This document discusses oral cancer in Saudi Arabia. It provides data on oral cancer incidence rates by region and gender in Saudi Arabia. The highest rates are seen in the Northern and Jazan regions. Risk factors discussed include tobacco use, HPV infection, age, and genetics. There is seen to be a lack of comprehensive studies and data on oral cancer in Saudi Arabia. Specialists believe this is due to lack of collaboration and a national database. Improved research efforts are needed to better understand and address oral cancer in the country.

1. ORAL PATHOLOGY
ONLINE
CONFERENCE
Third year dental students
Supervised by Dr.Dalal ALQahtani
dalalq@ksu.edu.sa
College of Dentistry
King Saud University
SUMMARY

2. TOPIC NAME: ORAL CANCER IN
SAUDI ARABIA
DONE BY:
Asma Al-Owaiouid
Aisha Al-Sanie
Eman Al-Abdulqader
Reem Al-Dhafiri
Shahad Al-Harran

3. In this topic “Oral cancer in Saudi Arabia” we will
cover: the incidence, risk factors and some
specialists' opinions about the lack of studies and
researches about this topic.
Oral cancer is a serious lesion that happened by
an abnormal and uncontrolled growth of cells
which cause damage to the surrounding tissue. It
includes cancers of the lips, tongue, floor of the
mouth, hard & soft palate, cheeks, pharynx and
sinuses. Oral cancer is a life threatening if not
diagnosed and treated early.

4. According to Cancer Incidence Report Saudi Arabia 2004 the total
number of cancer incident cases is 9381 In general men were
affected more than women the men indecent 50%.9 while the female
49.1% The analyze of 2004 shows that the group age of 60-74
males have the highest colo-rectal cancer,While it shows that the
group age of 45-59 females have Brest cancer.
Going in depth to our main subject oral cancer in KSA .In general
some regions have high percentage of oral cancer such as northern
region which tongue cancer in males take the fourth place by a
percentage of 6.1%. Also Jazan shows ahigh percentage of oral
cancer with 9.4% and tongue cancer of 3.8% in males .Tongue
cancer takes the second place by 9.2% in females and oral by 5.5%
.Najran also have a percentage of 3.4% tongue cancer in male .
Baha region have the percentage of 6.9% of tongue caner in males
while 2.7% in females.(1)

5. Relative frequencies for oral cancer cases among Saudi males and
females by site and region, 2004(1) (Picture 1)
Riyadh
FemaleMaleSites
0.0%0.2%Lip
0.4%0.7%Tongue
0.4%0.7%Mouth
0.3%0.2%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx
Relative frequencies for oral cancer cases among Saudi males and
females by site and region, 2004 (Picture 2)
Makkah
FemaleMaleSites
0.1%0.5%Lip
1%0.5%Tongue
0.4%1.2%Mouth
0.2%0.5%Salivary glands
0.0%0.2%Tonsil
0.1%0.2%Oropharynx

6. Relative frequencies for oral cancer cases among Saudi males and
females by site and region, 2004 (Picture 3)
Relative frequencies for oral cancer cases among Saudi males and
females by site and region, 2004 (Picture 4)
Eastern province
FemaleMaleSites
0.0%0.4%Lip
0.5%0.7%Tongue
0.2%0.5%Mouth
0.3%0.4%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx
Najran
FemaleMaleSites
0.0%0.0%Lip
2.7%3.4%Tongue
2.7%1.7%Mouth
0.0%0.0%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx

7. Relative frequencies for oral cancer cases among Saudi males and
females by site and region, 2004 (Picture 5
Jouf
FemaleMaleSites
1.8%0.0%Lip
0.0%0.0%Tongue
0.0%0.0%Mouth
3.6%0.0%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx
Relative frequencies for oral cancer cases among Saudi males
and females by site and region, 2004 (Picture 6)
Tabuk
FemaleMaleSites
0.0%0.0%Lip
0.0%0.0%Tongue
1%0.0%Mouth
0.0%0.9%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx

8. Relative frequencies for oral cancer cases among Saudi males and
females by site and region, 2004 (Picture 7)
Northern Region
FemaleMaleSites
0.0%0.0%Lip
0.0%6.1%Tongue
1%0.0%Mouth
0.0%0.0%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx
Relative frequencies for oral cancer cases among Saudi males and
females by site and region, 2004 (Picture 8)
Madinah
FemaleMaleSites
0.5%0.0%Lip
0.0%0.5%Tongue
0.9%0.5%Mouth
0.0%0.0%Salivary glands
0.5%0.0%Tonsil
0.0%0.0%Oropharynx

9. Relative frequencies for oral cancer cases among Saudi males and females by
site and region, 2004 (Picture 9)
Hail
FemaleMaleSites
0.0%0.0%Lip
0.0%0.0%Tongue
0.0%0.0%Mouth
0.0%0.0%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx
Relative frequencies for oral cancer cases among Saudi males and females by
site and region, 2004 (Picture 10)
Qassim
FemaleMaleSites
0.0%0.0%Lip
0.0%0.6%Tongue
0.0%0.0%Mouth
0.0%1.2%Salivary glands
0.0%0.0%Tonsil
0.7%0.0%Oropharynx

10. Relative frequencies for oral cancer cases among Saudi males and females by
site and region, 2004 (Picture 11)
Asir
FemaleMaleSites
0.0%0.0%Lip
0.8%0.77%Tongue
0.8%1.2%Mouth
0.0%0.0%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx
Relative frequencies for oral cancer cases among Saudi males and females
by site and region, 2004 (Picture 12)
Baha
FemaleMaleSites
0.0%0.0%Lip
2.7%6.9%Tongue
1.4%1.7%Mouth
0.0%0.0%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx

11. Relative frequencies for oral cancer cases among Saudi males and
females by site and region, 2004 (Picture 13)
Jazan
FemaleMaleSites
2.8%0.0%Lip
9.2%3.8%Tongue
5.5%9.4%Mouth
0.0%0.0%Salivary glands
0.0%0.0%Tonsil
0.0%0.0%Oropharynx

12. Among the distribution of 20 most common malignancies (1975–2012) (total
cases=75,233) at King Faisal Specialist Hospital and Research centre Oral Cavity
was the 7th most common showing 3,458 cases, which represent 4.6%
Oral cavity tumors cases seen at KFSH&RC during 2002-2006 were 520 case from
total of 13,720 tumor cases, representing 3.8% While During 2007-2011, 502 Oral
cavity tumors cases from total of 12,723 tumor cases, which represent 3.9%

13. During 2012, 86 Oral cavity tumor cases was seen in KFSH&RC from total
of 2,544 tumor cases, which represent 3.4%
From 86 case, male cases was 41 while female 45 case. Analytic cases
79 while Non-Analytic cases 7.
More details about the analytic cases :

15. Among Distribution of 20 most common malignancies 2012
analytic cases (Total Cases = 2,288 at KFSH&RC)
Oral Cavity was

17. From total of 2,544 primary site cancer cases seen at KFSH&RC, LIP Cancer
histology showed 1 case of Squamous Cell Carcinoma .While 28 TONGUE
Cancer cases, histology showed 25 Squamous Cell Carcinoma cases, 1 case
Liposarcoma ,1 case Malignant Melanoma and 1 case Verrucous Carcinoma
,16 GUM cancer cases,histology showed 15 Squamous Cell Carcinoma cases
and 1 Malignant Melanoma case.
1 floor of mouth cancer case, histology showed Squamous Cell Carcinoma
case 4 PALATE cancer cases, histology showed 2 Polymorphous Low Grade,
2 Adenocarcinoma cases.1 Mucoepidermoid Carcinoma and 1 Squamous Cell
Carcinoma case .other part of mouth 13 cases, histology showed 10
Squamous Cell Carcinoma cases, 1 Adenoid Cystic Carcinoma case, 1
Mucoepidermoid Carcinoma case and 1 Verrucous Carcinoma. (2)

18. From MULTIPLE PRIMARY SITES cancer cases seen at KFSH&RC total of
114,
2 TONGUE cases, histology showed 1 Malignant Melanoma with other
primaries (Lymph Nodes, NHL) and 1 Squamous Cell Carcinoma with other
primaries (Gum-Sq Cell Carcinoma) .2 MOUTH cases, histology shoed 1
Squamous Cell Carcinoma with other primarie (Thyroid - Papillary
Carcinoma, Tongue-Sq Cell Carcinoma) and 1 Squamous Cell Carcinoma
with other primaries (Esophagus - Sq Cell Carcinoma)(2)

19. This video will show you the incidence in different countries worldwide in
comparison with the incidence in Saudi Arabia.
http://youtu.be/Q7ihowQauXM

20. Risk factors
After listing the incidence let's try to discover some of oral cancer risk
factors. What do you think what are the risk factors for oral cancer?
Oral cancer can develop in any person as the other cancers. But the
likelihood of developing this disease may increase with some factors as:
1. Gender: the likelihood of developing oral & oropharyngeal cancer in
men is twice as in women. The risk increased most probably because of
using tobacco & alcohol. (4)
2. Age: The risk is increased with age. 66% of patients diagnosed for oral
cancer are over the age of 55. (4)
3. Ultraviolet light: People with outdoor occupations or prolonged
exposure to sunlight may develop cancer of the lip. (4)

21. 4. Genetics syndrome: Some inherited genetic mutations
may carry a high risk of developing oral cancer. This include:
Fanconi anemia & Dyskeratosis congenital. (4)
5. Tobacco use: Most patients with oral or oropharyngeal
cancers use tobacco in form of cigarettes, chewing tobacco or
snuff. (4)
Developing of these diseases depends on the duration &
frequency of using tobacco. Smoking can cause many form of
cancer for example: cancer in the lips, cheeks, tongue, throat.
(4)
Many oral cancer cases in Saudi Arabia is linked to the history
of using smokeless tobacco (Shamma). (3)
6. Alcohol: many patients diagnosed for oral cancer are
heavy alcohol drinkers. (4)

22. 7. Human papillomavirus (HPV) infection: HPV is tied to the
development of cervical cancer.But it is also a risk factor for
oral and oropharyngeal cancers.
There is a strong link between HPV-16 and oropharyngeal
cancer. (4)
8. Immune system suppression: immune suppressor drugs
that used to prevent rejection of a transplant organ or to treat
certain immune diseases, may increase the risk of oral cancer.
(4)
9. Lichen planus: People with a severe case of this lesion
may have a higher risk of oral cancer. It may cause itchy rash
but sometimes appears as white lines or spots in the mouth
and throat. Lichen planus usually affects middle-aged people.
(4)

23. In summary the risk factors for oral cancer are:

24. Specialties opinions about the causes of
shortage of studies &researches in Oral cancer
in SA :
While collecting data about this topic
we found there is a shortage in studies
and researches, so we asked some
dentists from different specialties to
know their opinions.
http://www.slideshare.net/Oral_Path_Conf/dentists-
opinions-regarding-oral-cancer-in-saudi-arabia

25. To conclude,
a lot of dentists believe that there is no data base
and a lack of team work.
Can you suggest solutions or methods to improve
this shortage in researches?
We have discussed the incidence of oral cancer
in KSA, risk factor and causes for the lack of data
in oral cancer. Hope you enjoy it and get benefit
from it.
Thank you.