الفهرس 
Development of field cancerization in the clinically normal oral Mucosa of Shisha smokers
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Abstract
Head and neck cancer represents one of the most common cancer types. Surprisingly, prognosis remains relatively poor for patients suffering from HNSCC. Numerous risk factors are implicated in the development of HNSCC, such as Cigarette smoking, alcohol consumption and human papilloma virus (HPV) infection. However, minimal high quality studies were performed to study the effect of shisha smoking on oral cancer development. Accordingly, in our study we aimed to investigate the changes that occur in the oral mucosa of shisha smokers and compare them to cigarette smokers, non-smokers and smokers of both shisha and cigarettes. We also aimed to detect whether these changes could be detected biochemically in saliva, without the need to perform more invasive techniques.Four groups of subjects were included in our study (16 in each group); cigarette smokers, shisha smokers, non-smokers and smokers of both. A salivary sample and a mucosal biopsy were obtained from each subject. Salivary detection of CYFRA 21-1 was performed on each salivary sample.The mucosal biopsy was examined by routine H&E techniques. Furthermore, immunohistochemical expression of p53 was studied in all cases. The present work demonstrated that a statistically significant difference in p53 expression was present between non-smokers and the three smoker groups. However, no statistically significant variation was present between the 3 smoker groups. Moreover, evident dysplastic and predysplastic changes were detected histologically in the three smoker groups especially smokers of both cigarettes and shisha. However, no statistically significant changes were found in the CYFRA 21-1 levels amongst the four groups. Hence, it was concluded that shisha smoking has the same damaging effect on the oral mucosa as cigarette smoking, if not more. Furthermore, no correlation was detected between the histological findings and the salivary biomarker used (CYFRA 21-1)