Histological Types and Common Sites of Oral Cancer in Patients Presenting at Liaquat University Hospital Jamshoro/Hyderabad Sindh

1. Zaib un Nisa 2. Qadeer ul Hassan  3. Qamer un Nisa Memon 4. Ghulam Habib
5. Salman Shams

1. Asstt. Prof. of Periodontology, 2. Asstt. Prof. of Oral & Maxillofacial Surgery, 3. Asstt. Prof. of Orthodontics, 4. Lecturer of Oral & Maxillofacial Surgery, 5. Trainee, Oral & Maxillofacial Surgery, Liaquat University of Medical and Health Sciences Jamshoro, Hyderabad Sindh

ABSTRACT

Objective: To determine the frequency of histological types and comman sites of oral cancer in patients presenting at Liaquat University Hospital Jamshoro/Hyderabad Sindh.

Study Design: Descriptive Study.

Place and Duration of Study: This study was conducted on patients presenting  atOral and Maxillofacial Surgery Department, Liaquat university hospital Jamshoro/ Hyderabad Sindh over a period of one year from January 2010 to December 2010.

Materials and Methods: Patients of all age group and gender with biopsy proven oral cancer along with its Histopathological types were included in the study. Patients reported irradiated,metastatic,benign and inflammatory lesions were excluded from the study.

Results: Total number of patients was 100. There were 53 Males and 47 Females. Age range was 3years to 85years. means age was 44.2 years. Most comman site was cheeck mucosa. Histopathological analysis showed 75% patients having well diffrentiated squamous cell carcinoma, 13% patients having moderately diffrenciated squamous cell carcinoma, 2% patients having  poorly diffrenciated anaplastic carcinoma,7% patients having basel cell carcinoma.1% Patients having Melanoma, 1% patients having Mucoepidermoid Carcinoma and 1% patients  having  Rhabdomyosarcoma.

Conclusion: This study gives a detailed account of the histopathological types of oral cancer along with their frequency and site. oral cancer occurred at a younger age with male prepondrance.      

Key Words: Oral Cancer,Comman Site,Histological Type.


INTRODUCTION

Various pathalogical conditions  affecting  oral cavity ranged from  benign inflamatory lesions to malignant lesions. Benign lesions can be neoplastic or non neoplastic. Non neoplastic lesions are usually inflammatory or represent reaction to some kind of irritation. Neoplasm represent a process  characterized by progressive growth1.

Malignant lesions of oral cavity has been recognized as a huge threat to public health because of its high morbidity and mortality 2-5.These  lesions  has high prevalence  in  various parts of world as well as in  Pakistan 6-9.

 More then 90% of oral malignancies are squamous cell carcinoma or one of its variants 10. Early detection of pre-malignant and malignant oral lesions are important regarding prognosis 11-15. Epidemiological evidence shows a correlation between use of smokeless tobacco and these lesions 16-18.

Clinically benign oral lesions can occasionally resemble malignancies19. When clinical features are not diagnostic or the persistent lesions for long time and suspected malignant only then the biopsy is done20.

Oral Carcinogenesis is a highly complex multifocal process that takes place when squamous epithelium is affected by several genetic alterations. Now a days the use of several molecular biology techniques to diagnose oral precancerous lesions and cancers may markedly improve the detection of alterations that are invisible under the Microscope. This would Identify Patients at a high risk of developing oral cancer 21

MATERIALS AND METHODS

This study was carried out on 100 patients at oral and Maxillofacial surgery department in collaboration with pathology department (Diagnostic research lab)  Liaquat University hospital Jamshoro /Hyderabad Sindh from January 2010 to December 2010. All histopathologically proven oral cancers included in the study. Those reported irradiated,metastatic ,benign and inflammatory lesions were excluded from the study. Tumor Sites included were as follow cheeck, buccal mucosa, tongue, gums and alveolus, palate, floor of mouth, lips and angle of mouth. Frequency and proportions were calculated for age, Sex, Site and histological type of oral cancer.

 

RESULTS

One hundred patients were confirmed as cases of oral cancer. The youngest patient was 3 years old male and oldest was 87 years old female. Mean age of oral cancer patients was 44.2 years. Maximum number of  patients (32%) were in 31-40 years of age group while very few patients were above 70 years of age(4%) table-1. out of one hundred patients of oral cancer 53% were males and 47% were females. Most common site of oral cancer was cheek (31%) followed by buccal mucosa (29%). Detailed distribution of site of oral cancer is given in table-2

Most common histological type was well differentiated squamous cell carcinoma accounting for (75%) cases, followed by the moderately differentiated squamous cell carcinoma (13%) cases. Detailed distribution of histological types of oral cancer is given in table-3.

Table No.1: Age Distribution

Age in years

No. of cases

%age

1-10

1

1%

11-20

3

3%

21-30

10

10%

31-40

32

32%

41-50

27

27%

51-60

12

12%

61-70

11

11%

71-80

2

2%

81-90

2

2%

Total

100

100%

Table No.2: Distribution According To Site

Site 

No. of cases

%age

Buccal mucosa

         29

       29%

Cheek

         31

        31%

Tongue

         17

        17%

Palate

         02

        02%

Gums &alveolus

         06

        o6%

Floor of mouth

        0 2

        02%

Lips

         10

        10%

Angle of mouth

         03

         03%

Total

       100

         100%

Table No.3: Histological types of oral cancer

Histological type

No.of cases 

%age

Squamous cell carcinoma

90

90%

a. well differentiated

75

75%

b. moderately differentiated

13

13%

c. poorly differentiated anaplastic carcinoma 

02

02%

 Basal cell carcinoma

07

07%

 Melanoma

01

01%

 Mucoepidermoid carcinoma

01

015

 Rhabdomyosarcoma

01

01%

Total

100

100%

DISCUSSION

The most common age group affected by oral cancer as reported in the literature is 60-69 years 22 and 50-59 years23 . While in this study most of the cancer were present in a youngest age group of 31-40(32%) followed by 41-50 years of age group   (27%). The season could be the use of tobacco, pan, & betal nuts which is very common in our population. This is also supported by the study of Isaac U 24. The youngest patient reported in the literature is a six month old baby suffering from Kaposi sarcoma23 while in our study youngest patient was 3years old having Rhabdomyo-sarcoma.

Oral cancer in our study was more common in males (53%). Other previous studies also indicate high ratio in males.24-25

Tongue is the most common site involved by oral cancer in western world 26-28 . In this study cheek is common site  (31%) cases followed by buccal mucosa   (29%)  cases. This is also supported by other studies conducted in Pakistan 23,29,30 .   

The difference may be due to environmental factor in different parts of the world and can be attributed to betal nuts, smokeless tobacco chewing and peoples in this part of world put snuff (naswar) in their cheek is also common.

In this study most common histological types of oral cancer was well differentiated squamous cell carcinoma (75%) followed by moderately differentiated squamous cell carcinoma (13%). This is well supported by other 

Studies 22,24,31. Haq M,E.U, et al  reported that poorly differentiated squamous cell carcinoma is the most common histological type in his study 32 .It is concluded from other previous studies that higher the grading of  tumor and poorer its differentiation more are its chances of metastasis.

CONCLUSION

Oral cancer occor at a younger age with male preponderance. Most common site is cheek. Well differentiated oral squamous cell carcinoma is most common histological type of oral cancer in this part of world.

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12.    Peterson PE. “Oral cancer prevention and control the approach of the world Health Organization. Oral Oncol 2009; 45(4-5):454-460.

13.    Tanaka T. Chemoprevention of oral carcinogenesis.  Euro J of Cancer part B 1995; 31(1):3-15.

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15.    Tanaka T. Chemoprevention of human cancer: biology and therapy; Critical Review in Oncology. Haematol 1997;25(3):139-174.

16.    Hetch SS. Progress and challenges in selected areas of tobacco carcinogenesis. Chem Res Toxicol 2008;21(1);160-171.

17.    Warnakulasuria KA, Ralhan R. Clinical, Pathological, Cellular and Molecular lesions caused by oral smokeless tobacco a review. J Oral Pathol Med 2007;36(2):63-77.

18.    Rodu B, Jansson C. Smokeless tobacco and oral cancer a review of the risks and the determinants. Crit Riv Oral Biol Med 2004;15(5):252-263.

19.    Al-Khateeb TH. Benign Oral Masses in a northern Jordanian Population a Retrospective study open duet. 2009;3:147.

20.    Silverman S. Demographics and occurrence of oral and pharyngeal cancers the outcomes the trends the challenges. J am Dent Assoc 2001;132:7-11.

21.    Joseph BK. Oral cancer; prevention and detection medical principles and practice. 2002;11(1):
32-35.

22.    Krolls  SO, Hoffman S. Squamous cell carcinoma of oral soft tissues: a statistical analysis of 14,253 cases by age, sex and race of patients. J Am Dent Assoc 1976;92;571.

23.    Kayembe MKA, kalengayi MMR. Histological and epidemiological profile of oral cancer in cango (zaire).    Odonto-stomatologie   tropicale 1999; 88:29-32.

24.    Isaac U, et al. presentation of histological types and common sites oral cancer in lower Sindh.  JLUMHS 2009;08:2010-13.

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26.    Warnakulasuria S. global epidemiology of oral cancer. Oral Oncol 2009;45:309-16.

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32.    Haq MEU, et al. Frequency and pattern of oral and maxillofac carcinomas. Annals 2009;15(4).

 

Address for Corresponding Author:

Ghulam Habib Arain.

Lecturer Oral surgery,

LUMHS Jamshoro/Hyderabad sindh. 

Cell: 03332606590

E-mail : This email address is being protected from spambots. You need JavaScript enabled to view it.  �3..�/� ��Children was not having important association with vaccination coverage of 50.4% for male and 49.6% for female respectively. Table 1.3 Chi-square value for the association is 1.325 with a p-value of .250 which is not significant.  Table 2.2 indicates that in the lower income group the vaccination coverage is 21.9%, in the middle income 51.8% and in the upper income group 83.8% which shows a strong association of income with vaccination status of children. This difference is statistically significant (X2 = 37.380; p .000). Father Education level is a strong contributing factor towards vaccination status of children as with no education the vaccination rate is 50.0%, with 1-5 year of education it us 30.0%, with 6-10 years of education it is 44.4% and with education of 11 years and above it goes up to 88.6% (2,3, 5). Table 3.2. The Chi-Square value for this association is 44.890 with a p-value of 0.000. Table 4.2 of cross tabulation for the mother’s education with vaccination status of children suggests a strong relationship. Mothers with no education (illiterate) vaccinated 36.3% and mothers with education (Literate) vaccinated 82.5% of their children (9). The Chi-Square test value for this relationship is 45.605 with a p-value of .000, which shows a significant association between mother’s education and vaccination of children.

 

CONCLUSION

This study indicates that Fathers Education, Household Income, Mothers Education and the Mothers knowledge about measles vaccination age are important factors affecting the vaccination status of children.

In this study sex of child did not influence vaccination status of children and was found insignificant by Chi-Square test of significance.

REFERENCES

1.       Nazish S, Khan A, Nisar N. Assessment of EPI Vaccine Coverage in Peri-Urban Area. JPMA 2007;57:391.

2.       Rafiqul IM, Rehman MM, Rehman MM. Immunization Coverage Among Slim Children. Middle East J of Family Med 2007;5(6).

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4.       Kidance T, Tekie M. Factors predicting child immunization coverage in a rural district of Ethiopia2000, (original article). Ethiopia. J Health Dev 2003;417(2):105-110.

5.       Cutts FT, Glik DC, Gordon A, Parker K, Diallo S, Haba F, et al. Application of multiple methods to study the vaccination programme in an urban area of Guinea. Bull World Health Org 1990;68:769-76.

6.       Simonetti A, Adamo B, Tancredi F, Trassi M, Grandolfo ME Evaluation of vaccination practices in Naples, Italy. Vaccine 2002;20:1046-9.

7.       Sing KK, Mathew MM, Bhalero VR. Impact of community-based immunization services. J Postgrad Med 1986;32:131-3.

8.       Rahman M, Islam MA, Mahalanabis D. Mother’s knowledge about vaccine preventable diseases and immunization coverage in a population with high rate of illiteracy. J Trop Pediatr 1995;41(6):376-8.

9.       Viswanthan, H. and Rohed, Jone. E. Immunization. The effect of Maternal knowledge and Attitude on Immunization Coverage”. Ind J Comm Med 1999; 15(4).

 

 

 

 

Address for Corresponding Author:

Prof. Dr. Muhammad Ishaq,
Chairman & Founder
Jinnah Medical College
Warsak Road Peshawar.

Cell: 0333-9152060