Head and neck squamous cell carcinoma in chronic areca nut chewing Indian women: Case series and review of literature

Abstract

Background:Head and neck squamous cell carcinoma (HNSCC) is an important public health problem in India. Several risk factors such as tobacco, human papilloma virus, alcohol, areca nut usage have been extensively studied as causative agents. Though Areca nut chewing is known cause of oral cancer, its association with hypopharynx cancer has not been previously reported. Since areca nut is mostly consumed along with tobacco, it is uncommon to find patients who consume the areca nut alone.Materials and Methods:This is a prospective case series of ten women who presented to us with HNSCC with history of chewing of areca nut alone for several years. We have excluded all those cases where areca nut was consumed along with tobacco in any form. The data were prospectively collected with regard to clinical parameters, duration and frequency of areca nut usage, the socio-economic status and education level.Results:All ten females had varying degree of submucous fibrosis and coexisting squamous cell carcinoma either in the oral cavity or hypopharynx. Submucous fibrosis was characterized by burning mouth, unhealthy oral mucosa, buried third molars, trismus, poor oral hygiene, etc. The disease presented in an advanced stage in majority of the cases. All patients were unaware of areca nut's deleterious effects.Conclusion:Areca nut chewing is an important risk factor for HNSCC in females. Despite plethora of information, little importance is given to areca nut control in cancer prevention campaigns in India.

Oral squamous cell carcinoma in the background of oral submucous fibrosis is a distinct clinicopathological entity with better prognosis

“…Primary malignancy of buccal mucosa and tongue was the most common site for OSCC‐OSMF compared to OSCC. These findings are in accordance with studies of VanWyk CW et al , Chourasia et al , and Muttagi et al . Betel quid being placed in close contact with buccal mucosa could be the reason for most common site in the OSCC‐OSMF group.…”

Epidemiology of Oral Cancer in Asia in the Past Decade- An Update (2000-2012)

“…The causal link between chewing quid without tobacco and carcinogenesis has been recognised (Merchant et al, 2000). Areca nut used in betel quid is known to cause OC due the presence of arecoline specific nitrosamines that are carcinogenic (Warnakulasuriya et al, 2002;Muttagi et al, 2012;Shah et al, 2012). Lime, a constituent of quid, acts as a tumour promoter by hydrolysing alkaloids present in the areca nut to cytotoxic and mutagenic compounds (Shah et al, 2012).…”

Statistical analysis of human papillomavirus in a subset of upper aerodigestive tract tumors

“…[Decker and Goldstein, ; Franceschi et al, ; Mashberg et al, ; Talamini et al, ; Werbrouck et al, ]. Furthermore, epidemiologic studies suggest that opium abuse, foods contaminated with Fusarium verticillioides , diets lacking in fresh fruit and vegetables, nutritional deficiencies, and certain regional habits, including the consumption of pickled foods that contain nitrosamines, the drinking of hot tea, and the chewing of betel‐nuts are additional risk factors that contribute in the progression of carcinogenesis [Ke et al, ; Chen et al, ; Mao et al, ; Lin et al, ; Muttagi et al, ; Akhtar, ].…”