Early Detection of High-Risk Oral Pre-malignant Lesions

Treating oral lesions at earliest stage remains the key to improve survival and patient quality of life. This requires clinicians being able to identify low-grade oral premalignant lesions that are at high-risk of becoming cancer. Currently, no standard biomarker or approach has been established. Uncovering the clinical and biological profiles of oral lesions therefore has substantial basic and clinical importance.

In the Poh lab we currently have a broad interest in the discovery and validation of biomarkers for oral cancer progression from oral pre-malignant lesions (OPMLs). In particular, we want to not only identify genetic signatures but also integrating clinical-pathological phenotypic characteristics to better understand how lesions have different clinical behaviour and outcomes. This has important clinical implications if we can find a better model to triage patients to either immediate clinical care, as to avoid cancer, or to clinical monitoring, as to avoid loss of quality of life.

For early detection of at-risk pre-malignant lesions, we are currently pursuing studies in three general areas.

1. Copy number alterations as means to detect predisposition toward tumorigenesis.

2. Liquid biopsy towards non-invasive detection and monitoring

Quantitative cytometry from oral brushing

Blood protein concentration in oral cancer patients

3. Population-based Oral Biopsy Service centralizes provincial wide data and tissue collection

The Profile of Oral Cancer Metastasis

Regional metastasis to neck lymph nodes is one of the most significant prognostic factors in oral cancer. Tumour is reported to metastasize in ~50% of patients for whom the survival rate can decrease drastically by half. Prophylactic intervention, such as elective neck dissection, is often sought after to prevent tumour from spreading especially for tumours that are bigger in size. However, not all tumours require such aggressive intervention yet too many missed the window. 

For stratification of oral cancer patients to optimal treatment, we are focusing on several studies in aim to integrate clinical, genetic, and phenotypic profiles of oral tumours.

1. Gene expression profile (miRNA, gene expression, copy number alteration)

2. Cell sociology across oral tissue landscape