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Journal of Medicine, Radiology, Pathology & Surgery (2015), 1, 3–6
ORIGINAL RESEARCH
Oral squamous cell carcinoma: A 5 years institutional study
Vaidhehi Narayan Nayak1, Mandana Donoghue2, Selvamani M3
Department of Oral Pathology, Rajarajeshwari Dental College and Hospital, Bengaluru, Karnataka, India, 2Consultant, Oral Pathologist OMFP Center, Belgaum,
Karnataka, India, 3Department of Oral Pathology, Mahe Institute of Dental Sciences, Mahe, Puducherry, India
1
Keywords:
Davangere, incidence, oral squamous
cell carcinoma
Correspondence:
Dr. Vaidhehi Narayan Nayak, Department of
Oral Pathology, Rajarajeshwari Dental College
and Hospital, Bengaluru, Karnataka, India.
Email: [email protected]
Received: 02 August 2015;
Accepted: 10 September 2015
doi: 10.15713/ins.jmrps.28
Abstract
Background: Oral squamous cell carcinoma (OSCC) is a major contributor to disability
and death caused by malignant tumors. While of global relevance, variations in social,
cultural, and geographic factors affect tumor behavior and response to treatment. In
this study, we undertake a 5 years institutional review and analysis of OSCC cases in the
south Indian setting.
Materials and Methods: A retrospective study of 145 histologically diagnosed cases of
OSCC seen between the years 2001 and 2006 in Davangere Dental Colleges, Karnataka,
India.
Results: The total number of the patients included 65 males (44.8%) and 80 females
(55.2%) whose age ranged from 23 to 80 years (mean ± standard deviation;
52.86 ± 13.18 years). An incidence was highest in 40-45 and 60-65 age group. Buccal
mucosa 44 (30.4%) was the most common site, followed by tongue 27 (18.6%). Most
lesions (58%) were well differentiated. Patients with poorly differentiated lesions had a
comparatively lower mean age than their counterparts with other histological varieties,
and this was statistically significant (P < 0.05).
Conclusion: The pattern of OSCC differs from that of previous studies in relation to
incidence and age correlation with the grade of carcinoma. Since the majority of the
lesions were well differentiated, there is a need for intensive oral health awareness to
encourage early presentation, to cancer center, as this will further enhance prognosis.
Introduction
Materials and Methods
Squamous cell carcinoma (SCC) is the most common malignant
neoplasm of the oral cavity and represents about 90% of all oral
malignancies. It is insidious and potentially life threatening
malignant epithelial neoplasm. The overall 5 years survival rate
of patients is <50%.[1] Studies has shown that the incidence of
oral SCC (OSCC) varies significantly among various parts of
the world. The global variation in the incidence of SCC has been
linked to various sociocultural characteristics, major geographic
differences in risk factors, differences in data collection, and the
level of development of health services in various populations.
Properly registered data is an essential indicator for the
magnitude and pattern of the cancer problem in India. Such data
is not easily available for regional small centers like Davangere,
Karnataka, India.
The present study is a review of OSCC cases that were
reported and treated in a major regional center in Karnataka over
a 5 years period.
A retrospective study on OSCC was conducted on the basis
of oral biopsy specimens retrieved from the archives of the
Department of Oral and Maxillofacial Pathology, College of
Dental Sciences, Davangere, Karnataka, India, available from the
year January 2001 to January 2007.
The following data were collected and analyzed from clinical
case sheets.
The age, sex, religion (Hindu, Muslim, and Christian), habits
(beedi, gutkha, smoking, and paan), and anatomical site were
considered as:
• Keratinized mucosa - (gingiva, palate)
• Non-keratinized mucosa - (floor of the mouth, buccal
mucosa, labial mucosa, lateral tongue, retromolar area)
• Specialized mucosa-(dorsum of the tongue).
Histopathology slides stained with hematoxylin and eosin
(H and E) were selected and re-evaluated according to the
current concepts outlined by the WHO. Inclusion criteria
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Nayak, et al.
Oral squamous cell carcinoma
involved the histological confirmation of OSCC. Lesions with
histological findings that were not compatible with OSCC were
excluded from the study. Some records that were sent with the
biopsy material were inadequate and were omitted.
Data were subjected to descriptive statistical analyses with
the SPSS version 16.0 statistical software package (SPSS Inc.,
Chicago, USA).
Results
Age
Graph 1: Age distribution of the patients with oral squamous cell
carcinoma
SCC was seen from 3rd decade to 9th decade of life with mean
age of 53 years with range of 23-80 years. The most affected age
groups were between 40-49 and 60-69 years (Graph 1).
Sex
The study had 65 (44.8%) male and 80(55.1%) female patients
with male/female ratio of 0.72:1. It was observed that there were
no female patients in the 3rd decade of life (Graph 2).
Habits
Graph 2: Age distribution of the patients with oral squamous cell
carcinoma among male and female
From the data collected, 93 (64.1%) cases gave history of gutkha
chewing, smoking beedi, and cigarette.
Rest of the cases data was unavailable.
Religion
The study observed 130 (89.6%) people from Hindu religion.
15 (10.3%) cases were Muslims. There were no Christian
patients in the study.
Anatomical site distribution
In our study, buccal mucosa recorded maximum number of
cases. Gingiva was the least affected site (Graph 3).
Clinical presentation
The most common presentation of the lesion was an ulcer or
ulceroproliferative growth (Figure 1). Two cases had previous
history of oral submucous fibrosis and one case from leukoplakia.
Common symptom was pain and burning sensation. Exact
numbers is not mentioned due to error in data collection
(patients were asked leading questions).
There were a total of 136 (93.7%) cases of OSCC occurring in
non-keratinized mucosa (buccal mucosa, labial mucosa, floor of
the mouth, lateral and ventral tongue). 9 (6.2%) cases occurring
in keratinized mucosa (gingiva, hard palate). There were no
cases reported in the specialized mucosa (dorsal tongue).
Histological types of OSCC
There were 84 (57.9%) cases of well differentiated SCC
(Figure 2). 50 (34.4%) cases of moderately differentiated SCC.
11 (7.5%) cases of poorly differentiated SCC.
4
Graph 3: Site distribution of the patients with oral squamous cell
carcinoma
Discussion
OSCC is a major cause of morbidity and mortality globally
accounting for approximately 2,75,000 new cases and >1,20,000
deaths per annum.[2] It is the 8th most common cancer worldwide[3]
and is leading cancer among men in India.[4] The male-female
ratio is approximately 2.4:1 World Wide.[2] This study a slight
female predilection is seen with male:female ratio 0.72/1 which
is similar to studies from Connecticut, Thailand, and Pakistan
showing increasing trends in female population.[5-7] On the
contrary vast majority of studies show a male predilection.[4,8-13]
Increased incidence in females is linked to liberalization and
habit association among conservative female population.[7]
OSCC typically occurs in the 5th-8th decade of life.[3] Peak
incidence of OSCC in our study was in the age range was
40-49 years with minimum age being 23 years. This is in
correlation with other Indian studies which have documented
maximum cases in 5th decade.[4,9,10] A second peak of incidence of
oral squamous carcinoma was found in the age range 60-69 years
in the present study. Another Indian study by Sharma et al. in
Journal of Medicine, Radiology, Pathology & Surgery ● Vol. 1:5 ● Sep-Oct 2015
Nayak, et al.
Figure 1: Squamous cell carcinoma of gingivobuccal complex seen
as ulceroproliferative growth
Oral squamous cell carcinoma
India[4,8-10] and Taiwan.[13] There has been strong correlation
with tobacco usage in various forms.[18-20]
Buccal mucosa belongs to the gingivobuccal complex of
which lower gingivobuccal complex is known as Indian cancer.
This is the typical site associated with tobacco chewing. It is
known to have better prognosis than its upper counterpart even
in advanced case.[21] In Davangere, people use Gutkha which
is placed in the buccal vestibule region. The toxins from the
tobacco is absorbed after dilution with saliva and swallowed
or spat. The areas coming in close proximity with the tobacco
products probably become the site of maximum insult and thus
are maximally affected.
Pain and burning was the common complaint the patients
had in our study which was same as the study by Aree et al.[6]
Their study had additional complaints like numbness, bleeding,
dysphagia. 17.2% of cases were asymptomatic which explains the
delay in seeking treatment.
Ulceroproliferative growth was the common clinical
presentation. There were 2 cases with history of oral submucous
fibrosis and one case arising from leukoplakia. These findings
were similar to the study by Aree et al. in Thai patients.[6]
Histologic type
Figure 2: Hematoxylin and eosin stained of well differentiated
squamous cell carcinoma showing numerous keratin pearls ×10
magnification
Western UP have also recorded second peak in 6th decade.[10] A
Nigerian study also recorded two peaks at 3rd and 5th decade. The
first peak occurring in younger decade compared to our study.
The reason for this trend is not known.[14]
People of Hindu religion were more affected probably
because they constitute the major population of Davangere,
Karnataka, India. The social custom and culture may also
have some role in the disparity No other studies are available
highlighting the religious aspect affecting OSCC.
The site predilection also varies widely throughout the world.
Lip was favored site in people exposed to UV radiation in Iraq.[12]
Palate was common site in Filipino because of prevalence of
reverse smoking habit seen in women.[15] Tongue was the most
common site in many studies.[5,7,11,16] Gingiva was the common
site in Sao Paulo Brazil.[17] Most common site involved in our
study was buccal mucosa which was same as studies from
In our study it is seen that most cases of OSCC occurred in nonkeratinized mucosa (136 cases). This shows the susceptibility
of nonkeratinized mucosa for tumorigenesis. There were only
9 cases affecting the keratinized mucosa.
Rautava et al. in their study also had 57% of their cases in nonkeratinized mucosa and 42% in keratinized mucosa.[16] Probably
the keratin layer on the surface of the keratinized mucosa acts as
a barrier against the carcinogens.
Though, OSCC occur at site which is accessible for clinical
examination, most cases report when the lesion is established.In
the present study there is higher incidence of well differentiated
carcinoma.Most studies have reported same incidence[6,7,9,22]
except for Nigerian study where poorly differentiated SCC
was prevalent.[14] The mean age of occurrence for poorly
differentiated carcinoma was 48 years in our study which is
tending to lower age group.
Conclusion
OSCC has been a topic of intense research; very few
epidemiological studies have been conducted exclusively on
OSCC. Considering the prevalence and magnitude of the
problem a thorough background data is necessary to have a
tailored preventive and treatment plans to be administered.
This paper is one of the earliest attempts to gather baseline
data in Davangere which is a small pocket of South India. The
differences noted in this study in comparison to the data from
other regions underline the importance of establishing data basis
for different region to enable adequate screening, diagnosis,
prevention, and treatment measures.
Journal of Medicine, Radiology, Pathology & Surgery ● Vol. 1:5 ● Sep-Oct 20155
Oral squamous cell carcinoma
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How to cite this article: Nayak VN, Donoghue M,
Selvamani M. Oral squamous cell carcinoma: A 5 years
institutional study. J Med Radiol Pathol Surg 2015;1:3-6.
Journal of Medicine, Radiology, Pathology & Surgery ● Vol. 1:5 ● Sep-Oct 2015