Oral cancer aetiopathogenesis; past, present and future aspects

Oral cancer appears to be increasing in incidence, and mortality has hardly improved over the past 25 years. Better understanding of the aetiopathogenesis should lead to more accurate and earlier diagnosis and more effective treatments with fewer adverse effects. Cancer is the result of DNA mutations arising spontaneously and from the action of various mutagens, especially in tobacco and alcohol. A sequence of genetic changes leads eventually to loss of growth control and autonomy. Countering these changes are mechanisms to metabolise carcinogens, repair DNA damage, control growth, and defend against cancer. Cancer is a consequence of an interaction of these many factors. Diagnosis is increasingly aided by detection of cellular and now molecular changes. Treatment is increasingly looking towards chemotherapy and now gene therapy. However, there is no doubt that prevention is the most important aspect, particularly patient education and the reduction of lifestyle risk habits and environmental factors.