Abstract
Field cancerization is a well-known and well-documented process of malignant transformation first coined by Slaughter et al. in 1953. Tobacco chewing was associated with the greatest increase in the risk of multiple oral premalignant lesions and may be the major source of field cancerization of the oral cavity in the Indian population. The field cancerization will probably help clinicians in complementing evaluation of pathologic biopsy specimens. We present a case report of field cancerization in a 63-year-old Indian female. She presented with an intra-oral generalized hyperkeratotic verruciform type white lesions involving right and left buccal mucosa, lower labial mucosa, upper and lower vestibule, dorsal, ventral and right lateral border of the tongue, hard and soft palate. Microscopic examination revealed features of verrucous carcinoma in one area, squamous cell carcinoma in another and carcinoma in situ in other areas. Based on the overall features in various areas of the oral cavity, the lesion was diagnosed as field cancerization. Reviewing the literature revealed the presence of a field with genetically altered cells appear to be induced by tobacco (smoking/smokeless form). The large number of premalignant cells in the fields may increase cancer risk considerably. Thus screening and monitoring of the field may have serious implications for oral cancer prevention.
Highlights
An important physiological function of epithelia is its protective role by its frequent self-renewal process
A potential mechanism for the development of multiple oral premalignant lesions is explained by the field cancerization theory which proposes that carcinogenic exposure can cause simultaneous genetic defects in the epithelium of the upper aerodigestive tract, putting the epithelium at high risk, for the development of multiple lesions[2]
Since the term field cancerization is applied to explicate the oral cancer developing in multifocal areas of a precancerous change, abnormal tissues surrounding the tumor, oral cancer often consisting of multiple independent lesions that may coalesce and the persistence of abnormal tissue even after surgery[4]
Summary
Field cancerization is a well-known and well-documented process of malignant transformation first coined by Slaughter et al in 1953. Tobacco chewing was associated with the greatest increase in the risk of multiple oral premalignant lesions and may be the major source of field cancerization of the oral cavity in the Indian population. We present a case report of field cancerization in a 63-year-old Indian female. She presented with an intra-oral generalized hyperkeratotic verruciform type white lesions involving right and left buccal mucosa, lower labial mucosa, upper and lower vestibule, dorsal, ventral and right lateral border of the tongue, hard and soft palate. Based on the overall features in various areas of the oral cavity, the lesion was diagnosed as field cancerization. The large number of premalignant cells in the fields may increase cancer risk considerably.
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