Squamous Cell Carcinoma of the Oral Cavity: A Case Series Analysis of Clinico-Pathological Features
Background: Oral cancer is a major public health issue worldwide and it remains a highly lethal and disfiguring disease. Squamous cell carcinoma is the most common malignant neoplasm of the oral cavity and represents about 90% of all oral malignancies. Increase in incidence and mortality rates is a Global health problem. Squamous cell carcinoma is known to show geographical variation with respect to the age, site, sex and habits of the population. It is a malignant tumor of epithelial origin, with varied regional distribution involved in the biological activity of the neoplasm. Each anatomic site has its own particular spread pattern and prognosis. Hence this study was undertaken to present a comprehensive data on the trends of squamous cell carcinoma of oral cavity. Material and Methods: The study included a total of 127 previously diagnosed cases among a period of 5 years from January 2005 to December 2009. Results: It occurred in an age range from 17 to 86 years and male to female ratio of 3:1. Most commonly affected site was buccal mucosa with ulcero-proliferative growth and large number of cases in the 4th and 5th decades of the life. According to histopathological grading 83% cases were well differentiated, 16% were moderately differentiated and only 1% case was poorly differentiated. Conclusion: Thus squamous cell carcinoma of the oral cavity shows geographical variations with respect to the age, site, sex and habits of the population.
Key words: Epidermoid carcinoma;Head and neck cancer;Squamous cell carcinoma;Geographic Variations.
Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity and represents about 90% of all oral malignancies.1 Oral squamous cell carcinoma (OSCC) is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location.2 In India, oral cancer represents a major health problem constituting up to 40% of all cancers and is the most prevalent cancer in males and the third most prevalent in females. Even within one geographic location, the incidence varies among groups categorized by age, sex or race.1,2 Recent publications have highlighted variations in oral cancer trends by geographical location, anatomic site, race, age and sex.2,3 There have been studies reported on the incidence and pattern of OSCCs from various parts of the world.4-7 Thus, descriptive oral cancer data for each specific geographic area are important for many reasons, including understanding the extent of the problem, determining which groups within the population are at highest and lowest risk, and relating the burden of oral cancer to that of other cancers to evaluate the allocation of resources for research, prevention, treatment and support services.3,4
Material and Methods
The study included all previously diagnosed cases of OSCC from January 2005 to December 2009 retrieved from the Department of Oral and Maxillofacial Pathology archives. All the demographic data and clinical features were recorded. The anatomic sites recorded were - tongue, floor of the mouth, hard palate, buccal mucosa, labial mucosa and retro-molar area. The pathologic and epidemiologic features were tabulated. A comprehensive analysis was done on the data collected and the results were formulated.
A total of 127 cases of SCC with age range from 17 to 86 years and male to female ratio of 3.4:1 was evident. (Figure 1) Majority of cases presented in the 4th and 5th decades. (Figure 2) The most common site was buccal mucosa with 41%, followed by tongue with 29% and least commonly involved sites was floor of the mouth. (Figure 3) The most common clinical presentation was an ulcero-proliferative growth and few cases presented with a swelling. (Figure 4) Among 127 cases, the 46% patients used smokeless form of tobacco which was higher compared to smoking and mixed forms. (Figure 5) According to histopathological grading 83% cases were well differentiated, 16% were moderately differentiated and only 1% case was poorly differentiated. (Figure 6 & 7)
Figure 1: Pie chart showing gender distribution among oral SCC patients.
Figure 2: Bar chart showing age distribution of patients in oral SCC.
Figure 3: Pie chart showing various site and percentage of occurrence OSCC.
Oral squamous cell carcinoma of head and neck is a major health problem worldwide that usually appears in patients older than 50 years of age. An increase in the incidence of persons less than 40 years suffering from cancer, including OSCC has been reported in the last decade.8 Several studies have projected, between 1-6% of oral can_cers in patients under the age of 40 years.8-10 Even more, the presence of OSCC in young people without a history of exposure to carcinogenic risks factors has been reported.11,12 The frequency and prevalence of OSCC varies in regard to social, demographical and geographical characteristics.13,14
Figure 4: Clinical picture of SCC showing ulcero-proliferative growth on gingiva.
Figure 5: Pie chart showing frequency of habits in oral SCC patients.
Figure 6: Pie chart showing various grades and the frequency of oral SCC.
Figure 7: Photomicrograph showing features of OSCC (H & E stain X45).
In the present study, male predominance was noted when compared to females. Large numbers of cases were seen in the 4th and 5th decades of the life. Previous studies have also shown similar results in terms of gender and age.15,16 In the present study, buccal mucosa and tongue were the most frequently involved sites, where as labial mucosa and floor of oral cavity were least affected. Al-Rawi NH, et al.,15 have reported that lower lip and tongue as most commonly affected sites. Lawoyin et al.,1 noted that the palate and tongue were most frequently involved sites. In the present study, ulcero-proliferative growth was the most common clinical presentation and about 83% were well differentiated SCCs. In an earlier study, ulceration and swelling were the most common clinical complaints.15
Tobacco and alcohol consumption have been the main risk factors implicated in as many as 90-95% of studies for oral cancer, other potential risk factors have recently emerged.16,17 In the present study, use of smokeless tobacco, pan and gutkha chewing were most prevalent habits recorded and the habit being highest at mucosal site resulting in prolonged contact of mucosa with carcinogens. Behavioral interventions in reducing alcohol consumption and smoking have changed the incidence of most of Head and Neck tumors. Modification of lifestyle, including a diet rich in antioxidants, such as carotene, vitamin C and E, seems to prevent squamous cell carcinoma in heavy smokers and drinkers.18 About 83% of the tumors were well differentiated, 16% moderately differentiated and 0.9% poorly differentiated cases of OSCC. These findings were consistent with study by Krutchkoff et al.,19 Odukoya et al.,20 and Al-Rawi NH, et al.15
The incidence of OSCC seems to be increasing by leaps and bounds, becoming a major Global health problem with increasing incidence and mortality rates in spite of the advancements. OSCC is known to show geographical variation with respect to the age, site, sex and habits of the population. It is very important that more and more studies of the contributing factors that trigger these chronological and geographic trends be undertaken. Many lifestyle behaviors too contribute to oral cancer risk. Such information may be crucial to public health professionals to design population-specific prevention and education programs incorporating counseling for lifestyle behaviors, which may be implemented at the appropriate levels. Hence knowledge of existing trends in oral cancer can have a great impact in helping to reverse or decrease or change these mounting/alarming trends of oral cancer. So this study was undertaken to present a comprehensive data on the trends of OSCC.
1.Dr.Nitin Saini, Senior Lecturer, Department of Oral Pathology, DAV Dental College & Hospital, Yamuna Nagar, Himachal Pradesh, 2.Dr.Manjunatha BS, Professor, Dept. of Oral Histology and Biology, Faculty of Dentistry, Al-Hawaiya, Taif University, Taif, Kingdom of Saudi Arabia, 3.Dr.Vandana Shah, MDS, Professor & Head, Department of Oral Pathology, KM Shah Dental College & Hospital, Vadodara, 4.Dr.Deepak Pateel GS, Associate Professor, Department of Oral Pathology, Faculty of Dentistry, MAHSA University, Selangor, Malaysia.
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Professor & Head,
Department of Oral Pathology,
KM Shah Dental College & Hospital, Vadodara, Gujarat State, India.
Source of Support: Nil, Conflict of Interest: None Declared.
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