the highest degree of dysplasia and is also defined as a premalignant lesion [3, 10, 34]. Premalignant lesions are usually clinically screened for mouth mucosa such as white, red, or red-white mixed patches and are also called leukoplakia or erythroplakia [34, 35].

and malignant cells have higher nucleic acid content; hence, it is stained with dyes that can be identified under the microscope due to nucleic acid and have been used since 1980 [34]. Toluidine blue stain, ViziLite, and VEL scope sensitivity and specificity in oral dysplasia patients are presented by Awan et al. [37] to be 84.1 and 77.3%, 15.3 and 27.8%, and 65.8 and

Early Detection and Multidisciplinary Approach to Oral Cancer Patients

http://dx.doi.org/10.5772/intechopen.81126

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Exfoliative cytology procures cells from a wide surface area of the affected tissue with fewer invasive effects on the tissue than biopsy. It also involves a lower contamination risk prior to DNA obtaining than surgical intervention [5]. Exfoliative cytology is obtained by scrapping the mucosa lesion using a blade as tongue blade. The obtained material is spread on a dry, clean glass lam and fixed with 100% ethanol. The lam is then sent to an experienced pathologist for examination under a light microscope for dysplastic evidences in the cells [35]. In addition, serum and saliva are the most commonly used as less invasive, easily accessible, cost-effective, and convenient samples for cancer detection [15]. The sensitivity and specificity of exfoliative cytology for oral cancer detection were revealed as 93.5 and 50.6%, respectively [15]. Although exfoliative cytology is less invasive, it is highly subjective and dependent upon the expertise of examiners. Moreover, exfoliative cytology related to the DNA aneuploidy and quantitative cytomorphometry has low specificity due to the collection of disassembled cells [15]. If the exfoliative cytology is used on heavy smoker and alcohol-using patients with negative malignancy findings, a biopsy procedure should be carried out as an additional supportive test [22]. OralCDx or Orcellex® brush cytology is a bit advanced for complementary forms of the exfoliative cytology, due to it including representative cells of all layers of epithelial tissue [34, 38]. Moreover, brush cytology has provided diagnostic accuracy because of computer assistance screening [34, 38]. Studies demonstrated that OralCDx or Orcellex® cytology has a potential value as an adjunct to oral diagnosing or screening in identifying premalignant pathologies at early stages that provides surgical or curative treatment that is most effective [39]. In the future, developing automatic, cytometric, or cytomorphometric techniques combined with genetic and related features may enhance screening strategies [34]. Affecting tissue with any pathology sample technique is still recommended if there is a strong suspicion of any lesion

with malignancy regardless of the oral brush cytology result [34].

Biological, chemical, or reactional molecular agents named cell markers and biomarkers mean that signs of living organisms and the obviousness of their availability as tumor necrosis factor-alpha (TNF-α), epithelial growth factor (EGFR), vascular endothelial growth factor (VEGF), IL-8 and IL-8 mRNA, and interleukin 6 (IL-6) [10, 15]. Biomarker investigation of abnormalities of oral tissues as normal, tumorous, and inflammatory keratinocyte proteomes is likely to find new biomarker agents for oral cancer diagnosis, treatment, follow-up, and the development of personalized therapies for oral cancer and other tumorous regions [16].

The most visible oral premalignant or precancerous lesion is oral leukoplakia (OL) that has been studied for its establishment of a biomarker that signals the malign transformation of OL [22]. For instance, OL has low prevalence in western countries, so the development of a new biomarker is challenging due to the low rate of malignant transformation, and it requires long follow-up periods to achieve a new biomarker [22]. Besides these, loss of heterozygosity (LOH) was described as the strongest and most valuable biomarker by Mao et al. at the end

56.8%, respectively.
