Short Communication
Views and Observation on Orofacial Cancer
Raja Kummoona*
Department of Maxillofacial Surgery, Iraqi Board for Medical Specialization’s , Iraq
*Corresponding author: Raja Kummoona, Department of Maxillofacial Surgery, Department of Maxillofacial Surgery, Baghdad, Iraq
Published: 18 Feb, 2018
Cite this article as: Kummoona R. Views and Observation
on Orofacial Cancer. Clin Oncol. 2018;
3: 1415.
Short Communication
Cancer is dreadful disease very distressing to the people they are scared from cancer. Orofacial
cancer includes groups of malignant disease effect the oral, nasal mucosa, jaws and salivary glands
and parotid and mesenchymal surrounding structures of the orofacial regions. The incidence of
head neck cancer is about 8% of the total body malignancies while oral cancer in general represent
about 4%, that percentage might increase to 40% in India but in US and Europe the incidence very
much reduced, but in the south of Iraq the incidence very much increased because, pollution of
depleted uranium been used during gulf wars.
Oncogenic viruses is a strong cause of cancer such as EBV causing Burkett’s Lymphoma and
nasopharyngeal carcinoma, herpes like viruses causing Kummoona jaw lymphoma, it was noticed
an association between herpetic papilloma virus (HPV virus) with oral cancer, HIV virus with AIDS
disease can cause leukoplakia as pre-cancerous white lesions and end with oral cancer also Kaposi
Sarcoma noticed with HIV infected cases.
The recent studies of Harvard medical school they did found strong association between
advanced infection of periodontal and gum disease with incidence of oral cancer specially people with
low socioeconomic group and heavy smoking, the microorganism causing infection of periodontal
pockets is strepto mutant type, cancer might associated with chronic hyperplastic candidiasis in the
oral tissue. There is strong association between spicy food like Chile and precancerous submucosal
fibrosis, also there is a strong cause of cancer by effect of smoking with consumption of alcohol,
hereditary and genetic factors should not exclude.
Oral cancer is more common in male after 50 years of age and the signs of cancer appeared
as thick white spongy lesion with tendency to red or as mass or lump or a fissure or an ulcer, the
most common site is the lateral side of the tongue or the floor of the mouth or alveolar bone or the
cheek. Hard palate might affect either by primary adeno carcinoma or squamous cell carcinoma
from maxillary sinus. Cervical lymph nodes might involve especially submandibular lymph nodes
or jugulodigastric than submental lymph node that associated with floor cancer.
The tumors in general classified according to staging of the diseases based on TNM system
which is quite simple and informative. We did a lot of research on oral cancer including AgNOR
for studding the proliferative activity of cancer cells also we studied apoptotic changes of cancer
cells by BcL2 proto-oncogene belong to family of apoptosis, BcL2 was first described in follicular
lymphoma that beret 14:18 (q32,q21) translocation. This structural chromosomal aberration leads
to over production of BcL2 messenger RNA and protein BcL2 is localized at outer mitochondria and
nuclear membrane as well as in the endoplasmic reticulum. In AgNOR we did found the increase
number of NORS in the nuclease represent the high malignancy as in poorly differentiated squamous
cell carcinoma but the number of NORS in well differentiated squamous cell carcinoma very much
reduced, by EM studies showed an irregular shape and size of tumor cells with remarkable divisions
of nuclei and chromatin clumps emarginated towards nuclear membrane, few mitochondria with
dilated crista and abundant rough endoplasmic reticulum with few apoptotic changes also observed.
Our policy of management of oral cancer is based on 3 lines, line one by radical surgery with supra
omo hyoid neck dissection and fallowed by 3 courses of chemotherapy (5FU+Toxter+Carboplatin)
and finally deep X-ray therapy, sometimes we give a course of chemotherapy before surgery, this
type of managements was quiet effective and survival rate were between 3-5 years.
We brought the attention of the world to peculiar and very aggressive rapid growth of jaws
tumors nominated as (Kummoona Jaw Lymphoma) during 1977-78. The tumors effect the children
between age of 3-6 years, the growth very rapid and duration of illness between 3-4 weeks might
terminate the life of children, patients are feverish anemic with high ESR and patients passed through
depleting status and children might passed during 3-4 weeks ,the tumors effect the posterior part
of the jaws in the molar premolar area ,both upper and lower jaws
might involve at once, we think that highly oncogenic virus effect
odontogenic tissue of jaws bone, we reported 28 case and only 2
survived and the mortality rate was 92%, it is not Burkett’s lymphoma.
For understanding the behavior of this disease we did our modified
staging of the disease, Stage I (early disease) the tumor found only
in one jaw side in molar-premolar region in the mandible or maxilla
or in cancer found in single lymph node, Stage II (locally advanced
disease), the tumors found in both sides of the mandible or maxilla
or in lymphoma cancer found in 2 or more lymph nodes regions in
one side diaphragm, Stage III (advanced disease) tumors involve the
viscera or in lymphoma cancer, the cancer involve lymph nodes above
and below diaphragm, Stage IV (wide spread disease),tumors involve
the CNS, bone marrow, reticuloendothelial system, in lymphoma
cancer, cancer cells found in several parts of one or more organs or
tissue, liver, blood and bone marrow.
The therapeutic regimen based on NCI recommendations, the
therapy used was an IV combinations of Vincristine 1.5mg/m2,
Adramycin 50mg/m2, cyclophosphamide 1000mg/m2, Methotroxate
10mg/m2 and prednisolone 50mg/m2 in 8 doses and duration of
therapeutic regimen for 24 weeks.
We did research by serological studies for Epstein Barr
Nuclear Antigen( EBNA), for Early Antigen (EA) and Virus
Capsid Antigen(VCA), with print cytology as quick method for
diagnosis, plastic sections and EM studies, the general feature of jaw
lymphoma the cells oval or round or elongated with high nucleuscytoplasmic
ratio with presence of in vagination or cleft in nuclear
membrane, chromtin clumps near nuclear membrane, mitochondria
homogenous, some cells showed apoptotic changes with virus like
particles scattered and vacuoles also observed, some lymphoblast
transferred to plasma cells.