[Fat Bear Science] Many people eat this kind of food that causes a high incidence of oral cancer! Check these 7 parts in the mirror for self-examination

On March 7, 2019, the Hunan Areca Nut Food Industry Association issued a "Notice on Stopping Advertising" which attracted everyone's attention. The notice requires all companies to stop all domestic advertising from now on, and this work must be completed before March 15.

For a time, betel nut as a food came into everyone's attention, and also triggered heated discussions on "betel nut causes oral cancer."

In Chongqing, betel nut is not common. It is occasionally sold in supermarkets and few people eat it. However, it is very harmful. In addition to causing many diseases, it may also cause cancer. Today, Pang Xiong consulted experts from the Head and Neck Tumor Center of the Affiliated Tumor Hospital of Chongqing University to tell you about the great harm of betel nut.

Wu Jian, Doctor of Medicine, Associate Chief Physician, Deputy Director of Head and Neck Tumor Center of Chongqing University Affiliated Tumor Hospital, Standing Committee Member of Head and Neck Tumor Professional Committee of China Medical Education Association, Member of Thyroid Youth Committee of China Anti-Cancer Association, Member of Head and Neck Tumor Professional Committee of Chongqing Anti-Cancer Association, Member of Otolaryngology Youth Committee of Chongqing Anti-Cancer Association, Member of Head and Neck Tissue Repair and Regeneration Group of Tissue Repair and Regeneration Branch of Chinese Medical Association, Member of Tumor Reconstruction Branch of China Plastic and Aesthetic Surgery Association. He is good at primary repair and reconstruction of defects after head and neck tumor surgery, laparoscopic thyroid surgery, and surgery and comprehensive treatment of head and neck tumors such as thyroid cancer, oral cancer, laryngeal cancer, hypopharyngeal cancer, etc.

Clinic hours: Friday all day

Betel nut is a first-class carcinogen, which has long been confirmed

It is understood that betel nuts are mostly produced in Hainan, but not many are consumed locally. More than 90% are shipped to Hunan and processed in Xiangtan City to make chewy food similar to "chewing gum".

“Betel nut plus cigarettes, the power is boundless; betel nut with wine, eternal immortality.” Fat Bear once studied in Changsha, Hunan. He was familiar with betel nut and had tried it before, but he did not know much about the harm.

When you first take a bite, a cool feeling rushes straight into your nose, and the taste is rich; after chewing a few times, a slightly bitter taste fills your mouth, and your brain instantly becomes clear; chewing for a while longer, your taste buds are stimulated to secrete a lot of saliva, and you feel stuffy in your chest, flushed in the face, dizzy, and your heartbeat speeds up. Because I'm really not used to it, I never eat it again after trying it once or twice.

The World Health Organization has long classified betel nut, betel nut chewing pieces containing tobacco, and betel nut chewing pieces without tobacco as a class of carcinogens with the same harmful effects as alcohol.

At the end of 2018, the Hunan Provincial Cancer Prevention and Treatment Office released the province's latest cancer registration data. Among the top ten incidence rates among men, oral cancer ranked eighth, accounting for 3.2% of the total incidence rate.

Studies have shown that smoking, drinking and betel nut consumption are closely related to the occurrence of oral cancer. The incidence of oral cancer in people who smoke, drink and consume betel nut is 123 times that of the general population. In developing countries, more than 80% of oral cancer is attributed to smoking, consuming betel nut and drinking a lot of alcohol.

A series of substances in betel nut are clearly carcinogenic

There are two main reasons why betel nut causes cancer:

■ Many substances in betel nut are clear carcinogenic compounds.

■ Betel nut is hard and can easily cause mechanical trauma to the oral mucosa when chewed.

Chemical factors:

A large number of literature reports show that chewing betel nut causes oral cancer because arecoline (ARC), areca tannins, areca-specific nitrosamines (ASNA) and reactive oxygen species (ROS) in betel nut are cytotoxic, genotoxic, mutagenic and carcinogenic.

Arecoline. It has clear genotoxicity and mutagenicity, and is cytotoxic to a variety of cells including oral fibroblasts and keratinocytes, affecting the cell proliferation cycle and inducing programmed cell death;

Tannins. Areca nut polyphenols containing tannins are the main carcinogenic components of betel nut;

Betel nut-specific nitrosamines. 3-Methylnitrosaminolactone (a strong carcinogen) can induce DNA chain breaks and DNA protein cross-linking in human buccal mucosal keratinocytes, and the target organs of carcinogenesis include the nasal cavity, esophagus, tongue, etc.

Reactive oxygen species. A large amount of reactive oxygen species can be produced during betel nut chewing, which can cause oxidative damage to DNA and activate oncogenes, leading to the occurrence of cancer. A newly discovered proteoglycan in the betel nut extract increases the level of intracellular reactive oxygen species and a series of signal cascades, upregulating the expression of hypoxia-inducible factor-1 in oral cancer cells and ultimately inducing cell autophagy.

Cellular autophagy helps protect cancer cells from arecoline-induced programmed cell death and promotes the development of oral cancer. Areca nut extract may also enhance the platelet aggregation-stimulating effect of tongue squamous cell carcinoma cell lines through reactive oxygen species, thereby promoting the metastasis of tongue cancer.

in short

Betel nut is a strong carcinogen

Physical factors:

The crude fiber in the betel nut shell and the hard core, as well as the repeated friction and stimulation of the oral mucosa caused by repeated chewing, cause mechanical stimulation to the oral mucosa.

When eating betel nut, people usually put it in the cheek, which can easily lead to mucosal lesions in the cheek and tongue. Therefore, oral cancer is often a complication of one or more of the following: buccal mucosal cancer, tongue cancer, gum cancer, and floor of mouth cancer.

Other factors:

These include unreasonable production processes, toxic and harmful auxiliary materials or additives, such as tobacco (nicotine), betel leaves, betel leaves (containing a variety of trace elements and a large amount of the carcinogen safrole), inflorescences and quicklime, as well as some special seasonings and other ingredients.

For example, nicotine in tobacco is itself a psychoactive substance, and adding tobacco can increase the psychological dependence on betel nut;

Nicotine and arecoline have a synergistic cytotoxic effect. Nicotine can enhance the cytotoxic response and at the same time make buccal mucosal fibroblasts more sensitive to the attack of other active substances in betel nut by reducing the quality of intracellular glutathione.

Tobacco itself also contains carcinogenic factors such as nitrosamines.

In addition to causing oral cancer, betel nut also has these hazards

■ Bad for the teeth themselves: Long-term chewing of betel nut can cause serious wear and tear on the teeth.

■ Bad for periodontal health: Betel nut juice mixed with lime can easily form dental calculus, which not only affects the appearance but also affects periodontal health. Betel nut fibers are coarse and hard, and may also pierce the gums or block the gaps between teeth, causing gum compression and inflammation.

■ Bad for the temporomandibular joint: Long-term chewing will increase the load on the temporomandibular joint, causing symptoms such as joint clicking and pain. In severe cases, it can also lead to perforation of the articular disc.

■ Impact on the digestive system: Some components of betel nut can damage the taste nerves and saliva secretion, affecting digestive function. In addition, betel nut residue can also irritate the stomach wall, which can cause inflammation or even perforation of the gastric mucosa.

After talking about the harm of betel nut, let’s go back and talk about the knowledge of oral cancer.

Compared with lung cancer and liver cancer, the incidence of oral cancer is not high and it is a niche cancer, but in fact its harm is not small.

Cause: Oral cancer prefers these types of people

Oral cancer is a general term for malignant tumors occurring in the oral and maxillofacial regions. Generally speaking, oral cancer in a narrow sense includes malignant tumors occurring in six parts: buccal mucosa, upper and lower gums, retromolar triangle, floor of mouth, hard palate, and anterior 2/3 of tongue. It accounts for 5% to 20% of head and neck malignant tumors.

Oral cancer is more common in men, with a peak incidence in China between 40 and 60 years old, and in foreign countries, it mostly occurs in people over 60 years old. Oral cancer progresses rapidly, infiltrates widely, and has a relatively poor prognosis.

In addition to the above-mentioned betel nut chewing that can cause oral cancer, some bad lifestyle habits can also induce:

Long-term addiction to smoking and drinking. Most oral cancer patients have a long history of smoking and drinking, and the risk is proportional to the time and amount of smoking and drinking. People who smoke and drink have a higher risk of cancer, which can be up to 6 times that of non-smokers and non-drinkers.

Poor oral hygiene: Poor oral hygiene habits create conditions for bacteria or fungi to grow and multiply in the mouth, which is conducive to the formation of carcinogenic nitrosamines and their precursors.

Long-term stimulation by foreign bodies. Tooth roots or sharp tooth tips, or ill-fitting dentures can cause long-term stimulation of the oral mucosa, often leading to traumatic ulcers or chronic inflammatory ulcers on the edge of the tongue or on the buccal mucosa. Chronic ulcers that do not heal for a long time may become cancerous.

Malnutrition. Oral cancer is related to vitamin A deficiency, because vitamin A plays a role in maintaining the normal structure and function of the epithelium. Vitamin A deficiency can cause thickening and hyperkeratosis of the oral mucosal epithelium. At the same time, the occurrence of oral cancer is also related to vitamin B deficiency or insufficient intake of trace elements (such as low zinc content in food). In addition, insufficient intake of total protein and animal protein is also related to oral cancer.

Other stimuli: Mental stimulation; many chemical components in air pollution, water pollution, and food pollution have teratogenic and carcinogenic effects on the human body; excessive heavy metal ions in inferior cosmetics and inferior lipsticks irritate the lip mucosa, causing a sharp increase in the incidence of lip cancer.

In addition, the relationship between oral cancer and age is very obvious. The risk level increases sharply with age. The incidence rate of oral cancer in 30-year-old men is 7/100,000, while it is close to 80/100,000 at the age of 60.

Warning: These signs may be precursors to cancer

The key to early detection of oral cancer is self-identification of "precancerous lesions", especially their "high-risk phases", and the characteristics of "early cancer".

The "precancerous lesion" state is not oral cancer, but it is an oral mucosal lesion with great malignant potential. According to research, when the irritant exists for a long time or is ignored, the probability of malignant transformation can be as high as more than 10%. Therefore, the appearance of abnormally colored patches in the mouth is a major clue that the body is telling us that we need to seek medical attention.

Precancerous lesions of oral cancer include oral leukoplakia, oral erythroplakia and lichen planus.

Leukoplakia. Leukoplakia is the most common white mucosal lesion, manifested as localized milky white, grayish white or brownish patches on the oral mucosa. These white lesions cannot be wiped off. Over time, their color gradually deepens, the surface may thicken and harden, and slightly protrude from the mucosal surface. Wrinkled patches or protrusions may also appear in the white lesion area. The surface is rough and not smooth, with small white nodular protrusions that are villous, horn-like, warty or papillary. Erosion and ulcers may occur in the late stage.

Erythema. Erythema lesions are bright red, smooth, soft, and do not protrude from the mucosal surface; patients generally have no clinical symptoms and may only feel uncomfortable when eating irritating foods. Erythema is a lesion with a greater chance of malignancy than leukoplakia, and a considerable number of lesions are carcinoma in situ or invasive cancer.

Lichen planus. Lichen planus is a common lesion of the oral mucosa, a chronic superficial non-infectious inflammation occurring in the oral mucosa.

Use brushing: Do oral self-examination regularly

To prevent oral cancer, you can do regular oral mucosal examinations. You can also use the opportunity of brushing your teeth every day to do a self-examination in front of a mirror:

Face. First check whether the face is symmetrical, including the surface skin and upper and lower jaws. Then check the surface skin to see if the color is the same. Pay attention to whether the protruding parts such as moles and lumps are larger, thicker or have changed color than before.

Lips. When checking, turn both the upper and lower lips outwards with your hands and pay attention to the color of each part of this part or whether there are any abnormalities in the structure of certain parts, such as ulcers, protrusions, or white spots.

Gums. When checking, turn the lips outward to expose the gums. At the same time, pay attention to the cheeks and tongue to check for any color differences, and pay attention to whether there are lumps, ulcers, bleeding, and abnormal tooth movement on the surface.

Cheek mucosa. The inner cheek is a common site for oral cancer. The surface is often papillary or ulcerated, and the area near the occlusal surface is often easily bitten by teeth.

Tongue and floor of mouth muscles. When checking, stick the tongue out of the mouth and swing it left and right to check the mobility of the tongue. Normally, it should be very flexible. Then roll up the tongue and check the ventral surface of the tongue, the left and right edges of the tongue, and the tissues at the bottom of the mouth. Use your fingers to feel for protrusions at the bottom of the mouth.

Palate. This can be seen by tilting the head back and opening the mouth (that is, the surface that the tongue touches when it is lifted up in the mouth), noting any ulcers, rough surfaces, or protrusions.

Both sides of the neck. During the examination, feel both sides of the neck for lumps, including lymph nodes larger than 2 cm in all areas of the neck.

Text/ Fat Bear Picture/ Internet (Please contact to delete) Review/ Wu Jian

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Science Popularization China Co-construction Base

Chongqing Science Popularization Base/Chongqing Health Promotion Hospital

Chongqing Municipal Science and Technology Commission Science and Technology Communication and Popularization Project

National Health Commission National Basic Public Health Service Health Literacy Project