Oral Cancer in Malaysia: Awareness, Etiology, Prognosis, Quality of Life and Early Detection

• Main Author: Wan Abdul Ghani, Wan Maria Nabillah
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2019
• Subjects: Alcohol; Biomarkers; Caffeine; Cancer therapies; Chromatography; Collagen; Diet; Disease; Epidemiology; Ethnic studies; Food; Gender; Human papillomavirus; Indigenous studies; Medical prognosis; Medical research; Medicine; Metastasis; Minority & ethnic groups; Mortality; Native peoples; Native studies; Oncology; Patients; Pharmaceutical sciences; Polymerase chain reaction; Prevention; Risk factors; Sociology; Southeast Asian studies; Tobacco; Viruses
• ISBN: 9798380438339

It is well established that oral cancer occurs more commonly in developing countries rather than developed countries. Prognosis of patients is poor, mostly attributed to the presentation of disease at advanced stages. The visibility of the tumor, which is located at the head and neck region, further affects the quality of life of these patients. Variations in the risk factors for oral cancer across different geographical regions have also been documented. However, data with regards to oral cancer among the Malaysian population is severely lacking. Realizing the debilitating impact of oral cancer, and in view that it is ranked within the top ten most common cancers among ethnic Indians in Malaysia, the need for information on oral cancer in Malaysia is imperative. In this thesis, a series of original published works on oral cancer in the Malaysian context are presented. These studies encompass a wide spectrum, ranging from i) before the onset of disease; assessing the level of awareness and etiological factors, ii) impact of disease; evaluating the prognosis and quality of life of patients, to iii) secondary prevention of disease; exploring potential tools for the purpose of early detection.Firstly, the awareness level of the Malaysian public on oral cancer was assessed. Awareness was found to be poor, whereby only about half of the respondents knew of the risk habits and signs and symptoms of oral cancer. Interestingly, gender and ethnic differences were observed in their level of awareness. Mass media was quoted as the main source of information on oral cancer, however our study found that information dissemination through mass media did not confer a significant improvement in the knowledge of the public on signs and symptoms associated with oral cancer.Following this, we conducted studies on the etiology of oral cancer. The role of tobacco smoking, alcohol drinking and betel quid chewing as risk factors for oral cancer and its synergistic effect were further validated in our study. Findings showed that there were significant differences in the practice of these risk habits across the different ethnic groups. Further analysis revealed that habit initiation was influenced by gender, ethnicity and combined practice of other risk habits, whereas cessation was associated with practice of another risk habit and the type of cigarette smoked or betel quid chewed. Findings on the etiological role of dietary intake showed that a reported diet pattern loaded with consumption of meat, dairy, fermented food, carbonated beverages and caffeine increased cancer risk, whereas a high intake of fruits and vegetables decreased the risk for oral cancer.In terms of assessing the disease impact, we determined the prognosis of Malaysian oral cancer patients. The 5-year survival rate was observed to be slightly poorer than the world average statistics. No significant ethnic difference was found in the prognosis of these patients. Larger tumor size, lymph node metastasis and advanced disease stage were elucidated as reliable indicators of prognosis. Apart from clinical factors, the potential of biomarker as an indicator of prognosis was also investigated. Our study on the collagen triple helix repeat containing-1 (CTHRC1) gene showed that high expression of CTHRC1conferred a poorer patient survival, indicating the utility of this biomarker as a method for prediction of prognosis.