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By: Z. Bengerd, M.A., M.D., M.P.H.
Clinical Director, Cooper Medical School of Rowan University
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Signs and symptoms of oral cancer include the 1 following list below (modified from Most often, the listed symptoms are not from oral cancer; other health problems can also cause them. Risk factors for oral cancer and actions Certain relatively uncommon but important clinical situations may warrant increased surveillance as judged by the relevant medical case manager. These include a personal history 2 1 of prior oral cancers, prior potentially malignant oral lesions (leukoplakia, erythroplakia), 3 4 immunosuppression from renal transplant or other organ transplant, erosive lichen planus, 5 and Fanconi anemia. Using tobacco (current or past): Avoid tobacco use 1) Smoking: cigarettes, cigars, pipes, or other methods of smoking 2) Using spit tobacco: chewing tobacco, snuff, or other smokeless tobacco exposure 1 6 b. Exposure to direct sunlight (lip cancer Use lip balm with sunscreen to reduce sun exposure 1 6 only) of lips 8. Not eating enough vegetables and fruits Diet with fruit and non-starchy vegetables may increase the risk of oral cancer, some 1 studies suggest f. However, the professional opinion of the Medical Advisory Committee supports the Actions listed in b. Screening for oral cancer: Opportunistic screening and targeted public health screening. In patients reporting for routine dental care, screening for oral cancer provided by dentists is one component of the patient evaluation to detect any oral 11 abnormality. Similarly, in patients reporting for routine medical examination, screening for oral cancer is one component of the patient evaluation to detect any oral abnormality. Targeted public health screening for oral cancer: Targeted public health screening may be considered if: a. Screening can occur among people at high risk of oral cancer who are unlikely to have routine dental and medical care (for example, heavy smokers and/or chronic alcohol users), and b. It is possible that those adults with symptoms suggestive of oral cancer may be seen in a screening setting. Although an oral cancer screening exam may be performed, an oral cancer diagnostic exam is needed depending on the degree and duration of symptoms and initial findings of the exam. Educate the general public on risk reduction: Educate about risk factors and actions (pages 2-3, above). Studies have shown that quitting smoking decreases the risk of developing oral cancer. Individuals who can perform an oral cancer screening exam: Dentists, dental hygienists, physicians, physician assistants, and nurse practitioners, with proper training, can all perform an oral cancer exam in Maryland. Training: Training during college or post graduate school and continuing post graduate education/training on how to conduct an oral cancer screening exam is recommended.
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Perspectives are usually invited articles, but may also be submitted as unsolicited articles as long as they conform to the above instructions to authors. Case reports must include an unstructured abstract and should not exceed 1200 words of body text with up to 15 references and 4 tables or figures. Correspondence the correspondence section (Letters to the Editor) includes various different types of letters. All items of correspondence should be formatted in one continuous section, with no bulleted statements or abstract. Rapid Response to Recently Published original articles should be scholarly, respectful to other authors, concise and to the point. They are intended to provide post-publication peer review; as such, these letters are important and are published by fast track. Letters that are opinion pieces are also welcome; this type of letter provides 59 an opportunity to publish original ideas, innovations, scholarly opinions, debates and controversies at an early stage of academic development; such pieces must also be concise. With the exception of Research Letters (see above), other forms of correspondence should not exceed 800 words, 10 references and two figures. For all forms of correspondence, authors are advised to seek their own peer review by local scholars (who can be acknowledged) prior to submission. Photographs or images should be visually arresting, of high quality and of educational value. The image should be submitted with a concise, scholarly caption (of up to 100 words) explaining the image, which will be printed on the inside of the front cover. Examples of potential cover pictures include clinical photographs of normal or diseased skin, images of a diagnostic technique (for example, histopathological images, immunostains, electron microscopy) or device or a historical image. Cover pictures will be selected for their visual impact, scientific merit, originality and relevance to the journal readership. Editorials/Commentaries Editorials and commentaries are typically commissioned by the Editors. However, suggestions for such articles are welcomed and should be directed to the Editorial Office. Once a user is logged onto the site, submissions should be made via the Author Centre. After acceptance, you will be contacted to provide print-quality figures if you have not already done so. Abbreviations must be defined when first used in the abstract and in the main text, as well as when first used in table and figure captions. Repetition of information or data in different sections of the manuscript must be carefully avoided. The structured abstract should adopt the format: Background, Objectives, Methods, Results, Conclusions. Review articles and case reports require abstracts but they need not be structured.
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The lesions characteristi cally involve the soft palate and uvula, the tonsils, faucial pillars, posterior pharyngeal wall, and rarely the buccal mucosa and the tongue. The absence of lesions from the lips, gingiva, and the floor of the mouth are characteristic. The disease lasts for 7 to 12 days, and the diagnosis is exclusively based on clinical criteria. The differential diagnosis includes primary her petic gingivostomatitis, aphthous ulcers, her petiform ulcers, acute lymphonodular pharyngitis, 1 5. Acute lymphonodular pharyngitis, multiple discrete papules on the soft palate and uvula. Hand-Foot-and-Mouth Disease Measles Hand-foot-and-mouth disease is usually associ Measles is an acute, contagious infection of child ated with Coxsackie virus A16, occasionally with hood, caused by a specific paramyxovirus. It an incubation period of 8 to 12 days the patient usually affects children and young adults. The presents with fever, malaise, chills, cough, and disease may occur in epidemics or isolated cases. Three to 4 days later a characteris Clinically, there appear a few (5 to 10 in number) tic maculopapular rash appears behind the ears small vesicles that soon rupture, leaving slightly and on the forehead and spreads within 24 hours painful, shallow ulcers (2 to 6 mm in diameter) to the rest of the face, the neck, the trunk, and the surrounded by a red halo (Fig. The rash fades from the 6th to 10th buccal mucosa, and palate are the usual sites of days. The lateral and dorsal surfaces of the second molars, 1 to 2 days before onset of the fingers and toes are the more frequently involved rash. A diffuse erythema, petechiae, and rarely occur on the palms, soles, and buttocks. Low small round erosions on the oral mucosa may also grade fever of short duration and malaise may be be observed (Fig. The differential diagnosis includes aphthous the differential diagnosis of oral lesions includes ulcers, herpetiform ulcers, primary and secondary acute candidosis, minor aphthous ulcers, herpetic herpetic stomatitis, and herpangina. Serologic tests are useful in the tion in newborn mice may be needed to confirm diagnosis of atypical cases. Infectious mononucleosis is more com by serologic examination and isolation of the virus mon in children and young adults. Elevated serum amylase and relative period is about 30 to 50 days, followed by low lymphocytosis may be present. Bed rest during the lymphadenopathy also begins early and is a com febrile period, and analgesics. Splenomegaly, hepatomegaly, and very rarely central nervous system involve ment may also occur. A maculopapular eruption Verruca Vulgaris usually on the trunk and arms is present in 5 to 15% of cases.
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The affected nodes are generally situated in the submaxillary area and less frequently in the cervical or facial ones (Grinspan, 1983; Jovanovic et al. Risk factors and location of the tumor To highlight: It is essential for everyone to undergo a proper oral examination. Pain in itself is not a reliable indicator of malignancy; in many of the studied cases, early lesions were associated with only minor discomfort. Mobile, painless nodes whose volumes increase in course of time, and fix to surrounding tissue in the advanced stages, are those clinically suggestive of malignancy. Level V: nodes in the posterior triangle, bounded at the back by the anterior border of the trapezius muscle, anteriorly by the posterior border of the sternocleidomastoid and below by the clavicle. Descriptive purposes can be divided into high, medium and low by two horizontal planes: the superior plane is situated below the hyoid bone and the inferior one in the lower edge of the cricoid cartilage. Proper classification and staging allows the physician to determine treatment more appropriately, evaluate results of management more reliably and compare worldwide statistics reported from various institutions. When the histology comes from another institution, it is recommended to have it reviewed by the pathologist in the working team. The staging of each case must be determined before treatment and should not be changed whatever findings emerge after starting it. If doubts arise concerning it, assigning the patient the lowest category is the most convenient procedure. Oral Squamous Cell Carcinoma Clinical Aspects 27 T N M Tumor Nodule Metastasis N0: nonpalpable regional M0: No distant Tis: in situ Carcinoma lymph node metastasis M1: clinical or N1: ipsilateral single ≤3 cm T1: < 2 cm. T4: invaded adjacent tissues T4a: moderately advanced local disease T4b: very advanced local disease Table 1. Unfortunately, the 5-year survival rate has not changed during the last half of the century, still being around 50–55% in spite of the advances in diagnosis and treatment (Neville and Day, 2002). Late diagnosis is the result of either patient or professional delay (Kerdpon & Sriplung, 2001, Rogers et al. There is a vast literature about the results of research on this interesting topic carried out in populations from all over the world (Table 5). Oral exams and diagnosis at both centers were made by the same trained professionals and supervised by the same head professor. The symptoms were classified as pain, swelling, ulceration, white lesions, poor denture fit and others. C Patient and professional delay: considers the period of time between the final diagnosis and the beginning of treatment (Kowalski & Carvalho, 2001). A lapse of more than 30 days in any category (A, B or C) was regarded as delay (Shah & Lydiatt, 1995). In our study, 68% of the patients in the early stage and 54% in the advanced stage evidenced patient delay (see Table 3).
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The analysis we do very critical of its own performance: Acknowl is on more than 50 sub-lines of business edging our shortcomings and mistakes and and hundreds of products, incorporating studying them intensely and learning from not just fnancial data but also operational them make for a stronger company. They looked at what our current performance is, we cannot clients’ problems, improved straight through rest on our laurels. A fortress company starts with a fortress You can see in the chart below that our balance sheet. Predominantly includes cash on deposit at central banks and highly liquid securities including U. We have always believed that a deep and detailed understanding of a company’s fnan But a fortress balance sheet isn’t enough. It is capital whether they are on or of-balance sheet), is and liquidity combined with strong earn critical to running a safe and sound organi ings and margins that provide the ability to zation. I want to remind earnings, is not a perfect measure of perfor shareholders that we run hundreds of mance or economics. I would like to discuss stress tests internally each month, some of a few reasons why: which are far more severe than the Federal. We but you can’t make business decisions based also believe that we should have strong on them. While we are rigorous about earnings after making investments for the proper accounting and disclosure, some future – which may reduce earnings in the times accounting can distort the actual short run. In credit card accounting, for continually analyze our businesses, both to instance, new card customer costs are maximize their individual performance and expensed over the course of a year and to make sure they are contributing to the inexplicably as a contra-revenue item health of the whole company. In addition, under upcoming accounting rules, losses that are We much prefer to use our capital to grow expected over the life of the card balance than to buy back stock. Meanwhile, back stock should be considered only when the earnings from the card are booked either we cannot invest (sometimes as a over the life of the card, which averages result of regulatory policies) or we are gener approximately seven years. In connection ating excess capital that we do not expect to with mortgage loans we don’t own but use in the next few years. But in cash management, for your excess capital over the short term, asset management and many other prod buying back stock is an important capital ucts that have a similar, somewhat predict tool – as long as you are buying it back at able annuity-like revenue stream, the prac a reasonable price. The reason I am making buy back stock (which we only do when it this point is that you need to understand is at a price that we think adds value to our the economics of decisions. Accounting remaining shareholders), the capital is redis can easily make people do silly things. We currently have excess capital, but we hope in the future to be able to invest more of it to grow our businesses. While we the real damage to an organization always try to make intelligent economic comes from the cumulative corrosive decisions, I do believe that appropriately ness of trying to “make” its numbers.
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