Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015, 159(2):178-183 | DOI: 10.5507/bp.2013.092

An overview of the risk factors associated with multiple oral premalignant lesions with a case report of extensive field cancerization in a female patient

Gadiputi Sreedhara, Masineni Narayanappa Sumalathab, Deepika Shuklac
a Department of Oral Pathology and Microbiology, Babu Banarasi Das College of Dental Sciences, Lucknow, India
b Department of Oral Medicine, Babu Banarasi Das College of Dental Sciences, Lucknow, India
c Department of Oral Pathology and Microbiology, Babu Banarasi Das College of Dental Sciences, Lucknow, India

Background: Field cancerization is a well-known and well-documented process of malignant transformation first coined by Slaughter et al. in 1953. Tobacco chewing was associated with the greatest increase in the risk of multiple oral premalignant lesions and may be the major source of field cancerization of the oral cavity in the Indian population. The field cancerization will probably help clinicians in complementing evaluation of pathologic biopsy specimens.

Material and Methods: We present a case report of field cancerization in a 63-year-old Indian female. She presented with an intra-oral generalized hyperkeratotic verruciform type white lesions involving right and left buccal mucosa, lower labial mucosa, upper and lower vestibule, dorsal, ventral and right lateral border of the tongue, hard and soft palate. Microscopic examination revealed features of verrucous carcinoma in one area, squamous cell carcinoma in another and carcinoma in situ in other areas. Based on the overall features in various areas of the oral cavity, the lesion was diagnosed as field cancerization.

Conclusion: Reviewing the literature revealed the presence of a field with genetically altered cells appear to be induced by tobacco (smoking/smokeless form). The large number of premalignant cells in the fields may increase cancer risk considerably. Thus screening and monitoring of the field may have serious implications for oral cancer prevention.

Keywords: field cancerization, oral cancer, tobacco chewing, premalignant lesions

Received: August 5, 2013; Accepted: December 10, 2013; Prepublished online: January 3, 2014; Published: June 28, 2015  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Sreedhar, G., Narayanappa Sumalatha, M., & Shukla, D. (2015). An overview of the risk factors associated with multiple oral premalignant lesions with a case report of extensive field cancerization in a female patient. Biomedical papers, 159(2), 178-183. doi: 10.5507/bp.2013.092
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Chung KY, Mukhopadhyay T, Kim J, Casson A, Ro JY, Goepfert H, Hong WK, Roth JA. Discordant p53 Gene Mutations in Primary Head and Neck Cancers and Corresponding Second Primary Cancers of the Upper Aerodigestive Tract. Cancer Res 1993;53:1676-83. Go to PubMed...
    2. Califano J, Riet P van der, Westra W, Nawroz H, Clayman G, Piantadosi S, Corio R, Lee D, Greenberg B, Koch W, Sidransky D. Genetic Progression Model for Head and Neck Cancer: Implications for Field Cancerization. Cancer Res 1996;56:2488-92. Go to original source... Go to PubMed...
    3. Slaughter DP, Southwick HW, Smejkal W. "Field cancerization" in oral stratified squamous epithelium. Clinical implications of multicentric origin. Cancer 1953;6:963-8. Go to original source...
    4. Braakhuis BJM, Tabor MP, René Leemans C, van der Waal I, Snow GB, Brakenhoff RH. Second primary tumors and field cancerization in oral and oropharyngeal cancer: Molecular techniques provide new insights and definitions. Head Neck 2002;24:198-206. Go to original source... Go to PubMed...
    5. Thomas G, Hashibe M, Jacob BJ, Ramadas K, Mathew B, Sankaranarayanan R, Zhang Z-F. Risk factors for multiple oral premalignant lesions. Int J Cancer 2003;107:285-91. Go to original source... Go to PubMed...
    6. Dakubo GD, Jakupciak JP, Birch-Machin MA, Parr RL. Clinical implications and utility of field cancerization. Cancer Cell Int 2007;7:2. Go to original source... Go to PubMed...
    7. Hoffmann D, Djordjevic MV. Chemical composition and carcinogenicity of smokeless tobacco. Adv Dent Res 1997;11:322-9. Go to original source... Go to PubMed...
    8. Nieburgs HE, Herman BE, Reisman H. Buccal cell changes in patients with malignant tumours. Lab Invest 1962;11:80.
    9. Ogden GR, Cowpe JG, Green MW. The effect of distant malignancy upon quantitative cytologic assessment of normal oral mucosa. Cancer 1990;65:477-80. Go to original source... Go to PubMed...
    10. Ogden GR, Cowpe JG, Green MW. Detection of field change in oral cancer using oral exfoliative cytologic study. Cancer 1991;68:1611-5. Go to original source... Go to PubMed...
    11. Incze J, Vaughan CW Jr, Lui P, Strong MS, Kulapaditharom B. Premalignant changes in normal appearing epithelium in patients with squamous cell carcinoma of the upper aerodigestive tract. Am J Surg 1982;144:401-5. Go to original source... Go to PubMed...
    12. Högmo A, Lindskog S, Lindholm J, Kuylenstierna R, Auer G, Munck-Wikland E. Preneoplastic oral lesions: the clinical value of image cytometry DNA analysis, p53 and p21/WAF1 expression. Anticancer Res 1998;18:3645-50. Go to PubMed...
    13. Ai H, Barrera JE, Pan Z, Meyers AD, Varella-Garcia M. Identification of individuals at high risk for head and neck carcinogenesis using chromosome aneuploidy detected by fluorescence in situ hybridization. Mutat Res 1999;439:223-32. Go to original source... Go to PubMed...
    14. Voravud N, Shin DM, Ro JY, Lee JS, Hong WK, Hittelman WN. Increased polysomies of chromosomes 7 and 17 during head and neck multistage tumorigenesis. Cancer Res 1993;53:2874-83.
    15. Choi G, Chung K. Polysomies of chromosomes 7 and 17 in head and neck squamous cell carcinomas. Arch Otolaryngol Head Neck Surg 1996;122:1062-7. Go to original source... Go to PubMed...
    16. Oijen M. G. C. T. V, Poorts LK, Slootweg PJ. Mucosal changes in head and neck cancer. Incipient tumors or micrometastases? J Cancer Res, ClinOncol 1999;125:S105.
    17. Van der Velden LA, Schaafsma HE, Manni JJ, Ramaekers FC, Kuijpers W. Cytokeratin expression in normal and (pre)malignant head and neck epithelia: an overview. Head Neck 1993;15:133-46. Go to original source... Go to PubMed...
    18. Lindberg K, Rheinwald JG. Suprabasal 40 kd keratin (K19) expression as an immunohistologic marker of premalignancy in oral epithelium. Am J Pathol 1989;134:89.
    19. Copper MP, Braakhuis BJ, de Vries N, van Dongen GA, Nauta JJ, Snow GB. A panel of biomarkers of carcinogenesis of the upper aerodigestive tract as potential intermediate endpoints in chemoprevention trials. Cancer 1993;71:825-30. Go to original source... Go to PubMed...
    20. Ogden GR, Lane EB, Hopwood DV, Chisholm DM. Evidence for field change in oral cancer based on cytokeratin expression. Br J Cancer 1993;67:1324-30. Go to original source... Go to PubMed...
    21. Bongers V, Snow GB, de Vries N, Braakhuis BJ. Potential early markers of carcinogenesis in the mucosa of the head and neck using exfoliative cytology. J Pathol 1996;178:284-9. Go to original source... Go to PubMed...
    22. Bosch FX, Ouhayoun JP, Bader BL, Collin C, Grund C, Lee I, Franke WW. Extensive changes in cytokeratin expression patterns in pathologically affected human gingiva. Virchows Arch B Cell Pathol Incl Mol Pathol 1989;58:59-77. Go to original source... Go to PubMed...
    23. Izzo JG, Papadimitrakopoulou VA, Li XQ, Ibarguen H, Lee JS, Ro JY, El-Naggar A, Hong WK, Hittelman WN. Dysregulated cyclin D1 expression early in head and neck tumorigenesis: in vivo evidence for an association with subsequent gene amplification. Oncogene 1998;17:2313-22. Go to original source... Go to PubMed...
    24. Bartkova J, Lukas J, Müller H, Strauss M, Gusterson B, Bartek J. Abnormal Patterns of D-Type Cyclin Expression and G1 Regulation in Human Head and Neck Cancer. Cancer Res 1995;55:949-56. Go to PubMed...
    25. Sonenberg N, Gingras AC. The mRNA 5' cap-binding protein eIF4E and control of cell growth. Curr Opin Cell Biol 1998;10:268-75. Go to original source... Go to PubMed...
    26. Franklin S, Pho T, Abreo FW, Nassar R, De Benedetti A, Stucker FJ, Nathan CA. Detection of the proto-oncogene eIF4E in larynx and hypopharynx cancers. Arch Otolaryngol Head Neck Surg 1999;125:177-82. Go to original source... Go to PubMed...
    27. Eisbruch A, Blick M, Lee JS, Sacks PG, Gutterman J. Analysis of the Epidermal Growth Factor Receptor Gene in Fresh Human Head and Neck Tumors. Cancer Res 1987;47:3603-5. Go to PubMed...
    28. Grandis JR, Tweardy DJ. Elevated Levels of Transforming Growth Factor α and Epidermal Growth Factor Receptor Messenger RNA Are Early Markers of Carcinogenesis in Head and Neck Cancer. Cancer Res 1993;53:3579-84.
    29. Christensen ME, Engbaek F, Therkildsen MH, Bretlau P, Nexø E. A sensitive enzyme-linked immunosorbent assay used for quantitation of epidermal growth factor receptor protein in head and neck carcinomas: evaluation, interpretations and limitations. Br J Cancer 1995;72:1487-93. Go to original source... Go to PubMed...
    30. Shin DM, Ro JY, Hong WK, Hittelman WN. Dysregulation of Epidermal Growth Factor Receptor Expression in Premalignant Lesions during Head and Neck Tumorigenesis. Cancer Res 1994;54:3153-9. Go to PubMed...
    31. Van Oijen MG, Rijksen G, ten Broek FW, Slootweg PJ. Increased expression of epidermal growth factor receptor in normal epithelium adjacent to head and neck carcinomas independent of tobacco and alcohol abuse. Oral Dis 1998;4:4-8. Go to original source... Go to PubMed...
    32. Schwint AE, Savino TM, Lanfranchi HE, Marschoff E, Cabrini RL, Itoiz ME. Nucleolar organizer regions in lining epithelium adjacent to squamous cell carcinoma of human oral mucosa. Cancer 1994;73:2674-9. Go to original source... Go to PubMed...
    33. Kirsch DG, Kastan MB. Tumor-suppressor p53: implications for tumor development and prognosis. J Clin Oncol 1998;16:3158-68. Go to original source... Go to PubMed...
    34. Nees M, Homann N, Discher H, Andl T, Enders C, Herold-Mende C, Schuhmann A, Bosch FX. Expression of Mutated p53 Occurs in Tumor-distant Epithelia of Head and Neck Cancer Patients: A Possible Molecular Basis for the Development of Multiple Tumors. Cancer Res 1993;53:4189-96. Go to PubMed...
    35. Cruz IB, Snijders PJ, Meijer CJ, Braakhuis BJ, Snow GB, Walboomers JM, van der Waal I. p53 expression above the basal cell layer in oral mucosa is an early event of malignant transformation and has predictive value for developing oral squamous cell carcinoma. J Pathol 1998;184:360-8. Go to original source... Go to PubMed...
    36. Shin DM, Kim J, Ro JY, Hittelman J, Roth JA, Hong WK, Hittelman WN. Activation of p53 Gene Expression in Premalignant Lesions during Head and Neck Tumorigenesis. Cancer Res 1994;54:321-6. Go to PubMed...
    37. Waridel F, Estreicher A, Bron L, Flaman JM, Fontolliet C, Monnier P, Frebourg T, Iggo R. Field cancerisation and polyclonal p53 mutation in the upper aero-digestive tract. Oncogene 1997;14:163-9. Go to original source... Go to PubMed...
    38. el-Naggar AK, Lai S, Luna MA, Zhou XD, Weber RS, Goepfert H, Batsakis JG. Sequential p53 mutation analysis of pre-invasive and invasive head and neck squamous carcinoma. Int J Cancer J Int Cancer 1995;64:196-201. Go to original source... Go to PubMed...
    39. Bongers V, Snow GB, de Vries N, Cattan AR, Hall AG, van der Waal I, Braakhuis BJ. Second primary head and neck squamous cell carcinoma predicted by the glutathione S-transferase expression in healthy tissue in the direct vicinity of the first tumor. Lab Investig J Tech Methods Pathol 1995;73:503-10.
    40. Tabor MP, Brakenhoff RH, Houten VMM van, Kummer JA, Snel MHJ, Snijders PJF, Snow GB, Leemans CR, Braakhuis BJM. Persistence of Genetically Altered Fields in Head and Neck Cancer Patients Biological and Clinical Implications. Clin Cancer Res 2001;7:1523-32.
    41. Hittelman WN. Genetic instability in epithelial tissues at risk for cancer. Ann N Y Acad Sci 2001;952:1-12. Go to original source... Go to PubMed...
    42. Brennan JA, Mao L, Hruban RH, Boyle JO, Eby YJ, Koch WM, Goodman SN, Sidransky D. Molecular assessment of histopathological staging in squamous-cell carcinoma of the head and neck. N Engl J Med 1995;332:429-35. Go to original source... Go to PubMed...
    43. Davies PDO, Yew WW, Ganguly D, Davidow AL, Reichman LB, Dheda K, Rook GA. Smoking and tuberculosis: the epidemiological association and immunopathogenesis. Trans R Soc Trop Med Hyg 2006;100:291-8. Go to original source... Go to PubMed...
    44. Alcaide J, Altet MN, Plans P, Parrón I, Folguera L, Saltó E, Dominguez A, Pardell H, Salleras L. Cigarette smoking as a risk factor for tuberculosis in young adults: A casecontrol study. Tuber Lung Dis 1996;77:112-6. Go to original source... Go to PubMed...
    45. Mao L, Lee JS, Kurie JM, Fan YH, Lippman SM, Broxson A, Khuri FR, Hong WK, Lee JJ, Yu R, Ro JY, Kemp BL, Morice RC, Walsh GL, Hittelman WN. Clonal Genetic Alterations in the Lungs of Current and Former Smokers. J Natl Cancer Inst 1997;89:857-62. Go to original source... Go to PubMed...
    46. Wistuba II, Lam S, Behrens C, Virmani AK, Fong KM, LeRiche J, Samet JM, Srivastava S, Minna JD, Gazdar AF. Molecular damage in the bronchial epithelium of current and former smokers. J Natl Cancer Inst 1997;89:1366-73. Go to original source... Go to PubMed...

    Return to the content