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The etiological factors of squamous cell carcinomas of the head and neck have been well known for a long time. It is also well known that the incidence of oral cancer diagnosed in younger patients is on the rise. Due to the young age of these patients, the increase in the number of these cases and the fact that many of them neither smoke nor drink alcohol it has been suggested that other factors might be at play in the carcinogenesis of oral cancer. Thus, along the classic etiological factors of smoking and alcohol abuse certain molecular marker anomalies and the human papilloma virus (HPV) have emerged as potential factors. The aim of the present study is to verify the potential prognostic factors and to map the differences in biomarker expression between the young and the old patient groups. In the present study the immunohistochemical profile of samples obtained from oral squamous cell carcinomas was studied and compared with various clinico-pathological parameters. In 88 samples the expressions of p16, p53, Ki67, EGFR were studied with a tissue microarray technique under standard reaction conditions as well as the detection and typing of HPV infection with the Full Spectrum HPV DNA method. The biomarker expression profile of young patients with oral squamous cell carcinoma was compared to that of older patients (above 50). A significant difference was found between the immunohistochemical profile of the young and old patient groups in p16, Ki67 expression. The overall survival and progression free survival were influenced by p16 expression in young age., Competing Interests: MB was employed by Synlab Genoid Molecular Diagnostic Laboratory. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Csurgay, Zalatnai, Benczik, Csomó, Horváth, Lőrincz, Komlós and Németh.)

Background: The aetiology of oral cancer is multifactorial, as various risk factors (genetics, socioeconomic and lifestyle factors) contribute to its development. Data in the literature suggest that people with periodontal disease have an increased risk of developing oral cancer, and the severity of periodontitis correlates with the appearance of oral squamous cell carcinoma. The aim of this study was to revise the non-genetic risk factors that may influence the development of OC, while focusing on the dental and periodontal status and OH., Methods: Two hundred patients (hundred diagnosed with oral cancer and hundred without oral cancer) were enrolled in our case-control study, to evaluate the association between oral cancer and the presence and severity of periodontitis, while examining several risk factors that might be responsible for oral cancer formation. A questionnaire customised for oral cancer patients was used to obtain the socioeconomic and lifestyle risk factors that may influence the development of oral squamous cell carcinoma. The dental and periodontal status along with the level of oral hygiene was recorded quantitatively. The chi-square and Mann-Whitney tests and logistic regression were used for the statistical analysis., Results: By considering both the case and the control groups, a significant correlation was found between the incidence of oral cancer and some socioeconomic factors and lifestyle habits, such as the sex, age, education and alcohol consumption of an individual. The mean value of the Silness-Löe plaque index was significantly higher in the case population. The number of completely edentulous patients was higher among the oral cancer population. The incidence of oral cancer was 57.1% in patients with periodontal disease. In comparison, the incidence of oral squamous cell carcinoma was only 28.6% among the patients without periodontitis. Most of the oral cancer patients (72.1%) had stage 4 periodontitis. On the other hand, the vast majority of the control group (51.6%) had stage 2 periodontitis., Conclusion: Periodontitis can be an individual risk factor for oral cancer development. Periodontally compromised individuals should be strictly monitored, especially those with severe periodontitis and coexisting lifestyle risk factors. Maintaining their periodontal health in at-risk patients can minimize cancer risks., (© 2021. The Author(s).)

Introduction: Data proves that Hungary has a leading role in the statistics of oral cancer and patients living with type 2 diabetes., Aim: Our aim was to understand the statistical correlation between oral cancer and metabolic disorder (diabetes mellitus and impaired fasting glucose) due to the valuable data from the Semmelweis University., Method: We analyzed the data of 835 patients diagnosed with malignant oral cancer and 587 tumor-free control patients. We investigated the incidence and location of oral cancer among patients living with diabetes, and compared these datasets with our previous data from 14 years earlier., Results: We found that in oral cancer patients, 26.1% had diabetes and 20.8% had impaired fasting glucose; in the control group these ratios were 10.8% and 11.1%. This difference is significant (p<0.05). 14 years ago in the tumor group 14.6%, in the control group 5.6% had diabetes, while 9.7% and 5.5% had impaired fasting glucose. Lip cancer had the biggest incidence., Conclusions: The rise of type 2 diabetes in the tumor group was significant. This could be a burden for the health care system. We want to highlight the importance of interdisciplinary cooperation between health care professionals. Orv Hetil. 2018; 159(20): 803-807.

Background: Hungary has a leading place in global statistics of oral cancer and there is a high incidence of type-2 diabetes., Patients and Methods: A retrospective diabetes and impaired fasting glucose (IFG) screening of 758 inpatients with histologically-confirmed oral malignancies was performed. The control group comprised of 534 tumor-free adults. The results were compared to data collected 14 years earlier., Results: Diabetes mellitus (DM) was found in 25.9% and IFG in 20.6% of patients with oral cancer. Fourteen years earlier, DM was diagnosed in 14.6% and IFG in 9.7% of cancer patients. Among diabetic patients, the labial tumor location showed long-term dominance. The smoking rate of diabetes patients with oral cancer was higher in the present than in the previous study., Conclusion: The prevalence of type 2 diabetes and IFG increased significantly among oral cancer patients in the last 14 years., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

The problem of malignant tumors developing in a young age is a topic of special importance and subject of intensive research. The occurrence of oral cavity tumors shows a decreasing trend worldwide, while the incidences of oral squamous cell carcinoma diagnosed at young adulthood is increasing. The etiology of tumors developing in young age is not yet fully understood, however, it can be stated that the usual high-risk behavioral patterns (i.e. smoking and alcohol abuse) play only a minor role in this patient group, if any. Our own observations indicate a higher regional and locoregional relapse for these patients and, although they turn for help early, at an early stage of the disease, a lower chance of survival. The target of our research was to analyze the differences in certain etiological, pathological and clinical parameters of our own patient group consisting of both young and older patients. The data of 105 young (<50 years) and, as a control group, 105 older (>50 years) patients were analyzed. The patients have undergone surgery and, if necessary, radiotherapy and/or chemotherapy. The tumor-specific survival was determined at 36 months. Our study aimed at understanding the relationship between the clinical prognostic factors (stage, localization, anamnestic time), smoking habits, gender and age of the patients. Relationship between cancer occurrence (local, locoregional relapse) and survival rate, as well as age and survival rate were analyzed. We found that young patients report themselves for treatment at an early stage. Smoking and alcohol abuse were considerably less. When a relapse occurs, it occurs more frequently and earlier than at older patients. The most decisive correlation was observed between age and anamnestic time, age and number of cigarettes smoked, age and time elapsed until relapse, as well as age and cancer-specific survival. Moreover, cancer-specific survival of patients younger than 50 years of age was found significantly shorter than in the control group.

The etiology of tumors in young age is not precisely known yet, but studies on the topic generally agree that in this group of patients the traditionally known behavioural risk factors (tobacco and alcohol abuse) play no or a significantly less important role. Oral squamous cell carcinoma occurring at a young age is a topic of utmost importance that is extensively and intensively researched as, while the overall incidence of oral cancer is decreasing worldwide, that of squamous cell carcinoma diagnosed in young adults is steadily increasing. The present article aims at presenting the main questions and characteristics of tumors in young adults in Central-Eastern Europe and in developed West European countries as contrasted to tumors found in middle aged and elderly patients. Factors influencing the development of oral cancer include regulatory factors of the cell cycle, the inherited vulnerability of the genetic code of certain proteins and the presence of HPV infection with an oncogenic genotype. The connections of HPV infection and genetic damages are studied intensively. It is known that the prevalence of oral HPV infections is growing with a background of potentially changing sexual habits. It is debated, however, whether smoking and alcohol consumption could have a connection to HPV associated oral cancer and whether the spread of HPV in itself could be an explanation for the growing occurrence of young-age tumors. There is no consensus in the literature as to the prognostic significance of age. Some research groups have found a better life expectancy for young patients, while other authors found a worse prognosis for these patients. It is known that the prognosis of head and neck tumors, the prevalence of HPV infections as well as genetic mutations show regional and ethnic variations. This might be explained by differences in the degree of development of a preventive system, in the quality of care and in the attitudes of young patients towards visiting a doctor. The study is made difficult by incomparable patient selection criteria as well as by the question of the intraoral localisation of tumors as an independent risk factor.

Neurofibroma is a benign peripheral nerve sheath tumour, which arises from Schwann cells and perineural fibroblasts. It is one of the most frequent tumours of neural origin and its presence is one of the clinical criteria for the diagnosis of type 1 neurofibromatosis (NF-I) also known as von Recklinghausen's disease (VRD). Oral localization is rarer showing an incidence ranging from 4 to 7% in most series of different authors. The most frequent involvement site in oral neurofibromatosis is the tongue, followed by the oral mucosa and floor of the mouth; palate and maxillary-mandibular bones are a rare localization of the disease. The aim of this article is to report a case of NF-I with a huge, quite old palatal involvement and its treatment.

Syndecan-1, a transmembrane proteoglycan, may exert anti-proliferative effects and promote cell growth by binding various growth factors. Malignant epithelial cells often down-regulate their own syndecan-1 production, and are capable of inducing an aberrant syndecan-1 expression in stromal fibroid cells. Decreased tumor cell syndecan-1 levels in human head and neck squamous cell carcinomas indicate poor prognosis, however, no correlation between stromal syndecan-1 expression and clinical parameters has previously been established. By means of immunohistochemistry, we observed a decrease in tumor cell syndecan-1 reactivity in 33/39 oral carcinoma cases, the degree of which, however, correlated only weakly with the clinical outcome (p = 0.097). Conversely, stromal syndecan-1 positivity proved to be a significant risk factor of recurrence (Cox analysis, p = 0.03) and tumor-specific death (p = 0.023) within a 24-month period after operation. Taken together, stromal expression of syndecan-1 is a reliable factor of adverse prognosis in oral carcinomas.

Sixty patients with tumors of the floor of the mouth or of the tongue (T2N0-1-2M0) were randomized into three treatment groups. The first two groups participated in low-dose inductive chemotherapy, surgery, and then radiotherapy, whereas the third control group underwent only surgery and radiotherapy. In all three groups, studies were made of the stage, grade, sex, localization, extents of expression of the pretreatment laminin and syndecan-1 and the cancer specific survival rate, and the correlations among these. The response to neoadjuvant chemotherapy was assessed by means of a method that we developed, involving measurement of the degree of histologic regression observed in response to chemotherapy. Immunohistochemical methods were applied to investigate the changes in degree of expression of laminin and syndecan-1 in response to the medication and their correlations with the survival. As concerns the overall tumorfree survival rate, a significant difference was not found between the two chemotherapeutic groups. However, there was a significant difference between the survival indices of those who participated in cytostatic treatment (70%) and the control group (40%). In the clinical and immunohistochemical examinations, the initial laminin and syndecan-1 levels obtained from biopsy samples could be used as prognostic factors. Our model measuring the extent of histologic regression clearly demonstrated that the survival indices of the patients who responded to the neoadjuvant cytostatic treatment with adequate tissue regression were better than those of the patients who responded to the treatment to only a decreased extent or not at all. The changes in the expressions of laminin and syndecan-1 in response to cystostatic treatment proved to be important predictive factors. The increase or stagnation of these clearly forecast a good prognosis, whereas their decrease was a definite indication of poor prognosis.

Despite of considerable advances in the diagnostic and therapeutic possibilities, the prognosis of epithelial tumors in the oral cavity is still very poor. A knowledge of the prognostic factors at the beginning of treatment is therefore indispensable for determination of the appropriate therapy for the given patient. These factors may be linked to the patient (e.g. age, sex, general condition and immunological parameters) or to the tumor localization. A survey of the literature reveals that the TNM stage, the grade, the mode of invasion and the depth of the tumor infiltration are generally the most important factors influencing the fate of the patient. The prognosis depends primarily on the clinicopathological parameters, though even if they are known, it is not possible to screen out those patients who are at particular risk of a relapse. During the past 10 years, study of the DNA content distribution, the proliferation markers and certain oncogenes has come into the focus of attention; great interest is also shown in the extracellular matrix components and the metalloproteinases, which play key roles in the invasion and metastasis formation.

Despite the considerable advances in the diagnostic and therapeutic possibilities, the prognosis of epithelial tumors in the oral cavity is very poor. A knowledge of the prognostic factors at the beginning of treatment is therefore indispensable for determination of the appropriate therapy for the given patient. These factors may be linked to the patient (e.g. age, sex, general condition and immunological parameters) or to the tumor (localization, TNM stage, histological features, DNA content, or immunohistochemical and other parameters). A survey of the literature reveals that the TNM stage, the grade, the mode of invasion and the depth of the tumor are generally the most important factors influencing the fate of the patient. The prognosis primarily depends on the clinicopathological parameters, though even if they are known, it is not possible to screen out those patients who are at particular risk of a relapse. During the past 10 years, study of the DNA content, the proliferation markers and certain oncogenes has came into the focus of attention; great interest is also shown in the matrix metalloproteinases, which play key roles in the invasion and metastasis formation.

Metastases of advanced tumours of the oral cavity sometimes affect the cervical segments of the carotid arteries. The situation is worse in the 5-10% of cases in which the metastasis involves the common or internal carotid to such an extent that resection and replacement of the artery become necessary. Following clinical, CT/NM, and angiographic examinations, a surgical plan for the resection and reconstruction of the affected vascular segment is formulated. In preparing a treatment plan, emphasis must be placed on the expected quality of life, and careful consideration must be given to the extent of the operation.A survey of the international literature reveals that the reported mean 1-year complaint free survival rate after resection and reconstruction varies between 0 and 44%. In our experience, the wall of the carotid vessels is very resistant to tumour invasion in a large majority of patients. When radical surgery and reconstruction are carried out in the same session, does this increase the long-term cure rate and lengthen patient survival? A number of authors agree that radical interventions do not alter the survival indices significantly, but may improve the quality of life and regional control of the disease. The controversy over this topic is illustrated by means of a case report.

This study reports on experience acquired during the care of patients who could not participate in surgery, chemotherapy or radiation therapy because of the extent of the primary, recurrent or metastatic tumour, or because of the deterioration of the general condition or (in the event of recurrence), intervention with a curative aim could not be performed for the mentioned reasons. In these cases, improvement or preservation of the quality of life is the fundamental goal to be achieved at all times, for these patients must receive the best possible supportive treatment for the remainder of their lives, Unfortunately, the quaranteeing of this often tends to become mainly a financial question rather than a professional one. The medical staff has very little chance to influence the financial aspects, and must therefore do everything possible to ensure the highest possible level of care during hospitalization. Attention is drawn to the significant roles to be played by the family, the family doctor, the various home-care services and the hospice.

In recent years, there has been a dramatic increase in the number of tumors of the head and neck. Their successful treatment is one of the greatest challenges for physicians dealing with oncotherapy. An organic part of the complex therapy is preoperative or postoperative irradiation. Application of this is accompanied by a lower risk of recurrences, and by a higher proportion of cured patients. Unfortunately, irradiation also has a disadvantage: the development of osteoradionecrosis, a special form of osteomyelitis, in some patients (mainly in those cases where irradiation occurs after bone resection or after partial removal of the periosteum). Once the clinical picture of this irradiation complication has developed, its treatment is very difficult. A significant result or complete freedom from complaints can be attained only rarely. Attention must therefore be focussed primarily on prevention, and the oral surgeon, the oncoradiologist and the patient too can all do much to help prevent the occurrence of osteoradionecrosis. Through coupling of an up-to-date, functional surgical attitude with knowledge relating to modern radiology and radiation physics, the way may be opened to forestall this complication that is so difficult to cure.

A number of studies have previously been carried out on patients with tumors of the oral cavity, a majority of whom proved to be heavy smokers and heavy drinkers. However, we are not aware of literature reports relating to the converse situation: a study of alcoholics and strong smokers to establish the incidence of malignant processes of the oral cavity among them. Accordingly, the present aim was to investigate the occurrence of oral cavity lesions among 300 subjects who were alcoholic and heavy smokers and of the opinion that they had no tumor. Malignant processes were detected in the oral cavity or its environment in 2.66% of the 300 subjects, and more than 19% of them were found to harbour benign tumors and precancerous lesions. These investigations highlight the importance of screening examinations of the endangered population.