Time elapsed between the first symptoms, diagnosis and treatment of oral cancer patients in Belo Horizonte, Brazil.

OBJECTIVE: One of the most important objectives of a public health service is early diagnosis of disease, which provides a better prognosis and reduction in treatment cost. We investigated the delay for diagnosis and treatment of oral cancer in a public hospital. MATERIAL AND METHODS: One hundred eighty records of patients who attended for their first consultation in the department of head and neck surgery in a public hospital from Belo Horizonte-Brazil, between the period from 1 January 1999 to 31 December 2001 were analysed. The following variables were analyzed: gender, age, evolution time (ET), time elapsed from referral to hospital and first appointment (RT), time elapsed from first appointment and treatment (TT), total time elapsed from first noticing the lesion and starting treatment (TTE), sites and staging. RESULTS: Results for males and females were, respectively: mean age = 57.9 and 60.8 years; ET= 169.4 and 215.4 days; RT = 27.9 and 40.6 days; TT = 40.9 and 44.9 days; TTE = 207.9 and 263.8 days. No correlation was observed between age and TTE for either gender. Women presented the highest mean values for ET and TTE (p<0.01). CONCLUSION: It was concluded that public health policy should be developed to address the excessively long time lapsed between diagnosis and treatment as well as improve public health education programs to promote early oral cancer identification.

Association between GSTT-1 gene deletion and the susceptibility to oral squamous cell carcinoma in cigarette-smoking subjects.

Oral squamous cell carcinoma (OSCC) is related to tobacco use and alcohol consumption and the individual susceptibility for development of this tumor has been associated with xenobiotic-metabolizing enzymes polymorphisms. Glutathione S-transferase Theta-1 (GSTT1) is a phase II metabolic enzyme that catalyzes detoxification reactions of carcinogenic compounds. A genetic polymorphism of the GSTT1 gene is characterized by a complete gene deletion and consequent absence of the enzyme. The null genotype (gene deleted) of GSTT1 has a decreased capacity in detoxifying carcinogens present in tobacco smoke, leading the formation of DNA-adducts and DNA damage. The purpose of the present study was to evaluate the association between GSTT1 polymorphism and risk for OSCC development in a Brazilian population. We investigated the GSTT1 polymorphism in 87 patients with OSCC and 81 age-sex matched controls. The genotypes were studied by PCR-based methods. Individuals homozygous for the wild type GSTT1 (+/+) and heterozygous (+/0) were grouped together. The prevalence of GSTT1 deficiency (null) was significantly higher in the group with OSSC patients with oral cancer of the floor of the mouth. The results suggest that GSTT1 polymorphism increases the risk for OSCC development.

TP53 codon 72 polymorphism in oral squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is a multifactorial neoplasm related to tobacco smoke, alcohol consumption and molecular genetic changes such as p53 mutations. The human tumor suppressor gene TP53 contains single nucleotide polymorphism that encodes either arginin (Arg) or proline (Pro) at amino acid codon 72 of the p53 protein. The relationship between human cancer susceptibility and p53 polymorphism at codon 72 is controversial. The aim of this study was to investigate the association between this polymorphism and OSCC development in a Brazilian population. MATERIALS AND METHODS: Eighty-two patients with OSCC and 82 age-sex-matched controls were included in the study. DNA was extracted from all subjects' normal oral mucosa and the polymerase chain reaction amplification (PCR) was performed for detection of the TP53 genotypes. PCR products were analyzed in a 6.5% polycrylamide gel and silver-stained. Statistical analyses were performed with the chi 2 test and Fisher's exact test. RESULTS: The frequencies of the genotypes Arg/Arg, Arg/Pro and Pro/Pro, were 37.8%, 54.8% and 7.4%, respectively, for OSCC cases and 40.2%, 54.8% and 4.9% for controls. No significant differences in the distribution of TP53 genotypes were seen between the groups (p = 0.794). CONCLUSION: The present study does not support the hypothesis that this TP53 polymorphism is associated with oral cancer susceptibility.

Evaluation of MAGE A1 in oral squamous cell carcinoma.

MAGE A1 is a cancer testis antigen (CTA) described in a variety of human cancers. CTAs exhibit a highly restricted tissue expression and by virtue of their immunogenic potential, these genes are promising target molecules for cancer vaccines. DNA hypomethylation is associated with gene regulation in several types of tumours. The aim of this project was to identify the presence of MAGE A1 in oral squamous cell carcinoma (OSCC) samples and to investigate the hypomethylation profile of CpG islands situated in the promoter region of this gene. The expression of MAGE A1 in OSCC and healthy oral mucosal samples was determined by real-time quantitative and conventional endpoint PCR and also by immunohistochemistry staining. In addition, to investigate the hypomethylation profile of promoter MAGE A1 CpG islands, we performed bisulphite sequencing. Real-time quantitative and endpoint PCR assays demonstrated a lower level of MAGE A1 transcription. Endpoint PCR showed expression of MAGE A1 in 10% (2/20) of OSCCs. Sodium bisulphite sequencing analysis of MAGE A1 CpG islands did not reveal a difference between OSCC and normal oral mucosal samples. We further assessed MAGE A1 protein immunoexpression and found 80% (16/20) of immunopositivity in OSCCs. We did not observe a correlation between the presence of MAGE A1 protein and lower levels of transcripts. Identification of MAGE A1 protein in OSCCs and absence of immunoexpression in normal oral mucosa support the idea that this protein can be used as a biomarker for detection of OSCC; however, it is not associated with hypomethylation or high expression of the MAGE A1 gene.

Reduced expression of mir15a in the blood of patients with oral squamous cell carcinoma is associated with tumor staging.

MicroRNAs (miRNAs) mir15a and let7a are important regulators of bcl-2, ras and c-myc proteins. Considering that these miRNAs are commonly altered in many human cancers and that these proteins are reported to be altered in oral squamous cell carcinoma (OSCC), we investigated them in a set of OSCC cases. The miRNAs as well as the proteins were evaluated in the tumor and blood of 20 patients by real-time quantitative PCR and immunohistochemistry, respectively. The expression of mir15a and bcl-2 proteins in the tumors was not associated with each other or with tumor staging. On the other hand, we found reduced expression of this miRNA in the blood of patients with an advanced stage of OSCC and with lymph node metastasis. The expression of let7a in the tumor and blood was not associated with tumor size, lymph node metastasis, tumor staging and immunoexpression of ras and c-myc proteins. In conclusion, the present study shows that reduced expression of mir15a is associated with OSCC staging.

Padrão e distribuição dos tumores de glândulas salivares em um hospital brasileiro / Pattern and distribution of salivary gland tumours in a Brazilian hospital

Objetivo: documentar a distribuição de tumores de glândulas salivares (TGS) diagnosticados em um período de 5 anos. Pacientes e método: estudo descritivo retrospectivo dos casos de TGS de um hospital brasileiro, entre janeiro de 1999 e dezembro de 2003. Dados obtidos: gênero, idade, evolução da doença, glândula envolvida ou sítio anatômico, diagnóstico histológico e tipo de atendimento (público ou privado). Resultados: a amostra constituiu 121 TGS. Parótida (62%) e glândulas salivares menores (21,5%) foram as mais envolvidas. Os tumores benignos compreenderam 69,5%. Adenoma Pleomórfico (61,5%) e Carcinoma Mucoepidermóide (11,5%) foram os mais prevalentes. Os tumores foram mais frequentes em mulheres (71,4%). Tumores malignos afetaram os pacientes mais idosos (55,6 anos). A prevalência de tumores malignos foi mais alta em glândulas salivares menores. Indivíduos do Sistema Público apresentaram um tempo de evolução da doença mais longo (18,5 meses ± 12,5) em comparação com o Sistema Privado (10,7 meses ± 9,4) (p=0.015). A prevalência de TGS foi de 7,1%. Conclusão: tumores malignos de glândulas salivares são mais prevalentes em pacientes idosos. Faria diferença para o paciente se os Serviços de Saúde, público e privado, mudassem suas políticas para reverter a demora no tratamento.

Objetivo: document the distribution of salivary gland tumours (SGT) diagnosed in a period of 5 years. Patients and Methods: A descriptive and retrospective study was conducted of SGT from a Brazilian hospital between January 1999 and December 2003. Data concerning gender, age, disease evolution, gland, histological tumour diagnosis and type of Health Care Service (private or public) was retrieved. Results: The sample consisted of 121 cases of SG. Parotid (62%) and minor salivary glands (21.5%) were the most common glands involved. The benign tumours comprised 69,5%. Pleomorphic Adenoma (61,5%) and the Mucoepidermoid Carcinoma (11,5%) were the most prevalent tumours. The tumours affected mostly females (71,4%). Malignant tumours affected older patients (55.6 years). The prevalence of malignant tumours was significantly higher in the minor salivary glands. Individuals from National Public Health Service had a longer waiting period for treament (18.5 months ± 12.5) in comparison to patients from Private Health Service (10.7 months ± 9.4) (p=0.015). The prevalence of SGT was 7.1%. Conclusion: Malignant tumours was more prevalent in older patient. It would a difference for patients if the National Health Service, both public and private, changed their management policies in older to reverse the treatment delay.

Carcinoma de células escamosas bucal: uma revisão de literatura entre o perfil do paciente, estadiamento clínico e tratamento proposto / Oral squamous cell carcinoma: a literature review of patient profile, clinical staging and proposed treatment

O carcinoma de células escamosas (CEE) é uma neoplasia maligna, com origem no epitélio de revestimento da boca,sendo responsável por cerca de 95 por cento das lesões malignas nesta região. No Brasil, a boca representa a quinta localização de maior incidência de câncer em homens e a sétima em mulheres. Este trabalho teve como objetivo analisar as variáveis: perfil (gênero, cor, idade, ocupação e escolaridade), fatores etiológicos (tabagismo, etilismo e exposição ao sol), com o estadiamento clínico (sistema TNM) e, conseqüentemente, o tratamento indicado. Foram incluídos 75 artigos. Verificou-se um predomínio das lesões na língua (32,7 por cento), seguido pelo assoalho bucal (23,3 por cento). A lesão foi predominantemente encontrada em feodermas, entre a quinta e a sétima décadas de vida. No momento do diagnóstico, a maioria dos pacientes se encontrava em estádio avançado da lesão (III ou IV). Os fatores mais associados ao desenvolvimento do CCE bucal foram: tabagismo, etilismo e radiação solar, considerando-se que estes podem complicar seu curso e prognóstico. Verificou-se que quanto maior o nível do estadiamento clínico, mais complexo foi o tratamento indicado.

Oral squamous cell carcinoma: a retrospective study of 740 cases in a Brazilian population / Carcinoma epidermóide de boca: um estudo retrospectivo de 740 casos no Brasil

The purpose of this study was to evaluate, retrospectively, the profile of patients with oral squamous cell carcinoma. They were referred to two hospitals of Belo Horizonte (MG, Brazil) between 1986 and 1996. The medical records of 740 patients presenting oral squamous cell carcinoma were reviewed in detail. The TNM classification and staging, age, gender, race, occupation, and site of the primary tumor were recorded. The male-to-female ratio was 4.8:1. The mean age was 58.6 years. Most of the patients were in their sixties and were farm workers. The tumors were found principally on the tongue. There was a close relationship between some habits (tobacco and alcohol consumption) and the development of oral squamous cell carcinoma. Most of the patients sought medical care in the first year, even though almost half of them had lesions in stage T4. The identification of the characteristics of this specific population might reflect either accomplishments or problems in oral cancer control and can enable the development of a primary prevention program for oral squamous cell carcinoma.

Mucocelegrafia frontal: apresentaçäo de um caso / Frontal mucocelegraphy: report of a case

Os autores apresentam um caso de MUCOCELE FRONTAL no qual foi usado HIPAQUE diluído em soro fisiológico para estudo radiológico. As radiografias deram boa imagem dos contornos da lesäo. O método mostrou-se isento de complicaçöes e, devido à sua rapidez, simplicidade e utilidade, recomendam seu uso como método complementar de exame pré-terapêutico. Os autores admitem que a técnica, associada à planigrafia ou arteriografia, possa talvez oferecer imagens mais reveladoras

Esclerona (rinoscleroma) / Scleroma (rhinoscleroma)

O HOSPITAL MARIO PENNA destina-se ao atendimento de casos oncológicos. De un total de 1348 pacientes atendidos para primeiro exame, foi diagnosticado um caso de ESCLEROMA. Os Autores fazem a apresentaçäo do caso, além de um levantamento da frequência da doença nos principais arquivos nosológicos de Belo Horizonte e um resumo de atualizaçäo dessa nosologia

Emprego da fórmula analgésica em paciente portador de câncer avançado do pescoço: relato de um caso / The use of analgesic formula in terminal patient with advanced cancer of the neck: a case report

Apresenta-se um caso de neoplasia intratável do pescoço, no qual foi usada uma fórmula analgésica para alívio da dor. Relata-se a observaçäo clínica durante 30 dias consecutivos de uso da soluçäo. Considerou-se a resposta clínica satisfatória e recomenda-se seu emprego para casos semelhantes

Epidemiologia e tratamento do câncer de pele / Epidemiology and treatment of skin neoplasm

Em revisão de 100 prontuários de câncer de pele, encontramos 56 pacientes portadores de carcinoma basocelular, 34 de carcinoma espinocelular e 6 de melanoma, distribuídos entre 55 homens e 45 mulheres, numa idade média de 64 anos. Discutimos a epidemiologia e chamamos a atenção para o diagnóstico tardio. Preferencialmente foram submetidos a ressecção cirúrgica em extensão e profundidade.

Carcinoma adenóide cístico do seio frontal: apresentaçäo de um caso / Adenoid cystic carcinoma of the frontal sinus: a case report

Apresenta-se um caso de carcinoma adenóide cístico primitivo do seio frontal, tratado por cirurgia radical, sendo que a paciente foi acompanhada por 9,5 anos sem que apresentasse sinais de recidiva ou metástase. Embora o tempo de acompanhadamento possa ser considerado relativamente curto, para esse tipo de neoplasia, considera-se que a radicalidade cirúrgica tenha sido essencial no controle local da doença

Mixoma da mandíbula / Myxoma of the mandible

Apresenta-se um caso de mixoma da mandíbula tratado cirurgicamente de modo conservador. Tal decisäo decorreu da extensäo da lesäo e da esperança de um pleno controle cirúrgico de eventuais recidivas, mediante um estreito acompanhamento pós-operatório. Chama-se a atençäo para a dificuldade em remover todo tecido tumoral da área cruenta. Recomenda-se o tratamento cirúrgico conservador para lesöes externas, que ainda mantém um arco mandibular, mesmo que seja uma fina camada cortical externa. Apresenta-se o que talvez seja a primeira imagem citológica da lesäo, obtida por aspiraçäo com agulha fina, em nosso meio. Citam-se ainda alguns casos locais tratados por colegas