Primary squamous cell carcinoma of the oral cavity at presentation in Pakistan

Abstract

e17002 Background: Squamous cell carcinoma of oral cavity (SCCOC) is characterized by marked geographical differences in frequency and site distribution. Pakistan is situated within the high risk zone on the global oral cancer map. However, no reliable data exists on oral cancer in this area. Our aim was to determine clinicopathological features and patterns at presentation of primary SCCOC in a comprehensive cancer centre in Pakistan. Methods: Demographic, risk factors, pathological and AJCC staging data for SCCOC treated at Shaukat Khanum Memorial Hospital for the period November 2003-October 2008 were obtained from the head and neck unit database. Results: The database identified 666 patients with biopsy proven primary SCCOC. Mean age was 53 years (range 12 - 90 years). Male (428): Female (238) ratio was M64%:F36%. The occurrence of major risk factors for oral cancer specifically smoking, betel quid chewing, naswar (smokeless tobacco) and alcohol use in males (428) was 45% (193), 28% (118), 29% (126), 3% (13), and in females (238) was 8% (20), 29% (68), 13% (30), 0% (0), respectively. Thirty-eight percent (411/666) had no association with tobacco, betel quid or alcohol use. Subsite within oral cavity; anterior tongue 41.1% (274), buccal mucosa 26.6% (177), lower gingival and alveolus 19.5% (130), upper gingival and alveolus 4.1% (27), lips 3.6% (24), retromolar trigone 2.9% (19), hard palate 1.7% (11), and floor mouth 0.6 (4). Broder's/World Health Organization histological grade; grade I 52% (334), grade II 34% (226), grade III 7% (49), and unknown 5% (36). According to AJCC 2002 system 0.2% (1), 10.8% (72), 12.2% (81), 13.2% (88), and 63.7% (420) had stage 0, I, II, III, and IV, respectively. Conclusions: Approximately 80% of patients with primary SCCOC present with stage III or IV disease with anterior tongue as the most common subsite in our hospital. While tobacco and betel quid chewing can be attributed to development of SCCOC in a significant proportion of patients, nearly 38% are unlinked to typical risks factors suggesting other environmental and genetic agents as etiological factors in this region. No significant financial relationships to disclose.

Demographic trends, affected anatomical sites and clinicopathological analysis for oral squamous cell carcinoma at a tertiary care hospital in Tuticorin, Tamilnadu

“…This is consistent with the findings of the study by Jamshed et al who also stated that well differentiated SCC was predominantly observed in OSCC affected patients. [7,14] A similar observation is also noted in the study by Rahman SS et al, who reports that majority of the patients had well differentiated carcinoma (70.73%). [10] In contrary, studies by Minhas et al [7],as well as Abdulla et al [13] reports most patients with moderately differentiated OSCC followed by well differentiated OSCC.…”

“…[7,14] A similar observation is also noted in the study by Rahman SS et al, who reports that majority of the patients had well differentiated carcinoma (70.73%). [10] In contrary, studies by Minhas et al [7],as well as Abdulla et al [13] reports most patients with moderately differentiated OSCC followed by well differentiated OSCC. The delay in diagnosis is largely due to lack of awareness among the patients, who resort to home remedies before seeking professional help.…”

“…Most frequent reasons are the early wrong diagnosis and the ignorance from the patient and/or attending physician or dentist. [7] This justifies the need for further demographic studies exploring the trends of the disease among the local community, which might help in devising strategies for prevention and treatment.…”