Abstract
Objective: To determine the clinico-histopathologic variations and etiological factors associated with oral squamous cell carcinoma (OSCC). Methods: A descriptive cross-sectional hospital based study was conducted at the University of Nairobi Dental Hospital (UNDH) and Kenyatta National Hospital (KNH) between September 2008 and February 2009. Eighty-two (82) patients presenting with lesions confirmed as OSCC were evaluated for habits identified as risk factors such as tobacco use, alcohol use and betel quid chewing. Demographic features including age and gender as well as clinical parameters such as site of the primary lesion, tumour size and nodal involvement were documented. Incisional biopsies were performed for all patients to confirm the diagnosis and histopathological features noted. Results: The mean age of the patients was 58.49 (range = 14 to 90 years), with a male to female ratio of 1.6:1. Remarkably, 13.4% of the patients were aged 40 years and below. The peak incidence was found to have been in the 6th - 7th decades. Tobacco use was the main associated etiological factor (73.2%) followed by alcohol use (57.3%). Notably, 25.6% of the cases had no identifiable risk factor. The tongue was the most common site (35%) followed by the palate (22%) (p = 0.03). The least commonly affected site was the floor of the mouth (10%). The most common stage at presentation was stage IV (52.4%) and; the poorly differentiated OSCC was the most common histopathologic variant (48.8%) followed by the well differentiated (30.5%) and moderately differentiated OSCC (20.7%). Conclusion: In the present investigation it is evident that OSCC has a male predilection with a peak incidence in the 6th - 7th decades and most commonly manifests in the tongue at stage IV with the poorly differentiated subtype being the most common. Of the cases diagnosed 13.4% were aged 40 years and below.
Highlights
Oral squamous cell carcinoma (OSCC) is the most common malignant tumour affecting the oral cavity accounting for about 90% of all malignant oral tumours
Study Area and Design The study was based at the University of Nairobi Dental Hospital (UNDH) and at Kenyatta National Hospital (KNH) in the Oral Surgery and Ear Nose and Throat (ENT) clinics
All patients presenting to these two hospitals between September 2008-February 2009 with oral lesions that were histologically confirmed as OSCC and who met the other inclusion criteria were included in the study
Summary
Oral squamous cell carcinoma (OSCC) is the most common malignant tumour affecting the oral cavity accounting for about 90% of all malignant oral tumours. OSCC is more common among males and is a disease of the elderly being rarely seen in patients under the age of 45 years. In East, West and Southern Africa, the peak age is reported to be between the 5th - 6th decades, a decade earlier than that in other parts of the world [2]-[10]. The aetiology of OSCC can be attributed to certain interactions between genetic and lifestyle risk factors. In a minority of cases, among the younger patients, common identifiable risk factors are absent, producing a challenge in research into their aetiology. Established risk factors for the development of OSCC include tobacco use, heavy consumption of alcohol, chewing betel quid (pan) especially in the Indian sub-continent, viral infections and the presence of potentially malignant lesions [11]. In most African populations, comprehensive information regarding the pattern of occurrence of OSCC is scanty
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