"Haemophilia A" - Presenting with oral squamous cell carcinoma diagnosis and management strategies.

Hemophilia is a hereditary disorder of coagulation that results in deficiency of factor VIII (Hemophilia A) or Factor IX (Hemophilia B) with characteristic X linked mode of inheritance, almost exclusively seen in males while females are asymptomatic carriers.The common clinical manifestation in both is prolonged bleeding on trivial trauma, mainly into larger joints or muscles. Life threatening bleeding episodes can result spontaneously or from trauma to the head or internal organs. Replacement of deficient clotting protein, known as Anti Hemophilic Factor (AHF) is the main stay in the treatment of haemophilia. Any Surgical treatment of these patients is to be planned in Institution hospital where comprehensive care is available. The availability of AHF has enabled surgeons to take up surgeries in patients with haemophilia. We discuss PWH with congenital factor VIII deficiency presented with oral squamous cell carcinoma of left side lower jaw with main aim is to provide insight into surgical management and care protocol of these patients.

An unusual intraoral lipoma: case report and review of the literature.

Lipoma is a common tumor of soft tissue with rare occurrence in oral cavity accounting for only 1-4% of benign oral tumours. It may be noticed only during routine dental examinations. Most of them rarely cause pain, resulting in delay to seek treatment. Lipoma of the oral cavity may occur in any region. The buccal mucosa, tongue, and floor of the mouth are among the common locations. A case of large intraoral lipoma occurring in mental region in a 60-year-old female patient is reported. It was treated surgically under local anesthesia, and 6 month follow up showed excellent healing without any recurrence.

Utilizing feline oral squamous cell carcinoma patients to develop NQO1-targeted therapy.

Developing effective therapies for the treatment of advanced head-and-neck squamous cell carcinoma (HNSCC) remains a major challenge, and there is a limited landscape of effective targeted therapies on the horizon. NAD(P)H:quinone oxidoreductase 1 (NQO1) is a 2-electron reductase that is overexpressed in HNSCC and presents as a promising target for the treatment of HNSCC. Current NQO1-targeted drugs are hindered by their poor oxidative tolerability in human patients, underscoring a need for better preclinical screening for oxidative toxicities for NQO1-bioactivated small molecules. Herein, we describe our work to include felines and feline oral squamous cell carcinoma (FOSCC) patients in the preclinical assessment process to prioritize lead compounds with increased tolerability and efficacy prior to full human translation. Specifically, our data demonstrate that IB-DNQ, an NQO1-targeted small molecule, is well-tolerated in FOSCC patients and shows promising initial efficacy against FOSCC tumors in proof-of-concept single agent and radiotherapy combination cohorts. Furthermore, FOSCC tumors are amenable to evaluating a variety of target-inducible couplet hypotheses, evidenced herein with modulation of NQO1 levels with palliative radiotherapy. The use of felines and their naturally-occurring tumors provide an intriguing, often underutilized tool for preclinical drug development for NQO1-targeted approaches and has broader applications for the evaluation of other anticancer strategies.

Hepatoesplenomegalia relacionada a linfoma de Burkitt en paciente pediátrico / Hepatoesplenomegalia related to Burkitt´s lymphoma in a pediatric patient

RESUMEN El linfoma de Burkitt, se trata de un subtipo poco frecuente del linfoma no Hodgkin, con elevada frecuencia en aquellos pacientes con sida. La hepatoesplenomegalia es un signo clínico de gran importancia para el diagnóstico oportuno de algunas patologías; entre los mecanismos de formación de la hepatoesplenomegalia se encuentra la infiltración celular, ocasionada por la migración de células tumorales. Se presenta por inflamaciones debido a la presencia de infecciones por virus o bacterias las cuales son muy comunes en pacientes con sida. Se presentó un caso de un paciente masculino de 4 años, diagnosticado con VIH positivo, con la configuración correspondiente de criterios clínicos en clasificación C para sida. El cual desarrolló a nivel de cavidad oral un Burkitt primario, que se acompañó de hepatoesplenomegalia. Se pretendió describir la relación y el comportamiento de este tipo de linfoma con la hepatoesplenomegalia, así como la repercusión a nivel del sistema estomatognático, a nivel sistémico y el plan de tratamiento. Por el cuadro clínico e inmunológico del paciente estudiado, se planteó un pronóstico reservado por presentar un cuadro clínico infrecuente, en el que se observó Burkitt; tanto a nivel del sistema estomatognático como a nivel abdominal. Se hizo necesario realizar un diagnóstico oportuno y certero para iniciar el tratamiento a tiempo, se comenzó inmediatamente con tratamiento (AU).

ABSTRACT Burkitt lymphoma (BL) is a rare subtype of non-Hodgkin lymphoma, with high frequency in those patients with AIDS. Hepatosplenomegaly is a clinical sign of great importance for the timely diagnosis of some pathologies; cellular infiltration is found among the mechanisms of hepatosplenomegaly formation; it is caused by the migration of tumor cells. It emerges by inflammations due to the presence of infections by virus or bacteria which are very common in patients with AIDS. The authors present the case of a male patient, aged 4 years, with a positive HIV diagnosis, and the correspondent configuration of clinical criteria in C classification for AIDS, who developed a primary Burkitt lymphoma at the level of oral cavity We present the case of a 4-year-old male patient diagnosed with HIV positive, with the corresponding configuration of clinical criteria in classification C for AIDS; who developed a primary LB at the oral cavity level that was accompanied by hepatosplenomegaly. The authors pretended to describe the relation and behavior of this kind of lymphoma with hepatosplenomegaly, and also the repercussion at the stomatognathic level, at the systemic level and the treatment plan. Due to the clinical and immunological characteristics of the studied patient a reserved prognosis was given because of presenting infrequent clinical characteristics in which a Burkitt was observed both, at the stomatognathic and at the abdominal level. It was necessary to make an opportune and accurate diagnosis to begin the treatment on time (AU).

An insight into crystallization test: A neoteric approach for screening premalignant and malignant lesions.

INTRODUCTION: Crystallization test is based on the principle that, when a salt crystallizes out of an aqueous solution, the crystal growth is influenced by the presence of other substances in the solution, such as blood or plant extracts. If a mixture of copper chloride solution with a small amount of whole blood is allowed to crystallize under controlled experimental conditions, an aggregate of crystals forms. Crystallization method can be used as a diagnostic aid to provide information about the systemic conditions and general health of the patient. AIM: This study aims to study the patterns of crystallization and to further determine the efficacy of crystallization test as a screening modality in premalignant lesions and oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Fifty patients of OSCC, 50 patients of premalignant lesions, and 50 healthy individuals were selected. One drop of blood was collected from the study groups to perform crystallization using cupric chloride. STATISTICAL ANALYSIS USED: Statistical analysis was performed using Chi-square test, Student's t-test (two-tailed), and analysis of variance. RESULTS: The different patterns of crystals formed were studied and statistically analyzed. CONCLUSION: Based on the study, it was concluded that Crystallization test can be used as an effective screening modality for detection of premalignant lesions and OSCC.

Knowledge, attitudes and practices of general medical practitioners in developed countries regarding oral cancer: an integrative review.

BACKGROUND: Oral cancer is a public health concern and is widespread in developing countries, particularly in South Asia. However, oral cancer cases are also rising in developed nations due to various factors, including smoking, viruses and increased migration from South Asia. In this context, the role of general medical practitioners (GPs) in identifying oral cancer is becoming increasingly important and, while some studies have explored their perspective about oral cancer, a synthesis of these results has not been undertaken. OBJECTIVE: The objective of this integrative review is to synthesize existing evidence regarding oral cancer-related knowledge, attitudes and practices of GPs in developed countries. METHODS: Four electronic databases were searched to identify studies focussing on the objective of this review. The inclusion criteria were: peer-reviewed English language publications; studies conducted in developed countries involving GPs; explored at least one study outcome (knowledge/attitudes/practices). No restrictions were placed on the publication date. RESULTS: A total of 21 studies involving 3409 GPs were reviewed. Most studies revealed limited knowledge of GPs about emerging risk factors, such as betel nut chewing (0.8-50%). Significant variation (7-70%) was evident in routine oral examination practices of GPs. Most GPs felt unsure about diagnosing oral cancer and many (38-94%) raised the need for further education. No study explored the specific relevance of GPs' practices concerning South Asian immigrants. CONCLUSION: This review suggests the need for educational programs to enhance GPs' knowledge regarding oral cancer. Further research exploring oral cancer-related practices of GPs caring for South Asian immigrants is warranted.

Amino acids signatures of distance-related surgical margins of oral squamous cell carcinoma.

BACKGROUND: Histological assessment of resected margins has some drawbacks. We therefore aimed to identify a panel of metabolic markers for evaluating the surgical margins of oral squamous cell carcinoma during surgery. METHODS: A total of 28 case of OSCC samples were enrolled in the study. Gas chromatography-mass spectrometry based untargeted metabolic analysis was employed to acquire the metabolic perturbation of the distance-related surgical margins in the development group. The acquired MS data were then subjected to univariate and multivariate analysis by MetaboAnalyst. Ultra-high performance liquid chromatography-tandem mass spectrometerbased targeted metabolomics for quantitative analysis of the validation group was performed to verify the results of the development group. Another 60 OSCC patients with dysplastic surgical margins were used to further validate the results of the development group by immunohistochemical examination of key enzyme expression, and correlate them with clinicopathological parameters and clinical outcomes. FINDINGS: We finally identified 4 amino acids as negative margin markers, and 6 amino acids as dysplastic margin markers. IHC analysis showed that asparagine synthetase positive expression in dysplastic surgical margins and its higher expression was correlated with tumor recurrence and local relapse-free survival. INTERPRETATIONS: We developed a panel of metabolic molecular markers to supplement the evaluation of negative and dysplastic margins. FUND: This study was supported by Nanjing Municipal Key Medical Laboratory Constructional Project Funding (Since 2012); Center of Nanjing Clinical Medicine Tumor (Since 2014). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

A Novel Multimodal NIR-II Nanoprobe for the Detection of Metastatic Lymph Nodes and Targeting Chemo-Photothermal Therapy in Oral Squamous Cell Carcinoma.

Current surgical treatment for oral squamous cell carcinoma (OSCC) must be as precise as possible to fully resect tumors and preserve functional tissues. Thus, it is urgent to develop efficient fluorescent probes to clearly identify tumor delineation, as well as metastatic lymph nodes. Chemo-photothermal therapy combination attracted a growing attention to increase anti-tumor effect in various types of cancer, including OSCC. In the present study, we designed a multimodal NIR-II probe that involves combining photothermal therapy with chemotherapy, imaging OSCC tumors and detecting metastatic lymph nodes. Methods: In this study, we synthesized a novel near infrared (NIR)-II probe named TQTPA [4,4'-((6,7-bis(4-(hexyloxy)phenyl)-[1,2,5]thiadiazolo [3,4-g]quinoxaline-4,9-diyl)bis(thiophene-5,2-diyl))bis(N,N-diphenylaniline)] via the Suzuki reaction and prepared multimodal nanoparticles (NPs) loading TQTPA and cis-dichlorodiammine platinum (CDDP) (HT@CDDP) by hyaluronic acid. The characteristics of the NPs, including their photothermal and imaging capabilities were investigated in vitro and in vivo. Their anti-tumor efficacy was evaluated using orthotopic, tongue tumor-bearing, nude mice. Results: The NPs possessed good stability and water solubility and were pH/hyaluronidase sensitive. The good tissue penetration quality and active targeting ability enabled the NPs to draw the outline of orthotopic tongue tumors and metastatic lymph nodes as small as 1 mm in nude mice by IR-808 under NIR exposure. In vitro and in vivo experiments validated the biocompatibility and low systematic toxicity of the NPs. At the same time, the NPs acted as multimodal therapy agents, combining photothermal therapy with chemotherapy. Conclusion: With a good imaging capability and anti-tumor efficacy, our NPs successfully outlined orthotopic tongue tumors and metastatic lymph nodes as well as enabled chemo-photothermal therapy combination. Our study established a solid foundation for the application of new clinical diagnosis and treatment patterns in the future.

Compatibility of Clinical and Histopathological Diagnosis of Oral Lesions in Iranian Patients

Objective: To determine compatibility between clinical diagnosis and the pathological reports of biopsies from oral lesions. Material and Methods: In this descriptive study, 1146 clinical files of patients referring to Tabriz Faculty of Dentistry from 2004 to 2016 were retrieved and evaluated. The kappa coefficient was calculated for each file for compatibility of clinical and pathological diagnosis. Results: In relation to clinical (40.2%) and pathological (39.2%) diagnosis, irritational lesions of soft tissues exhibited the highest frequency. In 72.3% of cases, the clinical and pathological diagnosis were compatible and in 27.7% of cases these diagnosis were not compatible. The highest compatibility rates were detected for irritational lesions of soft tissues (81.5%) and mucocutaneous lesions (76.9%). There was no compatibility for osseous malignant tumors, inflammatory tissues, granulation tissues, metastatic lesions and hematologic disorders. Conclusion: Approximately one-third of clinical and histopathological diagnosis were not compatible. Therefore, to reach a correct diagnosis, the clinical, radiographic and histopathological views should be evaluated simultaneously.

Acessibilidade da População Negra ao Cuidado Oncológico no Brasil: Revisão Integrativa / Accessibility of Black Population to Oncological Care in Brazil: Integrative Review / Accesibilidad de la Población Negra a la Atención Oncológica en Brasil: Revisión Integrativa

Introdução:Tem-se apontado a persistência de desigualdades raciais na acessibilidade a bens e serviços de saúde, estando o indivíduo com câncer inserido nesse contexto. Objetivo: Analisar os fatores que impactam a acessibilidade da população negra ao cuidado oncológico no Brasil. Método: Por meio de uma revisão integrativa da literatura, buscaram-se, nas bases PubMed, LILACS e Embase, artigos originais publicados em português, inglês e espanhol sem limite temporal. Resultados: Foram incluídos 13 artigos, analisados a partir do tipo de câncer abordado: câncer de mama, câncer ginecológico, câncer de próstata e câncer de cavidade oral. Conclusão: As desigualdades raciais e socioeconômicas refletem nas ações de acessibilidade ao cuidado oncológico, maioritariamente na detecção precoce. Independentemente do tipo de câncer e das formas de diagnóstico e de tratamento, é inegável a dificuldade do paciente negro aos cuidados oncológicos por razões de natureza social e econômica.Os profissionais de saúde deveriam assegurar o atendimento à população negra ao mesmo nível prestado aos demais grupos sociais para garantir e superar as barreiras de acesso aos bens e serviços de saúde.

Introduction: The persistence of racial inequalities in the access to health services has been pointed out and the individual with cancer is within this scenario. Objective: To analyze the factors that impact the accessibility of the black population to cancer care in Brazil. Method: Through an integrative literature review, it were searched original articles published in Portuguese, English and Spanish in the databases PubMed, LILACS and Embase without time limitation. Results: Thirteen articles were included and analyzed based in the type of cancer addressed: breast cancer, gynecological cancer, prostate cancer and oral cancer. Conclusion: The racial and socioeconomic inequalities reflect upon the actions of accessibility to cancer care, mostly in early detection. Regardless of the type of cancer and the forms of diagnosis and treatment, it is unquestionable the difficulty the afro-descendant population has to access oncological care because of social and economic issues. Healthcare providers must ensure the care to the afro-descendant population as much as they do with other social groups to overcome the barriers to access health services.

Introducción: Se ha señalado la persistencia de las desigualdades racial e la accesibilidad a los bienes y servicios de salud, con el individuo con cáncer insertado en este contexto. Objetivo: Analizar los factores que afectan la accesibilidad de la población negra a la atención del cáncer en Brasil. Método: A través de una revisión bibliográfica integradora, se realizar búsquedas en las bases de datos PubMed, LILACS e Embase artículos originales publicados en portugués, inglés y español sin límite de tiempo. Resultados: Se incluyeron 13 artículos, analizado sen función del tipo de cáncer abordado: cáncer de mama, cáncer ginecológico, cáncer de próstata y cáncer de cavidad oral. Conclusión: Las desigualdades raciales y socioeconómicas se reflejan en las acciones de accesibilidad a la atención del cáncer, principalmente en la detección temprana. Independientemente del tipo de cáncer y las formas de diagnóstico y tratamiento, la dificultad del paciente negro en la atención del cáncer es innegable por razones sociales y económicas. Los profesionales de la salud deben garantizar la atención de la población negra al mismo nivel que otros grupos sociales para garantizar y superar las barreras de acceso a los bienes y servicios de salud.

Fluorescence-based immunosensor using three-dimensional CNT network structure for sensitive and reproducible detection of oral squamous cell carcinoma biomarker.

A hierarchical three-dimensional network of carbon nanotubes on Si pillar substrate (3DN-CNTs) was developed for the accurate detection of oral squamous cell carcinoma (OSCC) in clinical saliva samples. The 3DN-CNTs were uniformly coated with a layer of aluminum oxides to enhance structural stability during biomarker detection. Cytokeratin-19 antigen (Cyfra 21-1) was utilized as a model biomarker of OSCC for fluorescence-based immunosensor using 3DN-CNTs (3DN-CNTs sensor). The 3DN-CNTs sensor enhances the sensitivity of Cyfra 21-1 detection by increasing the density of immobilized antibody through high surface area of 3DN-CNTs and enhancing the accessibility of biomolecules through the ordered pathway of hierarchical structure. The reliable detection limit for sensing of Cyfra 21-1 was estimated as in the level of 0.5 ng/mL and the quantitative estimation of Cyfra 21-1 was analyzed by 4-parameter logistic (4-PL) model for curve-fitting analysis. Clinical applicability of 3DN-CNTs sensor was evaluated through correlation with the commercially available electrochemiluminescence (ECL) detection system in the hospital. The assay results of the two systems for clinical saliva samples showed a good linear correlation. The 3DN-CNTs sensor offers great potential for accurate diagnosis of OSCC using Cyfra 21-1 biomarker in clinical fluids.

Diagnostic Pathway of Oral Cavity Cancer in an Integrated Health Care System.

CONTEXT: Survival for patients with oral cavity squamous cell carcinoma (OCSCC) has remained relatively stagnant despite advances in treatment. Few studies have examined why advanced-stage disease is diagnosed in 40% of patients with OCSCC nationally. OBJECTIVE: To characterize the diagnostic pathway of OCSCC in an integrated health care system. DESIGN: Retrospective study of patients with OCSCC (2007-2010). MAIN OUTCOME MEASURES: Referral patterns and demographic, clinical, and tumor characteristics associated with time to diagnosis (diagnostic interval). RESULTS: Of 247 patients, 167 (68%) had early-stage (I/II) disease, 86 (35%) were referred by dentists, and 70 (28%) had a history of premalignancy. The median time (interquartile range) from symptom onset to care sought from a primary care physician (patient interval), from primary care physician to otolaryngologist, and from otolaryngologist to diagnosis was 8.6 (4.0-25.8), 1.0 (0.6-3.1), 0.0 (0.0-3.0) weeks, respectively. These intervals did not differ by demographic characteristics, clinical factors, or tumor stage. Prolonged diagnostic intervals were observed among patients with premalignant lesions. CONCLUSION: The patient interval was the largest component of the total diagnostic interval. The subsequent professional workup proceeded relatively efficiently. Prolonged diagnostic interval in patients with premalignant lesions may reflect the natural history of malignant transformation rather than a delay in diagnosis. However, nearly one-fourth of these cases were diagnosed at an advanced stage; closer surveillance may represent an opportunity for diagnosis at an earlier stage. Surveillance for premalignant lesions and facilitating referrals from dentists may expedite the diagnosis and treatment of OCSCC. Further investigation is warranted.

Exploring determinants of care-seeking behaviour of oral cancer patients in India: A qualitative content analysis.

BACKGROUND: A major public health concern in India is the high morbidity and mortality rates of oral cancer because of late diagnosis. Among the several determinants of this late diagnosis, the most important is the healthcare-seeking behaviour of the oral cancer patients. The aim of this study was to explore the care-seeking behaviour and its determinants among oral cancer patients. METHODS: A face-to-face in-depth interview was conducted among 70 oral cancer patients using a semi-structured questionnaire, and qualitative content analysis of the results was performed. RESULTS: All the patients had squamous-cell carcinoma and none had attended any screening programme. The most common site affected was the buccal mucosa with a non-healing wound. Most of the patients contacted a doctor available nearby; only 7% of patients consulted a dentist. Only one patient approached a traditional healer. The median patient delay was 30 (4-365) days and the professional delay was 40 (4-650) days. Enablers included determinants such as increasing symptoms (80%), influence of the society (74%), fear (10%), and social media (3%). The main barriers were lack of awareness (97%), hope that the lesion will heal spontaneously (90%), lack of perception of seriousness (64%), financial constraints (55%), provider switching (47%), and missed diagnosis (44%). CONCLUSION: The care-seeking path among oral cancer patients is complex, customised, and influenced by multiple patient-related and system-related factors.

Knowledge and Health Belief Attitudes of Oral Cancer and Its Screening Among At-Risk Southern Thai Muslims.

Oral cancer is one of the leading cancers in Thailand; southern Thai Muslims seem to have a longer delay in attending treatment for oral cancer than Buddhists in the same area. Visual screenings of high-risk populations have been suggested to be an effective prevention method. This study assessed oral cancer knowledge and belief attitudes influencing oral cancer screening in Thai Muslim high-risk groups. Twelve semi-structured in-depth interviews and the focus group discussion were conducted based on the health belief model. Stratified purposeful sampling was used to recruit the participants. Inclusion criteria were those who practiced the risk habits for oral cancer and were 40 years of age or older, smokers (20+ cigarettes per day for at least 20 years) and/or betel quid chewers (10+ times per day for at least 10 years). Participants lacked knowledge about oral cancer in terms of signs and symptoms and predisposing factors. This influenced misleading belief attitudes concerning susceptibility of oral cancer, barriers, and their self-efficacy to have oral cancer screening examinations. Betel quid chewing was not regarded as a risk habit but as having a protective role against the disease. Perceived susceptibility was also seen by some to be dependent upon Allah's will. Traditional medication was mentioned as a preferred alternative to modern treatment. The latter was believed by some to be the cause of death for cancer patients. Interventions to promote oral cancer knowledge and right belief attitudes for oral cancer screening are clearly indicated.

Epidemiological Profile of Patients with Oral and Oropharyngeal Cancer Treated at a Referral Hospital, Salvador, Brazil

Objective: To describe the epidemiological profile of patients with oral and oropharyngeal cancer treated at a referral hospital in Salvador, Brazil. Material and Methods: A cross-sectional study was carried out at Aristides Maltez Hospital (HAM), analyzing the medical records of patients treated between 2008 and 2015. Of the 722 medical records analyzed, 154 were included, considering the following variables: gender, age, occupation and educational level; type of lesion of the mouth/oropharynx cancer, its location and stage. The data were presented using descriptive statistics. Results: There was a greater occurrence of squamous cell carcinoma (88.3%), with a higher prevalence for males (72.73) and age between 60-69 years (42%), with a predominance of farmers (38.31%). As for the educational level, 59% had only completed elementary school. The most common location for cancer was the tongue, 25.15% of the cases, and the professional responsible for the diagnosis was predominantly a doctor (94%). Prevalence of T3 and T4 size tumors (53.25%). Conclusion: Patients with oral and oropharyngeal cancer are mostly male, older than 60 years, with low educational level, and working as farmers. The most common location was the tongue, and T3 and T4 tumors were predominant.

The Retromolar Trigone: Anatomy, Cancer Treatment Modalities, Reconstruction, and a Classification System.

BACKGROUND: Retromolar trigone (RMT) tumors are rare and aggressive malignancies, spreading rapidly into surrounding structures. In reviewing the literature, there is lack of information and quality evidence pertaining to their management and high heterogeneity in treatment modalities. METHODS: A systematic Medline search was performed to gather all reports of articles related to retromolar trigone in tle last 10 years (2005-2015). Papers were excluded if they were related to oral cavity cancer but not specific for the RMT. RESULTS: Results were divided into 5 sections: anatomy and lymphatic drainage; etiology and diagnosis; cancer treatment modalities; reconstructive options; proposal of a classifications system. A clinical patient exemplification was also included. Various treatment modalities have been tried in the past including surgery, radiotherapy, and combination therapy using chemoradiation. All these modalities have intrinsic risks. There is also controversy regarding the extent of surgery. Reconstructive options differ with the size of the defects. The ability of the propeller lingual flap to rotate any angle up to 180 degrees allows it to reconstruct small-to-medium sized defects. If bulkier reconstructions are needed to separate oral and nasal cavities, a free flap (radial forearm, anterolateral thigh, medial sural) should be planned. CONCLUSIONS: In view of the rarity of the tumor and heterogeneity of treatment, there is limited information available pertaining to retromolar trigone tumors. A better understanding of RMT amatomy, cancer treatment modalities, and reconstructive options can improve the surgeon decision capacity and clinical results, when dealing with such uncommon and challenging tumors.

Tumour response following high-dose intratumoural application of Viscum album on a patient with adenoid cystic carcinoma.

Adenoid cystic carcinoma (ACC) is a rare type of cancer that typically originates in the salivary glands. Surgical removal can lead to functional loss and psychological distress. Viscum album extract (VAE) is a herbal remedy with dose-dependent cytotoxic, apoptogenic and immunological effects. In some case reports, tumour regression has been observed following high-dose local applications of VAE. An active 88-year-old man with fast-growing ACC of the hard palate refused surgical removal and received high-dose intratumoural injections of VAE (alone) over a 10-month period. The tumour decreased in size, softened and loosened from its surroundings. A biopsy during the course showed inflammation. The patient remained well and without functional limitations during the therapy and follow-up period (5 months). VAE produced no reported side effects. This aged patient exemplifies a satisfying course of ACC under VAE resulting in good quality of life and partial tumour regression.

Understanding the reasons why patients delay seeking treatment for oral cancer symptoms from a primary health care professional: an integrative literature review.

PURPOSE: The purpose of this integrative literature review was to investigate existing research on the reasons why patients delay in seeking treatment for oral cancer symptoms from a primary health care professional. METHOD: The systematic approach developed by Cooper (1984) was the guiding framework for this integrative review. Cooper (1984) identifies the process of conducting an integrative review as encompassing the following five stages: (a) problem formulation, (b) data collection, (c) evaluation of data points, (d) data analysis and interpretation, and (e) public presentation of results. RESULTS: Despite different research designs employed and sample sizes ranging from 15 to 559, three major themes emerged from the 16 studies included in the review, all of which are directly related to the reasons why people delay seeking treatment for oral cancer symptoms: Patient Sociodemographic Characteristics; Health Related Behaviours, and Psychosocial Factors. CONCLUSIONS: Overall, this integrative review demonstrates the complexity surrounding the reasons why patients delay in seeking help for oral cancer treatment. The association between knowledge and patient delay has implications for information provision about cancer to those at risk of developing the disease. The relationship between socioeconomic status and patient delay behaviour warrants further investigation as this has been shown to be an influential factor in the study of patient delay. The meaning of many of the investigated psychosocial factors (e.g. an individuals' symptom interpretation/attribution, disclosure of symptoms to significant others, social priorities), have not been discussed in detail and the research is not theory driven.