Non-Invasive Methods for Early Diagnosis of Oral Cancer

*Manoela Garcia Dias da Conceição, Ana Cláudia Figueiró and Vera Lucia Luiza*

#### **Abstract**

Oral cancer is a public health problem because of its high morbidity and mortality, and when not treated in a timely manner, it is significantly mutilating, causing damage to the physical and psychological aspects of patients and directly interfering with their quality of life. Several factors influence the early diagnosis of this pathology, including lack of self-care related to oral health, especially among people with prolonged use of dental prosthesis; delayed perception of the lesion; delayed search for professional assistance since the lesion is noticed by the patient; lack of information about oral cancer, its risk and protective factors, and oral lesions that may be suggestive of cancer; lack of health promotion and prevention activities aimed at oral cancer; and lack of training in oral cancer among oral health professionals. These factors must be tackled to promote the timely diagnosis of this pathology. The use of reliable noninvasive diagnosis methods is also important because they can be easily made available in low resource settings, increasing the coverage of people who are under risk of developing oral cancer.

**Keywords:** oral health, prevention, primary health care, secondary health care, oral cancer

#### **1. Introduction**

Oral health is part of general health and is essential to people's well-being. Good oral health implies being free from chronic orofacial pain, oral and pharyngeal cancer, soft tissue changes in the mouth, congenital disabilities, and other issues affecting the craniofacial complex [1].

Oral cancer (OC) is considered a public health problem because of its high mortality and morbidity rates. This problem also affects most people with low sociocultural level and who are alcoholics and smokers. However, there are other associated risk factors: chewing tobacco, use of a dental prosthesis, infection with human papilloma virus (HPV) type 16, nutritional deficiency, age, gender, poor oral hygiene, excess body fat, and chewing betel nut, among others [2, 3].

Data published by the International Agency for Research on Cancer (IARC) regarding cancer cases in general reported in 2012 about 14.1 million new cases, 8.2 million deaths within 5 years of diagnosis, and 32.6 million people living with cancer in the world. Of these, approximately 57% of new cases, 65% of deaths, and 48% of cases diagnosed in the last 5 years are in developing countries [4].

In 2018, new data were released, indicating an increase in new cases of cancer, with 18.1 million new cases and 9.6 million deaths [5]. The significant increase of this disease is clear, indicating the need for new plans for prevention and early diagnosis.

Regarding oral cancer, the highest rates have been observed in populations of Melanesia, Central-South Asia, Eastern and Western Europe, Africa, and Central America. Oral cancer is the sixth most common in the world, and most cases occur in India and Southeast Asia, according to the estimates for 2012 [6]. A change was seen in 2018 when oral cancer ranked in the 11th position among the most common cancers in the world. This type of cancer is quite common in Brazil, which has the third highest incidence in the world, behind only India and former Czechoslovakia [5].

Oral cancer is a condition that negatively interferes with the general and oral health of the individual. These oral problems cause pain and infection, leading to psychological and physical distress. It is important to note that such dental conditions express social exclusion. In general, they are associated with poor education, low income, unemployment, and difficulty in accessing care services [7]. Thus oral cancer patients represent a group of people that should receive differentiated attention because, besides cancer itself, they are highly susceptible to other ills [2]. When this disease affects individuals, they may have to face consequences such as facial mutilation. Also, they may render them unable to work, with severe damage to their quality of life. The disease may sometimes be lethal, mainly because of late diagnosis.

This pathology causes essential changes in the daily lives of the affected people, interfering with their body image, body functioning, and psychological, social, and family structure. The disease mostly affects the population in their working phase of life, causes indirect damage to the country. Late diagnosis is directly associated with shorter survival. However, if diagnosed early, it has a good prognosis and an average 5-year survival rate of 77.3% in stages I and II, but of 32.2% in stages III and IV [2].

Morbidity and mortality rates are high, with diagnosis in advanced phases in 65–85% of the cases, reducing the likelihood of cure [2, 8–11]. For most of these patients, palliative care is the only option available to achieve a better quality of life and control symptoms.

Protective factors against this condition include general and specific measures. The adoption of healthy lifestyle habits, including adequate nutrition, physical exercise, and self-care, is part of the prevailing standards. In turn, specific practices include oral health care, routine inspection of the oral cavity, periodic dental evaluation, and cessation of smoking and alcoholism, and recent studies have shown the consumption green tea as a protective measure [12, 13].

Although oral cancer is easily detected, its diagnosis is late in most cases. It is possible to improve diagnosis through the use of health promotion and prevention measures and improved access to health services, to promote early diagnosis [7, 14, 15]. Diagnosis is followed by curative treatment, preventing mutilating and disabling sequelae.

The relevance of this disease and its early diagnosis should be considered for the possibility of curative treatment and promotion of the quality of life of patients. It is essential to know and recommend methods that act in favor of the early diagnosis of this pathology. It may mean identifying early malignant and even premalignant lesions, leading to the cure of these patients and rehabilitation to their social routine. It is equally important to act on factors that influence to late diagnosis of this pathology, through the planning of actions.

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*Non-Invasive Methods for Early Diagnosis of Oral Cancer*

**2. Factors related to late diagnosis of oral cancer**

The problem of delayed diagnosis of OC is known worldwide, and each country or region has different strategies to address it. These factors are described in several studies [16, 17], showing that this is a global problem. Factors related to late diagnosis of OC concern the social determinants, health literacy, and characteristics of the

1.Profile of the affected people concerning lifestyle habits: most people who develop OC were smokers and alcoholics and are in situations associated with other unhealthy lifestyles, such as poor diet and physical inactivity [2].

2.Lack of self-care in oral health: the most vulnerable populations, which are those with a low socioeconomic level, frequently have poor self-care due to their living conditions, especially in terms of oral health, besides other health problems. This problem directly interferes with their quality of life and interaction with peers. They also present a low search for health care, leading to the worsening of health problems and, in this case, late diagnosis of oral

3.Delayed perception of the lesion: due to poor self-care, most do not identify the presence of initial lesions in the oral cavity. Thus, injuries are only perceived when they cause discomfort, pain, bleeding, or other symptoms, and at that

4.Lack of information about oral cancer and its protective and risk factors: many campaigns for the dissemination of information on disease have been promoted, but specifically on oral cancer is still incipient. People asked to appear to not know about oral cancer, suspected lesions or risk, and protective factors, even patients who are undergoing treatment for this type of cancer [14, 19].

5.Lack of health promotion and prevention activities aimed at oral cancer: a few specific actions to promote and prevent this type of cancer are carried out. These actions are usually linked to other campaigns such as those focused on

6.Lack of training in oral cancer among oral health professionals and deficits in addressing this content in the curricula of undergraduate courses: oral health professionals are not routinely updated and trained on this content. Still, the approach during undergraduate training is deficient, producing professionals with little experience to approach patients with suspected lesions [14, 16].

7.Delayed search for professional assistance when the patient perceives the

8.Difficulties in accessing dental treatment: many people are unable to get adequate dental care due to the difficulty in accessing health services. In general, it is due to their vulnerable conditions or even because they do not

lesion: people usually notice the presence of the injury but do not seek a professional for confirmation. Often they refer to fear of confirming the diagnosis of the disease. This delay in seeking the diagnosis causes the lesion to continue

vaccination, smoking, and oral health in general [14].

growing, leading to late diagnosis [14].

seek health services [14].

point, in most cases, the disease is already in an advanced stage [18].

*DOI: http://dx.doi.org/10.5772/intechopen.89280*

health system:

cancer [18].

*Oral Diseases*

diagnosis.

diagnosis.

stages III and IV [2].

and control symptoms.

disabling sequelae.

Czechoslovakia [5].

In 2018, new data were released, indicating an increase in new cases of cancer, with 18.1 million new cases and 9.6 million deaths [5]. The significant increase of this disease is clear, indicating the need for new plans for prevention and early

Regarding oral cancer, the highest rates have been observed in populations of Melanesia, Central-South Asia, Eastern and Western Europe, Africa, and Central America. Oral cancer is the sixth most common in the world, and most cases occur in India and Southeast Asia, according to the estimates for 2012 [6]. A change was seen in 2018 when oral cancer ranked in the 11th position among the most common cancers in the world. This type of cancer is quite common in Brazil, which has the third highest incidence in the world, behind only India and former

Oral cancer is a condition that negatively interferes with the general and oral health of the individual. These oral problems cause pain and infection, leading to psychological and physical distress. It is important to note that such dental conditions express social exclusion. In general, they are associated with poor education, low income, unemployment, and difficulty in accessing care services [7]. Thus oral cancer patients represent a group of people that should receive differentiated attention because, besides cancer itself, they are highly susceptible to other ills [2]. When this disease affects individuals, they may have to face consequences such as facial mutilation. Also, they may render them unable to work, with severe damage to their quality of life. The disease may sometimes be lethal, mainly because of late

This pathology causes essential changes in the daily lives of the affected people, interfering with their body image, body functioning, and psychological, social, and family structure. The disease mostly affects the population in their working phase of life, causes indirect damage to the country. Late diagnosis is directly associated with shorter survival. However, if diagnosed early, it has a good prognosis and an average 5-year survival rate of 77.3% in stages I and II, but of 32.2% in

Morbidity and mortality rates are high, with diagnosis in advanced phases in 65–85% of the cases, reducing the likelihood of cure [2, 8–11]. For most of these patients, palliative care is the only option available to achieve a better quality of life

Protective factors against this condition include general and specific measures. The adoption of healthy lifestyle habits, including adequate nutrition, physical exercise, and self-care, is part of the prevailing standards. In turn, specific practices include oral health care, routine inspection of the oral cavity, periodic dental evaluation, and cessation of smoking and alcoholism, and recent studies have shown the

Although oral cancer is easily detected, its diagnosis is late in most cases. It is possible to improve diagnosis through the use of health promotion and prevention measures and improved access to health services, to promote early diagnosis [7, 14, 15]. Diagnosis is followed by curative treatment, preventing mutilating and

The relevance of this disease and its early diagnosis should be considered for the possibility of curative treatment and promotion of the quality of life of patients. It is essential to know and recommend methods that act in favor of the early diagnosis of this pathology. It may mean identifying early malignant and even premalignant lesions, leading to the cure of these patients and rehabilitation to their social routine. It is equally important to act on factors that influence to late diagnosis of this

consumption green tea as a protective measure [12, 13].

pathology, through the planning of actions.

**106**
