We went back to high school to promote iGEM and introduce our project to students. Through this lecture, we hoped they can realize that everything they learn now is indeed useful in reality so that they may can be more passionate towards learning. We also wanted to give them the concept that synthetic biology application can solve problems and that the knowledge in books shall guide them to their bright futures.

Visit Dr. Kao from the Department of division radiation oncology of Taoyuan Min-Sheng General Hospital. We visit Dr. Kao from the Department of division radiation oncology of Taoyuan Min-Sheng General Hospital, who gave us this special opportunity to get more information about clinical diagnosis of Oral Cancers.

Q: How is oral cancer diagnosed?

A: We determine oral cancer by the changes in morphology through the doctors’ observation. However, changes that happen as early as in the molecular level have not yet been able to help the diagnosis.

Q: According to the previous question, is it the dentists that are more likely to discover oral cancer?

A: Basically, oral cancer is most likely discovered by dentists and ENT doctors. However, with oral cancer being common nowadays, the Health Promotion Administration has been requesting all clinics and departments in hospitals to keep an eye on precancerous lesions such as white/red patches in the mouth and to arrange the patients undergo a biopsy once these changes are observed.

Q: Is there high possibility for the result of a biopsy to be false positive?

A: Biopsy is pretty much accurate, but the result still varies from the tissue that is obtained, and that would depend on the doctor’s experience.

Q: According to your experience, at which stage have oral cancer developed when the patients were diagnosed of the disease?

A: This is hard to say since some patients happen to find out early while some never sought for treatment even they have already perceived abnormality.

Q: Is it common that people don’t seek for treatment after perceiving abnormality?

A: Yes, it is very common. That’s why the Health Promotion Administration have requested all doctors to check on the patient’s mouth once they know that he/she has a habit of smoking or chewing betel buts so that pathological changes can be noted as early as possible. This is by far the best strategy that can be adopted.

Q: If pathological changes can be discovered very early, is it possible to verify the position using devices?

A: A CT scan is able to detect a target which has a diameter more than 1 cm, and a phase scan can detect a target which has a diameter more than 0.5 cm. To discover any changes before they can be seen by the naked eye depends on a biomarker that has high specificity towards oral cancer and that the result of testing the biomarker’s existence can be well combined with phase scan.

Q: It is known that cancer happens because of gene mutation. Would knowing the conditions of gene mutation help doctors treat patients and make predictions?

A: Yes, and it is the reason that many researches regarding copy therapies, which is to block cancer pathways during development or to induce apoptosis, are being conducted.

Q: Are there patients who develop oral cancer because of the HPV virus?

A: Yes, HPV can cause not only genital cancers but also oral cancer through oral sex or French kiss.

Q: What does it take for doctors to adapt a technique or a product?

A: If we’re looking at medicine than it depends on the results after clinical trials, and if we’re looking at a technique than it depends on the number of people that are applicable to it.

Q: Although oral cancer is listed as one of the top ten fatal cancers of the country, it is not hard to discover, therefore we suppose that the survival rate for the first year is high?

A: No, because oral cancer varies a lot between different stages. There may be patients whose conditions deteriorate in a short period of time and that it is hard for them to recover. In addition, the top ten fatal cancers often affect more patients so there tend to be larger numbers of death. For instance, breast cancer is often a high-ranking cancer on the list because it affects a large number of patients, but the truth is that the treatments are usually effective. On the contrary, pancreas cancer doesn’t rank higher than breast cancer is because the population affected is smaller, not because that pancreas cancer cases are more likely to be cured. Therefore, we should not refer to the effectiveness of treatment by looking at the rankings.

Thanks for the education, people in Taiwan clearly aware that betel nuts would cause OSCC (Oral Squamous Cell Carcinoma). However, the side effect is that some people think they can’t get oral cancer if they don’t chew betel nut, smoke or drink alcohol. We decided to make a questionnaire to study this issue and give a more accurate education to public about oral cancer.

Questionnaire

The questionnaire listed two questions to find out how well people knew about the causes and the symptoms of oral cancer. We selected 100 people from our school and public respectively by random sampling. The results are below:

Just like what we had expected, most people did not know enough about the disease. For instance,“chewing betel nuts” is their intuitive answer to the cause of oral cancer, but actually tooth decay and exposure to HPV virus may also be the cause.

Education

After the questionnaire, we told people that actually all the factors we list may cause oral cancer. Then gave them an information card to let them know more about oral cancer such as the early symptoms and precautionary way. We are very encouraged when we heard some people said they are surprised about some causes and would like to tell their families and friends. We hope this instructive activity can raise people’s awareness of oral cancer and effectively reduce the incidence of oral cancer.

Component of sample

  CGU
Gender: male 53%,female 47%.
College: college of medicine 73%, college of engineering 18%, and college of management 9%.

  Public
Gender: male 36%, female 64%.
Age: under 15 years old 14%, 16-18 years old 6%, 19-22 years old 4%, 23-30 years old 9%, 31-40 years old 36%, 41-50 years old 28%, and over 51 years old 3%.
Educational level : junior high school 14%, senior high school 8%, university 55%, master 22%, and doctor 1%.

Visiting the Sunshine Social Welfare Foundation gives us a chance to understand the actual circumstances and the patient’s position from the social workers and an oral cancer patient. They gave us a better understanding of their feelings and the hardships they’re encountering. Other than wet lab, we want to show our care for oral cancer thorough listening to the situation and get to know the degree of concern holds by the government. Also, we want to let them know that there’s a group of students who cares about it and are putting efforts in improving the condition.
The following Q&As are the what we learned from the foundation:

Q:Why is the illness of oral cancer unable to control?

A:There lacks of legislation on banning the sell and consumption of betel nuts.
The concept of betel nuts can itself be carcinogenic is not known widely.

Q:Why is it hard to limit the planting of betel nuts?

A:The historical background of betel nuts is particular for that it was an important cash crop, the government cannot ban the sell and planting of betel nuts.
Managing a betel nut business is a common way for low income families to maintain their livings.

Q:Why do they chewing betel nuts?

A:To refresh oneself.
Betel nuts are shared as social etiquette

Q:What are the barriers of the treatments?

A:Direct observation can easily leads to error detection.
The fear of invasive biopsy evaluation.

What are the suggestions for public ?

A:Don’t smoke or drink alcohol.
Keep a regular daily routine.
Cancer screening is necessary for anyone who chews betel nuts.
Information about precancerosis is important.

Q:Are oral cancer patient concentrated in a specific region, occupation?

A:Most severe in Taitung city, Hualien city, Nantou city, Chiayi city and Pingtung city, where the education levels are lower and with greater betel nuts planting.

Q:What is Sunshine Social Welfare Foundation doing?

Form a social team for oral cancer.
Giving speeches around Taiwan with a patient who had oral cancer.