Letter to the Editor
Coping with the management of orofacial cancer with limited resources Dear Sir. Oral cancer consists of an array of systemic disease processes, some of which may be successfully treatable if appropriately diagnosed in their early stages. However, in circumstances of limited material and manpower resources, as may prevail in many economically developing parts of the world, overall management of these orofacial tumours tnay remain a daunting problem for a long time. This problem besets not only those in the medico-dental profession but also families and in fact entire communities. It is apparent that the psychosocial impact of oral cancer has hardly been evaluated in most parts of the economically developing world. Analysis of what cancer as a disease means to an ordinary citizen can be of great importance in detennining what preventive and/or curative strategies could be feasible in defined areas. The notions and expectations of the families and even communities to which afflicted patients belong, tnay form a useful measure of the basic understanding of a given disease in society in general. The fact that tnany common orofacial cancerous lesions tend to be insidious and painless, late presentation for medical attention may be a norm. Due to the advanced nature of the disease at presentation, these tumours often involve more than one anatomical region (1) and are invariably lethal (2). The appropriate management of such cases is therefore a formidable puzzle. When diagnosed early, many of these tumours tnay be successfully operable, thereby giving patients gainful leases on life. On the other hand, when they are extensive, invasive and metastatic, clinicians are often compelled to categorise thetn as inoperable. The management is then that of a
palliative/salvage course that comtnonly entails minimising pain and discomfort, most often with inadequate medication. Conceivably, the psychosocial suffering of the family is not only immeasurable but also often inadequately managed. The current interest of the detital profession in the overall oral health of the community that it serves augurs well for the future. Basic training trends should therefore aim at producing dental surgeons who are overall astute diagnosticians of most, if not all, disease processes that may affiict the oral and perioral structures. Postgraduate training should not only be largely limited to the traditional dental subjects but should also go hand in glove with the traitiitig in the basic biological sciences. Thus young dentists need encouragetnent to pave careers in molecular and cell biology. Currently technological advances from biochemistry, itnmunology, and physics have moved from their laboratories into the hospital atid combined to radically change the way medical diagnosis is arrived at or confirmed (3). It is therefore to be envisaged that dentally qualified biochemists, iinmunologists, physiologists, and physicists would immensely contribute to ptompt and properly defined investigations and management of oral cancer in particular. Furthermore they would form the badly needed source of original creativity in the basic medical and dental sciences in the economically developing countries of Africa in particular. It is only in this way that we are likely to emancipate ourselves frotn the long overdue dependency on the western world for even the very basic manufactured medical products that so often mean life or death. It is to be vehemently emphasized that the budding dental
schools in the economically developing countries endeavour to promptly institute basic molecular and biological research as a contribution to the already explosive efforts that are being made in the economically advanced countries. Since biological cancer material abounds at one end due to the cumulative tendency, and there is readily accessible technology at the other end, collaborative research efforts need sustained atnphfication. Due to the exponential advances in research it is already anticipated that in approximately 25 years it is possible that most forms of cancer would be easily diagnosed and readily treated in the economically advanced countries (3). The economically developing countries have this similar potential and it is just the foresight and commitment to duty that needs sustained energising.
Dr. MARK LuBtstA CHINDIA
Institute of Dental Surgery Eastman Dental Hospital Department of Oral and Maxillofacial Surgery 256 Gray's Inn Road London WCIX 8LD
References 1. ELBiiSHtR El, ABEEN H A , IDRIS A M . A B -
BAS K. Snuff dipping and oral cancer in Sudan: a retrospective study. Br J Oral Surg 1989; 27: 243-8. 2. DARAMOLA J O , AIAGBE HA, OLUWASANMI
JO. Pattern of oral caticer in a Nigerian population. Br J Oral Surg 1979: 17: 123-8. 3. BAUM BJ, BURSTONE CJ, DUBNER R, GoLDHABER P, LEVINE MJ. Advances in diagnosis and detection of oral diseases. Adv Dent Res 1989; 3: 7-13.
Coping with the management of orofacial cancer with limited resources Dear Sir. Oral cancer consists of an array of systemic disease processes, some of which may be successfully treatable if appropriately diagnosed in their early stages. However, in circumstances of limited material and manpower resources, as may prevail in many economically developing parts of the world, overall management of these orofacial tumours tnay remain a daunting problem for a long time. This problem besets not only those in the medico-dental profession but also families and in fact entire communities. It is apparent that the psychosocial impact of oral cancer has hardly been evaluated in most parts of the economically developing world. Analysis of what cancer as a disease means to an ordinary citizen can be of great importance in detennining what preventive and/or curative strategies could be feasible in defined areas. The notions and expectations of the families and even communities to which afflicted patients belong, tnay form a useful measure of the basic understanding of a given disease in society in general. The fact that tnany common orofacial cancerous lesions tend to be insidious and painless, late presentation for medical attention may be a norm. Due to the advanced nature of the disease at presentation, these tumours often involve more than one anatomical region (1) and are invariably lethal (2). The appropriate management of such cases is therefore a formidable puzzle. When diagnosed early, many of these tumours tnay be successfully operable, thereby giving patients gainful leases on life. On the other hand, when they are extensive, invasive and metastatic, clinicians are often compelled to categorise thetn as inoperable. The management is then that of a
palliative/salvage course that comtnonly entails minimising pain and discomfort, most often with inadequate medication. Conceivably, the psychosocial suffering of the family is not only immeasurable but also often inadequately managed. The current interest of the detital profession in the overall oral health of the community that it serves augurs well for the future. Basic training trends should therefore aim at producing dental surgeons who are overall astute diagnosticians of most, if not all, disease processes that may affiict the oral and perioral structures. Postgraduate training should not only be largely limited to the traditional dental subjects but should also go hand in glove with the traitiitig in the basic biological sciences. Thus young dentists need encouragetnent to pave careers in molecular and cell biology. Currently technological advances from biochemistry, itnmunology, and physics have moved from their laboratories into the hospital atid combined to radically change the way medical diagnosis is arrived at or confirmed (3). It is therefore to be envisaged that dentally qualified biochemists, iinmunologists, physiologists, and physicists would immensely contribute to ptompt and properly defined investigations and management of oral cancer in particular. Furthermore they would form the badly needed source of original creativity in the basic medical and dental sciences in the economically developing countries of Africa in particular. It is only in this way that we are likely to emancipate ourselves frotn the long overdue dependency on the western world for even the very basic manufactured medical products that so often mean life or death. It is to be vehemently emphasized that the budding dental
schools in the economically developing countries endeavour to promptly institute basic molecular and biological research as a contribution to the already explosive efforts that are being made in the economically advanced countries. Since biological cancer material abounds at one end due to the cumulative tendency, and there is readily accessible technology at the other end, collaborative research efforts need sustained atnphfication. Due to the exponential advances in research it is already anticipated that in approximately 25 years it is possible that most forms of cancer would be easily diagnosed and readily treated in the economically advanced countries (3). The economically developing countries have this similar potential and it is just the foresight and commitment to duty that needs sustained energising.
Dr. MARK LuBtstA CHINDIA
Institute of Dental Surgery Eastman Dental Hospital Department of Oral and Maxillofacial Surgery 256 Gray's Inn Road London WCIX 8LD
References 1. ELBiiSHtR El, ABEEN H A , IDRIS A M . A B -
BAS K. Snuff dipping and oral cancer in Sudan: a retrospective study. Br J Oral Surg 1989; 27: 243-8. 2. DARAMOLA J O , AIAGBE HA, OLUWASANMI
JO. Pattern of oral caticer in a Nigerian population. Br J Oral Surg 1979: 17: 123-8. 3. BAUM BJ, BURSTONE CJ, DUBNER R, GoLDHABER P, LEVINE MJ. Advances in diagnosis and detection of oral diseases. Adv Dent Res 1989; 3: 7-13.
