Discussions that mention phenytoin

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Hi Joe,

Not a problem at all, I can try to answer as many questions as you have.

1) No, I would not necessarily expect a person with early oral cancer to present with fever. In fact, a person with early oral cancer usually doesn't even know there is a problem. Most people don't thoroughly inspect their own mouths, and even though it is part of a complete physical examination, physicians rarely do a complete physical (it's unfortunately just not reasonable for most practices to take an hour per patient in this age of managed care). Most office visits involve some key physical exam components and a few focused inspections based on epidemiology and risk factors. For this reason, neither the patient nor the physician are usually aware of the cancer before it has become symptomatic (pain, difficulty speaking, etc) - at this point, it may have already begun to metastasize. In fact, it is usually the dentist that picks this sort of thing up, for obvious reasons. Back to fever: Fever is pretty much limited to anything involving the immune system, usually due to infection, but sometimes involving allergic and anaphylactic reactions. This is because it is the cells of the immune system that actually secrete chemicals called interleukins and prostaglandins on demand - these chemicals in turn affect the hypothalamus in the brain to change the temperature set point of the body. This is getting beyond the scope of the question, but you get where I'm going with it.

2) Yes, this is the common misconception - nicotine is NOT a carcinogen. People make too many funny jumps in logic when it comes to cigarettes: Cigarettes contain nicotine; cigarettes cause cancer; therefore, nicotine causes cancer? Not exactly. You are quite correct that it is nitrosamines that are the cancer causing agents in tobacco (among others). Additionally, there are many other carcinogens that don't get nearly as much press as they should. If I remember the chemistry right, cigarettes actually contain molecules called conjugated dienes that combine to form benzene at high temperatures - benzene is the carcinogen here. It is more common that carcinogens are formed rather than found in the tobacco itself. Anyway, the nicotine gum is quite safe. It will raise your blood pressure a bit (nicotine acts on receptors that help to regulate blood pressure - net result is constricted vessels), but other than that there should be no problem. For your reading pleasure, here is the US Dept of Health 2002 report on known and suspected carcinogens (side note that I found surprising - phenytoin, the antiepileptic drug commonly known as Dilantin, made the list!): [url]http://ehp.niehs.nih.gov/roc/toc10.html[/url]

3. Actually, either one of your descriptions could be an ulcer. Ulcer is actually a pretty generic term. Tumors are generally consider to have one of three qualities: exophytic (growing outward from the surface); flat (growing neither outward nor inward from the surface - this may be perceived as a change in color or texture); and ulcerative (growing inward from the surface and leaving a depression of any sort). These can look like what you consider to be a canker sore (a shallow, inward, discolored growth that has an even distribution and/or color) or the real nasty looking kinds (deeper, not as neatly defined or organized, not evenly encircled or colored, etc). Only when they get to the point where they have really started to take off will they really start looking bad (and large - they get wider/deeper as time passes). When they are just starting out, it will look less intimidating and more like a sore.

4) In terms of what I make of the regression, I don't have a whole lot of experience with prognosis for this sort of lesion - this is definitely a question for the ENT. I wish I had the knowledge/experience to answer this question, but I don't want to steer you wrong on this. I've read at some point that at least 1/3 of leukoplakias can completely regress if the inciting agent (i.e. chewing tobacco) is stopped. I also know that the biopsy is always the best determination of the diagnosis/prognosis of a leukoplakia. If there are no dysplastic (i.e. precancerous) cells found at biopsy, then the odds are highly in your favor for not developing an oral cancer. If there are in fact dysplastic cells discovered on biopsy, you will need to work with your ENT and keep an eye on the lesions (swab/biopsy every few months) so that you can act early and quickly in the event that some of the dysplastic cells become malignant.

Again, please feel free to ask any questions that might come to you. If you see your ENT soon, please keep this thread updated with any new information. Take care!

- fudd