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Posted: 24 Nov 2012 04:16 PM PST

The oral cavity is the most easily accessible part of the body. Hence, logically, oral cancers should be easily detected at the early stages. Yet, in the majority of cases, the diagnosis is made late.

The term "oral cancer" has been used to describe any malignancy that arises from the oral tissues.

Squamous cell carcinoma is the most common variety, and it accounts for about 90-95% of oral malignancies.

Oral cancer is the sixth most common form of cancer in the world. It accounts for half a million new cases diagnosed every year, and about a quarter of a million deaths every year.

In any cancer, the prognosis of the disease is measured in terms of five-year survival rates. The five-year survival rate for oral cancer is less than 50%, and this figure has more or less remained static over the last three decades.

Five-year survival rates reported for oral cancer is poorer than colorectal , breast and cervix cancers. The reason for the poor prognosis has been attributed to:

· Advanced stage of the disease when the diagnosis is made

· Distant metastasis of the disease

· Poor response to chemotherapy

However, we wish to highlight that the disease, if diagnosed and treated early, has a five-year survival rate of over 80%.

It is important to understand the reasons why oral cancer is usually diagnosed late. To do this, it is important to keep in mind the varied presentations of oral cancers. It can present as an exophytic growth or an ulcerative or infiltrative growth.

The oral cavity is the most easily accessible part of the body. Hence, logically, oral cancers should be easily detected at the early stage without the need for any costly diagnostic aids. Yet, in the majority of cases, the diagnosis is made late.

To give an example, approximately 80% of the cases that we see in our hospitals are usually in stage 3 or stage 4.

We all have experienced mouth ulcers at some time or other, and we all know how painful these ulcers can be. Those who have had these ulcers know the pain they experience, when eating, speaking or swallowing, etc. Because they are painful, you seek medical treatment almost immediately.

Unfortunately, the early stages of cancerous or malignant ulcers are usually painless or asymptomatic, hence the delay in seeking medical help.

It is evident from our interactions with patients that the reason they seek medical treatment so late is because the ulcer is not painful or asymptomatic. The other common reason is ignorance.

It is worrying that even the very educated are ignorant about mouth cancers.

Warning signs

· Any ulcer or a lump which does not heal in two weeks.

Those of us who have experienced mouth ulcers know that these ulcers usually heal within 10-14 days. Hence, it is important that we send the right message. Any ulcer that does not heal needs to be seen by a healthcare practitioner and a biopsy needs to be done to confirm the diagnosis.

· Lump or thickening of the oral soft tissues.

· Difficulty in chewing, swallowing or eating.

· Difficulty in moving the jaw or tongue.

· Numbness of the tongue, lips or mouth.

· Radiating pain, especially to the ear.

· The presence of leukoplakia. This is predominantly a white lesion of the oral mucosa that cannot be characterised as any other definable lesion. These lesions have a higher incidence of malignant transformations.

· The presence of erythroplakia. This term is used to describe a lesion of the oral mucosa that presents as red areas. These lesions have the highest potential for malignant transformation.

· The presence of lichen planus. This lesion has a white and red form and can manifest as different patterns – a lacy pattern, or a raised plaque. Those with areas of ulceration within carries an increased risk of of cancer.

· Oral submucous fibrosis. They can affect any part of the oral mucosa, and is characterised by mucosal rigidity where the normal feel of the pliable soft mucosal feeling is lost. This is clinically manifested by the patient as having difficulty in opening the mouth.

Risk factors

Risk factors can be broadly classified into two main ones: environmental and genetic.

Environmental risk factors include betel quid use, tobacco and alcohol use, excessive exposure to sunlight in fair-skinned people, and certain fungal/viral infections (eg Human Papilloma Virus, Candia albicans).

Genetic risk factors include individuals with a family history of mouth cancers.

Other contributing factors include:

· Age: Commonly occurs in the fourth to sixth decade of life, with the highest prevalence in the sixth decade of life.

· Gender: More common in men than women depending upon the extent of and the type of tobacco habits prevalent. In Malaysia, it is higher among Indian women.

· Race/ethincity: In the Malaysian scenario, this is very obvious, with more than 60% of cases occurring in the Indian population.

Cultural, social and religious traditions are very important contributing factors. For example, in general, the Malays do not take alcohol, while they chew betel quid and use tobacco. On the other hand, the Chinese use tobacco and alcohol, but do not use betel quid, while the Indians often use all the three. This explains why there is such a vast difference in the incidence among the Indian population.

· Diet: Scientific studies have shown that populations with a diet rich in fresh fruits, vegetables and olive oil have a lower cancer incidence. This is very evident from studies emerging from the East European block of countries like Romania, Hungary and Czechoslovakia. Over the last two decades, these East European countries have experienced an increased incidence of oral cancers while their counterparts in the Mediterranean countries have shown a decreasing trend. The only explanation to this trend is that the Mediterranean countries use a diet rich in fresh fruits and vegetables with olive oil while the East European countries lack this in their diet.

Treating oral cancer

Oral cancer can present as an ulcer or as an exophytic growth, and can occur anywhere in the oral mucosa (which is not painful initially). It usually occurs as a deep ulcer which does not heal even after two weeks, which bleeds on touch, with indurated or hard margins, and with the edges usually raised. It is commonly associated with swollen lymph nodes.

Oral cancer is conventionally treated by surgery, radiotherapy or chemotherapy. Treatment can be a combination of the above three methods, depending on the stage of the disease and the extent of spread.

Surgery and radiotherapy is usually the preferred choice of treatment, while chemotherapy is less effective in oral cancers.

With the advent of newer chemotherapeutic drugs, some of the lesions are showing good response. The decision to treat by one or all the three methods depends upon the patients medical condition and the ability to withstand the treatment, and whether they are planning for a curative or palliative outcome.

In any form of cancer, the outcome is usually stated as a five-year survival rate. The five-year survival rate for oral cancer is 80% in the early stages and in localised disease.

Once the cancer has spread to the lymph glands in the neck region, this five-year survival rate drastically decreases to 40%, and the five-year survival becomes less than 20% once the disease has spread to other organs, what we call metastasis of the disease.

Hence, it is very important that these lesions are picked up early and treated appropriately for better outcomes.

Like any other cancer, there is a lot of research is being carried out globally as well as in Malaysia. The Oral Cancer Research coordinating Centre (OCRCC) and the Cancer Research Initiative Foundation (CARIF) are currently carrying out numerous research in this field.

Some of the work has been directed towards identifying tumour markers in oral cancer. Identifying the tumour markers opens up a whole new phase in identifying prognosis and managing the disease.

Like any other cancer, there are a few things one can do to prevent the disease. First of all, abstaining from betel quid, tobacco, and alcohol can play a big role in preventing the disease.

The second thing you can do is mouth self examination. We would like to suggest that at least once in a fortnight, take an additional two minutes to stand in front of the mirror and have a proper look in your mouth. Look for any lumps or bumps in the mouth, any ulcer or break in the continuity of the mucosa.

Also look for any change in the colour of the mucosa, like a white or red patch or any white patterns. Seek medical treatment for any ulcer which has not healed within two weeks.

There are approximately seven steps to systematically examine your mouth:

1. Look at the lips with your mouth open and closed.

2. Look at the inner aspect of your upper and lower lips by pulling your lips outwards.

3. Look on the inner aspect of your cheeks on both sides.

4. Examine the roof of your mouth, including the soft palate.

5. Protrude your tongue and take a look on the surface of the tongue and also on both the sides of the tongue.

6. Lift your tongue up and look under the surface of the tongue and on the inner aspect of your teeth.

7. Feel for any swollen glands in the head and neck region.

8. Lastly, maintain good oral hygiene and visit your dentist every six months (or at least once a year).

The Oral Health division of the Health Ministry conducts outreach screening camps either individually or in conjunction with other NGOs. Take the time to visit one of these camps and get your mouth looked into to allay your fears.

You can also visit your dental healthcare practitioner and they would be able to make appropriate specialist referrals.

To conclude, if there is one message we wish to leave, it is seek professional help if you have noticed any lump or an ulcer which has not healed within two weeks. Remember that if you seek professional help early, it will help in the early diagnosis and early management of the problem, which gives a better outcome.

Dr M. Thomas Abraham is a consultant maxillofacial and oral surgeon as well as president of the Malaysian Association of Oral & Maxillofacial Surgeons.

Locker room nudity

Posted: 24 Nov 2012 04:14 PM PST

Most gym-goers have no qualms about showing off the bodies they have worked so hard to achieve. But just how much nudity is appropriate at the gym locker room?

THIS question has bothered me for years – it's kind of funny, but at the same time, just about as awkward as going condom shopping with your mum.

Here's the thing: Why do people walk around naked in gym locker rooms?

For as long as I can remember, going to the gym has been a constant in my life.

Whether it's killing an hour of spinning class or keeling over from wall balls, finishing a workout is always incredibly satisfying and rewarding.

It is no wonder that regular gym-goers have no qualms about showing off the bodies they have worked so hard to achieve.

But to saunter about in their birthday suits? Why?!!

Unfortunately, the routine preening over lumps, bumps and cellulite while revealing terrifying shocks of hair in unspeakable regions have become all too common in gym locker rooms.

These rebels routinely shirk the usage of a towel, curtains and changing stalls, preferring instead to air their privates or to towel themselves dry in public for your viewing pleasure.

Once, as I was putting my shoes on, a seasoned 40-something I met in Pilates class came up to me and started making small talk. I'm all for exchanging pleasantries, but it was a little hard to not get distracted when she had just her panties on.

Suddenly, the gym locker room becomes a racecourse of naked bodies from which I must dodge and navigate my way through while keeping a stoic expression. Most days, I try not to stare. Or wince. Depending on what's on display.

Apparently, these exhibitionist tendencies are equally rampant in the men's locker room. As my friend, Matt, shares his visual displeasure on a recent Facebook post: "Dear naked uncle in gym shower stall 3, the importance of closing the shower curtains on a scale of 1 to OH-MY-EYES is very high.

"Although I admire your ballsy act of exercising your right for transparency, at the expense of my libido, but let's save it for the upcoming general election.

"Sincerely, traumatised young man in gym shower stall 2."

The funny thing is, and as my fellow gym-goers would tell you, it is often the senior citizens who don't give a hoot about loafing around in the buff.

Maybe it is an age thing. I recently terminated my membership at a commercial gym, but in all my four years there, I've found that it is always the aunties who are most comfortable with nudity.

Then again, I suppose there is something just wonderfully liberating about letting it all hang. Maybe we just get more comfortable with our bodies as we age.

I can't be naked for more than three seconds. On most occasions, I do that old wrap the towel around, remove my undergarments quickly, hop into the shower, and do the reverse out.

I don't think I am in bad shape, but I'm no Rihanna, now. More importantly, I love my privacy.

In a way, I do admire these men and women for their free spirit. Especially those who are no longer the pretty young things they once were, and are yet absolved from all sense of insecurity that can plague even the most beautiful people.

God gave us one body and we should love and respect it. And well, as long as we're not hurting anybody (besides your eyes), I suppose there is nothing wrong with shaking what your momma gave you at the changing room.

I just won't be flashing any of my junk anytime soon. Maybe in 20 years.

Fiona Ho is a certified personal trainer and a CrossFit enthusiast who is infinitely grateful for closed cubicles and showers.

Motives for movement

Posted: 24 Nov 2012 04:13 PM PST

The absence of motivation is a key factor that leads many people to be physically inactive.

I CAN'T seem to get myself moving!" This is a claim made by many people when they are asked why they do not participate in some form of physical activity. What people are talking about is motivation, or rather a lack of it, as far as physical activity is concerned.

Lack of physical activity is one of the biggest risk factors for many major illnesses, including heart disease, diabetes, obesity, and some forms of cancer.

Globally, around 31.8% of those aged 15 years and older do not do enough regular physical activity to garner the important health benefits that result from being active.

In this country, 43.7% of Malaysians are considered to be sedentary.

The absence of motivation is a key factor that leads many people to be physically inactive. Motivation has two aspects, namely energy and direction.

When we are highly motivated, we feel like we have a strong drive (energy) pushing us. That drive pushes us in a particular direction.

Energy and enthusiasm are high when we think about going to watch a new movie (a positive direction), but they sink when we remember the housework that has to be done (a not-so-positive direction!).

This shows how the direction of motivation affects the energy we feel for an activity and determines what we do and what we avoid doing.

We all know some people, who, whether young or old, love doing physical activity; some people organise their lives around their golf or gym visits. Unfortunately, many of us are not active enough to gain health benefits, especially as we get older.

We claim we don't have enough time, there are no facilities in the locality, it costs too much, or our health stops us. These are the main reasons that people give to researchers, when asked why they are sedentary. With sufficient motivation, however, gaps can be found in the busiest schedule, there is always an area somewhere nearby where we can be active, and many activities cost little or nothing.

For most of us, getting active is precisely what we need to do to improve our health. We need to get motivated to become active.

Researchers have been studying motivation for many years, and those who examine participation in physical activity have identified a number of key factors that influence our motivation to be physically active.

The motive for physical activity that has the strongest support from a large body of research is confidence to perform a specific activity. This is called self-efficacy. It is closely associated with the direction of motivation.

Most of us do not run the marathon because we believe we could never run over 42 kilometers, but older adults, people who have had heart attacks and individuals with artificial lower limbs and in wheelchairs have completed marathons.

It is possible, but most people do not have the confidence or self-efficacy, so they are not motivated to train for such a demanding event.

Nevertheless, pretty much everybody likes to move. Just think how you feel when forced to remain inactive for a considerable time, such as during a long car journey or an aeroplane flight, or if you are confined to bed due to sickness or injury.

The first thing you want to do is move around.

Thus, people do like to move. One secret for starting to become physically active is to find a direction that suits each person. That means a direction for which confidence is relatively high, in other words, something that interests the individual.

For those who have been sedentary, it might be that there is little physical activity they are confident to do. That could be because they set their goals too high by watching people who have been active for some time and think "I can't do that".

Researchers who have studied self-efficacy have shown that increasing physical activity is most effective when people set goals that lead to them being successful most of the time (say 70-80%).

At the start, these might involve relatively low levels of activity, but once success is experienced, confidence increases and the goal can be increased. This approach of building confidence, and with it the level of physical activity (called stepwise mastery goal setting), can lead people to attain levels of activity that are health promoting. With confidence, that leads to the activity becoming a chosen direction, leading to the increase in energy for that activity that is the foundation of lasting motivation.

Another key to encouraging people to start and maintain physical activity is to help them choose something they want to do.

Studies have shown that personal choice leads people to keep doing an activity for longer. Psychologists propose this is because feeling in control of our own behaviour is a basic need we all possess. When people believe they chose to do a particular activity, their motivation for that activity is stronger, and more importantly, they are motivated by the activity, not by what somebody else says or by the thought that it will be good for them.

People who play golf or soccer, trek in the hills, swim or do tai chi because they enjoy that activity will sustain their involvement longer and make more effort than those who do the activity because they are told they should by a health professional or a gym instructor.

Participating because you enjoy the activity is called intrinsic motivation because the intrinsic aspects of the activity drive (motivate) involvement.

Recently, there have been many examples of successful programmes promoting long-term participation in physical activity that have encouraged people to choose their own activity, rather than prescribing specific exercise or sport involvement.

Although personal choice of activity is important for long-term participation, people are also influenced by their understanding of the benefits or costs of their actions.

An approach to behaviour change that pointed this out started some time ago with the goal of helping people to stop smoking. Research showed that many people didn't know that smoking was associated with many illnesses and premature death, so they had not thought about quitting. This is why we have seen so many advertising campaigns about the damage that smoking can do to health.

Similarly, many people do not realise that physical activity has been shown to promote physical health, protect against some of today's most problematic diseases, and enhance psychological well-being.

Alerting people to the many benefits of being physically active should encourage them to think more seriously about increasing their participation in physical activity.

It is also not well understood that there is a difference between fitness and health. Some of the fittest people in the world, elite athletes, are particularly prone to pick up infections. Many elite athletes push their bodies to the limits, causing their immune systems to weaken, leading to lower protection against bacteria and viruses.

Thus, very fit people can be unhealthy!

On the other hand, regular, but not obsessive physical activity helps the physical body and the mind to function more effectively, thus, providing added protection.

Physical activity researchers have shown that increasing people's knowledge about the physical and psychological benefits of being physically active and the risks of not being active motivates many to become more active.

One more key factor in promoting continued participation in physical activity is having somebody help you. They can do this either by engaging in the activity with you or simply by encouraging you.

Perhaps your partner might drive you to the physical activity venue and collect you afterward. Maybe a friend just asks now and again how you are getting on and is impressed by your progress, which encourages you.

Researchers have investigated the influence of what is called social support, the help others give us in any area of life. What some have termed the "buddy system", which involves finding somebody to do your chosen physical activity with you, whether it is a family member or somebody whose only connection is the common desire to do that activity, has been shown to be a valuable aid to motivation.

Sometimes, when you don't feel like doing the activity, knowing the other person is depending on you can be as big a motivator to be active as having them encourage you.

Physical activity certainly plays a key role in maintaining physical heath and psychological well-being. It is also now a core component of the treatment for many of the most prevalent, life-threatening medical conditions.

Exercise also helps people manage the stress associated with many aspects of life and is an effective treatment for depression.

Appreciating the benefits of being active and the risks of inactivity is one important key to becoming more active.

Choosing an activity that interests you is another crucial factor in promoting long-term participation.

Initiating involvement at a level where you will experience success, gain confidence and set stepwise goals is imperative for continued activity. Attracting support from others can sustain and enhance the experience of doing physical activity.

Perhaps the bottom line is that we should all aim to have the best quality of life possible in whatever circumstances we face. What better motivation is there for being physically active than enjoying life to the full?

Do more physical activity, so you don't just live longer, you live happier!

Prof Tony Morris and Dr Selina Khoo is with University of Malaya's Malaysian Elderly Longitudinal Research (MELOR) group. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

Kredit: www.thestar.com.my

Ahad, 25 November 2012

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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