Tongue cancer risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
The most potent risk factor in the development of oral cancer is alcohol intake, tobacco use and human papillomavirus transmitted through sexual contact. The other risk factors include history of betel quid intake, male gender, age over 55 year, ultraviolet light, Fanconi anemia, dyskeratosis congenita, lichen planus, graft-versus-host disease (GVHD), immune system suppression, mouthwash and irritation from dentures.[1]
Risk Factors
The major risk factors in the development of tongue cancer includes the following:[1]
- Human papillomavirus (HPV), especially HPV type 16[2]
- Tobacco smoking
- Cancer of the tongue is correlated the closest with the use of tobacco products.
- Approximately 90% of patients with oral cavity cancers use tobacco products and that the relative risk of oral cavity cancers increases with the amount smoked and the duration of the smoking.
- In persons who smoke the incidence of oral cavity cancers is approximately six times that of those who do not smoke.
- Tobacco exposure causes progressive sequential histological changes to the oral mucosa. Prolonged period of exposure eventually leads to neoplastic transformation, in particular changes in the expression of p53 mutations. If the tobacco exposure is discontinued, these changes may be reversible.
- There is compelling evidence supporting the benefit for head and neck cancer patients to cease smoking after treatment for their cancer. Approximately 40% of patients who continued to smoke after definitive treatment for an oral cavity malignancy developed recurrence or developed a second head and neck malignancy. In patients who stopped smoking after treatment, approximately 6% went on to develop a recurrence.
- There has been recent increase in the incidence of oral cavity cancer in young adults in the recent years. The explosive use of smokeless tobacco, or snuff, in certain regions of the United States has lead to increased numbers of mandibular alveolus, buccal mucosa, and tongue cancers.
- Alcohol ingestion
- The correlation between alcohol consumption, particularly hard liquor, and oral cavity cancer is significant, especially in patients taking more than four consumptions per day.
- Approximately 75% of patients who develop oral cavity cancers consume alcohol, and the cancer occurs six times more often in persons who drink than in those who do not drink. The role of alcohol consumption in the development of tongue cancer appears to be independent of smoking.
- The use of alcohol has a synergistic effect on the risk of carcinogenesis rather than cumulative effect. The risk for a person who drinks alcohol and smokes tobacco is fifteen times that of an individual with neither of these habits.
- Human papillomavirus
- The human papillomavirus, is an etiologic agent for carcinogenesis in the tongue cancer. Human papillomavirus (HPV) has been detected in various amounts in persons with leukoplakia, oral dysplasia, and malignancy. In the subset of patients without other risk factors, HPV should be considered as an etiologic factor. Human papillomavirus (HPV), especially HPV type 16[2]
- Plummer-Vinson syndrome
- Plummer-Vinson syndrome (Fe deficiency anemia; achlorhydria; and mucosal atrophy of the mouth, pharynx, and esophagus) has been associated with an increased risk of cancer of the tongue. Studies have suggested that vitamins A and C, along with the carotenoids, may be protective against epithelial cancers. Iron and riboflavin deficiencies are known to produce dysplastic changes to the oral mucosa.
- Other factors
- A number of other factors have been associated with an increased incidence of tongue cancer such as the use of the product of the areca catechu tree, the betel nuts or quid as well as the use of slaked lime. This mixture is highly irritating to the oral mucosa, and as well as carcinogenic.
- The mutations in tumor suppressor genes has been reported in patients with cancers of the oral cavity. The most abundant carcinogens in tobacco constitute nitrosamines. Nitrosamines can damage DNA, leading to point mutations. These point mutations lead to deregulation of tumor suppressor genes (TP53), which is located on chromosome 17. The other oncogenes associated with oral squamous cell cancers of tongue include c-myc and erb -b1.
Other less potent risk factors includes the following:
- Lifestyle
- Betel quid
- Genetics
- Fanconi anemia
- Dyskeratosis congenital
- Family history of squamous cell carcinoma
- General
- Male gender
- Ultraviolet light
- Age over 55 year
- Graft-versus-host disease(GVHD)
- Immune system suppression
- Lichen planus
- Unproven risk factors
- Mouthwash
- Irritation from dentures
References
- ↑ 1.0 1.1 Squamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 16, 2015
- ↑ 2.0 2.1 Oropharyngeal cancer. National Cancer Institute(2015) http://www.cancer.gov/types/head-and-neck/hp/oropharyngeal-treatment-pdq Accessed on November 16, 2015