Cell Carcinoma Of Oral Cavity Research Articles

Older age is a risk factor associated with poor prognosis of patients with squamous cell carcinoma of the oral cavity

PurposeWhether or not young patients with squamous cell carcinoma of oral cavity (OC-SCC) have a difference in prognosis remains a controversy. This study aimed to analyze the clinical characteristics and difference of survival rates between adult patients less than 40 years of age and those 40 years of age and older.MethodsA retrospective analysis was conducted using the database of patients diagnosed with OC-SCC between 1990 and 2013 in the Sun Yat-sen University Cancer Center, but patients older than 85 years, younger than 18 years, or died within 6 months of diagnosis were excluded. Patients were categorized into two groups: the young group (< 40 years of age) and the older group (≥ 40 years of age). Cox regression, survival and subgroups analyses were performed. The primary endpoints included the rates of 5-year overall survival (OS) and disease-specific survival (DSS).ResultsA total of 1902 OC-SCC patients were identified. The percentage of female in the young group was significantly higher than that in the older group (40.27% vs 31.03%, p < 0.001). This study failed to find the difference in TNM classification or tumor stage between the two groups (p > 0.05). The young group was more likely to receive adjuvant radiotherapy and/or chemotherapy (42.48% vs 26.91%, p < 0.001). The 5-year OS rate (71% vs. 57%, p < 0.001) and DSS rate (72% vs 58%, p < 0.001) in patients under 40 years were significantly higher than those for the older group.ConclusionOur findings suggested that OC-SCC in younger patients did not present at a more advanced stage. In addition, young age is an independent predictor for better survival.

A prospective study to compare conventional radiotherapy verses accelerated radiotherapy with concurrent chemotherapy in squamous cell carcinoma of oral cavity

A prospective study to compare conventional radiotherapy verses accelerated radiotherapy with concurrent chemotherapy in squamous cell carcinoma of oral cavity

Outcome of Treatment in Locally Advanced Upper Alveolar Carcinoma Extending to Infra-temporal Fossa.

Squamous cell carcinoma of oral cavity has a high prevalence in our region. Upper alveolar cancers are uncommon but present with locally advanced disease extending to infra temporal fossa. The outcome of treatment in these tumors is poor. Surgery followed by adjuvant therapy is the mainstay of treatment. We are presenting a retrospective analysis of outcome of treatment in 20 patients with locally advanced (T4b) upper alveolar carcinoma treated by infra-structure maxillectomy with compartment resection of infra-temporal fossa and neck dissection followed by adjuvant radiotherapy or radiotherapy with chemotherapy. Study period was from 2013 to 2018. Minimum follow up was 12months and mean follow up 30months. 12 patients are alive and disease free, 6 patients had local recurrence and 2 patients had regional recurrence with one having pulmonary metastasis. We observed that positive or close margins (< 5mm after formalin fixation) predisposed to early recurrence. Erosion of pterygoid plates was a poor prognostic factor. Cervical lymph node metastasis occurred late in disease, but carried poor prognosis. Compartment resection of infra temporal fossa gave better outcome compared to other studies which reported outcome of treatment in upper alveolar cancers.

The correlation of response to induction chemotherapy with neutrophil lymphocyte ratio and platelet lymphocyte ratio in oral cavity malignancy

Aims and Objectives: Induction chemotherapy yields significant response in locally advanced squamous cell carcinoma of oral cavity. Pre-treatment biomarkers can help to predict response to chemotherapy. The neutrophil–lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) are cost-effective and simple parameters that can predict response to chemotherapy. This study aims to find the correlation between NLR, PLR and response to induction chemotherapy in oral cavity malignancies. Materials and Methods: Details of 32 patients with locally advanced squamous cell carcinoma of oral cavity who received induction chemotherapy from Jan 2017- March 2019 were collected and the following were recorded. Pre-treatment total leukocyte count, neutrophil, lymphocyte and platelet counts. Post induction chemotherapy, reduction in size of tumour. Patients were categorised into complete, partial and non- responders.The mean NLR and PLR, and the significance in variation of NLR and PLR between the three groups was calculated and the statistical significance analysed. Results: The mean NLR is significantly low in both partial (2.62) and complete response groups (2.4) compared to the patients with static response (5.6). The mean PLR is also low in responders (124) when compared to the static group (180), but it is not statistically significant. With a cut-off value of 3.95 for NLR and 153 for PLR, response could be predicted with high positive predictive value. When both the ratios are combined the predictive value is further increased as shown in this study. Conclusion: Pre-treatment NLR and PLR are reliable biomarkers of the systemic immunologic phenotype of the cancer patients. They predict the response to chemotherapy in patients with oral cavity malignancy. Keywords: Neutrophil lymphocyte ratio, Platelet lymphocyte ratio, Oral cavity cancer, Induction chemotherapy.

The role of adjuvant (chemo-)radiotherapy in oral cancers in the contemporary era.

Squamous cell carcinoma of oral cavity (OSCC) is predominantly managed with surgery. Post-operative radiotherapy (PORT) and chemoradiotherapy (POCRT) enhance disease control in OSCC patients with adverse anatomic and pathologic primary and nodal features. Knowledge about disease behavior, surgery and radiotherapy advances, and the emergence of new systemic agents prompt refinement of PORT volumes and POCRT regimens. Traditional and emerging prognostic models that include adverse histopathological features underpin such approaches. This review summarizes research over recent decades with emphasis on the 2015 to Feb 2019 period describing: (1) Indications for PORT and/or POCRT, addressing surgical "margin status" including the definition of a "clear" margin to permit withholding PORT/POCRT; these concepts include characterizing the specimen yielding these measurements, the optimal time point to assess these findings, and the putative value of a "revised margin" performed during the same operative procedure, (2) Emerging prognostic factors including nodal burden (total number of involved lymph nodes) and perineural invasion, (3) PORT volume design, dose/fractionation and optimal surgery-to-PORT interval, (4) Chemotherapy dose, schedule, and agents, and (5) On-going clinical trials involving systemic agents and combinations of chemotherapy with immunotherapy.

Metastasis to Submandibular Salivary Gland in Oral Carcinoma

Objective: To determine the frequency of involvement of the submandibular gland as a metastatic site in squamous cell carcinoma of oral cavity, mechanism of its involvement and factors associated with it. Method: We reviewed the medical and pathologic records of patients who underwent neck dissection (unilateral or bilateral) for oral cavity squamous cell carcinomas (SCC) from January 2009 to July 2017 at the Liaquat National Hospital in Karachi. Cases of histopathologically confirmed SCC of oral cavity and cases of primary tumor in which excision of the submandibular gland (SMG) was done along with neck dissection were included. Those cases with previous surgery for oral cancer and those with previous chemo-radiotherapy were excluded. Results: Median age at presentation was 49.50 years (IQR= 42-58 years). Males were more commonly affected (n=167, 79.5%). The most frequent involved site was buccal mucosa (n=110, 52.4%). Out of 210 neck dissections, SMG was involved by the tumor metastasis in only 8 (3.8%) of the cases. Most common method of involvement was direct invasion by the primary tumor (n=5, 62.5%). Floor of mouth (p&lt;0.001) and level 1 lymph node involvement (p&lt;0.001) were significantly associated with SMG involvement. Conclusion: SMG is the major source of unstimulated saliva. Saliva plays an important role in maintaining oral hygiene and health. Especially in patients of oral cavity SCC who receive post-operative radiotherapy its removal can aggravate xerostomia which can lead to severe discomfort. In this study there was no involvement of SMG in cases in which floor of mouth was not involved and in cases with clinically negative neck. So we concluded that efforts should be made to preserve SMG in these cases to reduce post-operative morbidity associated with its removal.

Dissection of posterior triangle and lower deep jugular lymph node is mandatory in therapeutic neck dissection as a part of treatment for squamous cell carcinoma of oral cavity with clinically N1 neck

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In India oral cancer is the commonest malignant neoplasm, accounting for 20-30% of all cancers. Southern India presents the highest oral cancer incidence rates among women worldwide.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted in R. L. Jalappa Hospital and Research Centre and SDU Medical College Kolar, Karnataka. Thirty patients having oral squamous cell carcinoma with clinically N&lt;sub&gt;1 &lt;/sub&gt;neck undergoing modified radical neck dissection between December 2010 and June 2012 were enrolled in the study. The objective of study was to determine whether dissection of posterior triangle and lower deep jugular lymph node is mandatory in therapeutic neck dissection as a part of treatment for squamous cell carcinoma of oral cavity with clinically N&lt;sub&gt;1 &lt;/sub&gt;neck. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 24 patients, 16 patients underwent wide excision with hemimandibulectomy. In these 16 cases, 2 patients had reconstruction with double flap while rest 14 cases with island pectoralis major myocutaneous flap. Out of remaining 8 patients, 2 patients underwent marginal mandibulectomy. In all these 8 patients, reconstruction was done using nasolabial flap in 1 patient, buccal pad of fat in 2 patients, masseter flap in 1 patient and forehead flap in 4 patients. In carcinoma anterior 2/3&lt;sup&gt;rd&lt;/sup&gt; tongue, all 6 patients underwent hemiglossectomy with simultaneous modified radical neck dissection.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It was concluded that during neck dissection, it may be oncologically safe to avoid level IV and level V clearance in buccal mucosa squamous cell carcinoma with N&lt;sub&gt;1&lt;/sub&gt; neck.&lt;/p&gt;

Frequency of metastasis to posterior triangle and lower deep jugular lymph nodes in patients with squamous cell carcinoma of oral cavity having clinically N1 neck

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Oral cancer is the sixth most common cancer in the world and is largely preventable. The objective of the study is to find out the frequency of metastasis to posterior triangle lymph nodes and lower deep jugular (supraclavicular) lymph nodes in patients with squamous cell carcinoma of oral cavity having clinically N&lt;sub&gt;1 &lt;/sub&gt;neck.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A hospital based prospective study.&lt;strong&gt; &lt;/strong&gt;This prospective study was conducted in R. L. Jalappa Hospital and Research Centre and SDU Medical College Kolar, Karnataka. 30 patients having oral squamous cell carcinoma with clinically N&lt;sub&gt;1 &lt;/sub&gt;neck (single ipsilateral lymph node less than 3cms in diameter) undergoing modified radical neck dissection in R. L. Jalappa Hospital and Research Centre. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, 4 were male (13%) and 26 were females (87%). The age of the patients ranged from 41-70 years with a mean age of 53 years.&lt;strong&gt; &lt;/strong&gt;Majority of primary tumours were buccal mucosa tumours (24). We had 6 anterior 2/3&lt;sup&gt;rd&lt;/sup&gt; tongue tumours. The primary tumour staging included 17 T&lt;sub&gt;2 &lt;/sub&gt;lesions (57%), 3 T&lt;sub&gt;3 &lt;/sub&gt;lesions (10%), 10 T&lt;sub&gt;4 &lt;/sub&gt;lesions (33%) in patients with buccal mucosa carcinoma, fourteen patients had T&lt;sub&gt;2 &lt;/sub&gt;disease, 9 patients had T&lt;sub&gt;4&lt;/sub&gt; and one patient had T&lt;sub&gt;3&lt;/sub&gt; disease.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Most common nodal involvement in buccal mucosa carcinoma was level Ib (submandibular lymph node). The incidence of level IV (supraclavicular) and level V (posterior triangle) lymph node metastasis is low in buccal mucosa carcinoma patients with clinically N&lt;sub&gt;1&lt;/sub&gt; neck.&lt;/p&gt;

Squamous cell carcinoma of oral cavity and oropharynx: A retrospective analysis of nodal involvement and survival

Squamous cell carcinoma of oral cavity and oropharynx: A retrospective analysis of nodal involvement and survival - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2019.065, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Genetic variations of TLRs and their association with HPV/EBV, co-infection along with nicotine exposure in the development of premalignant/malignant lesions of the oral cavity in Indian population

Background: Despite being most preventable malignancies associated with smoked and smokeless tobacco products, squamous cell carcinoma of oral cavity is one of the most common malignancy in India. The aim of the present study was to evaluate the role of TLRs in oral pre-cancerous, cancerous cases and their genotypic correlation with HPV/EBV, co-infection & lifestyle habits in Indian population.Methods: The present study was conducted on 300 subjects (100 OSCC, 50 pre-cancer & 150 controls). The amplification of TLRs gene and HPV/EBV co-infection was assessed by Nested PCR, PCR–RFLP and further confirmation by direct sequencing.Results: The TLR 9(−1486 T/C), revealed that the TT vs. CT + CC genotype had a ˜5-fold increased risk for the development of pre-cancerous lesions as compared to controls (p = 0.0001). Further analysis showed that the risk of cancer was extremely pronounced in HPV/EBV, co-infection (p = 0.0141), implicating the possible interaction between TLR 9(−1486T/C) genotype and HPV infection in increasing cancer/pre-cancer risk. The ‘G’ allele of TLR 4(+896A/G) was also a higher risk of developing pre-cancerous lesions with 4.5 fold and statistically significant (p = 0.0001). The genotypic association of TLR 9(-1486T/C) in OSMF cases showed ˜8 fold increased risk and TLR 4(+896A/G) showed fourteen fold higher risk for leukoplakia (p < 0.0001, OR = 14.000).Conclusion: Genetic polymorphism of TLR 9(−1486 T/C) and TLR 4(+896A/G) may influence the effects of HPV/EBV, co-infection and play the significant role in development of the disease. The significance of these TLRs seemed to be enhanced by tobacco chewing and smoking habits also, which act as an important etiological risk factor for OSCC.

Head and neck cancer and occupational exposure to leather dust: results from the ICARE study, a French case-control study

BackgroundLeather dust is an established carcinogen of the sinonasal cavities; however, evidence is lacking regarding its association with other head and neck cancers (HNC). To date, few studies have been conducted on the association between occupational leather dust exposure and the risk of oral, pharyngeal, and laryngeal cancers. The objective of this study was to investigate the association between the risk of HNC and occupational exposure to leather dust.MethodsLifestyle habits and occupational history were collected for 2161 patients with squamous cell carcinoma of oral cavity, pharynx, and larynx, and 3555 controls, using a standardized questionnaire. Occupational exposure to leather dust was assessed using a job-exposure matrix. Odds ratios (OR) and 95% confidence intervals (CI) for HNC globally and by subsite were estimated using multivariate unconditional, and polytomous logistic regressions, respectively.ResultsCumulative lifetime exposure to leather dust < 6 mg/m3-years was associated with an increased risk of laryngeal cancer (OR = 2.26, 95% CI: 1.07–4.76); higher levels were not related to elevated risks of HNC. Some tasks performed and the use of some glues were associated with elevated, although non-significant, risks of HNC. No dose-response relationships were observed.ConclusionOur study did not provide enough evidence for an increased risk of HNC related to occupational exposure to leather dust. Further studies are needed to understand the risks of specific tasks in the leather industry.

Correlation of modified Anneroth's histological grading system with E-cadherin expression in squamous cell carcinoma of oral cavity and oropharynx

Correlation of modified Anneroth's histological grading system with E-cadherin expression in squamous cell carcinoma of oral cavity and oropharynx

Assessment of apoptotic index in potentially malignant pathologies and squamours cell carcinoma of oral cavity- an in vitro study

Oral cancer is a serious and growing problem in many parts of the globe. Oral squamous cell carcinoma is the sixth most common cancer worldwide. Prognostic evaluation for oral squamous cell carcinoma OSCC is mainly based on clinical TNM classification but this staging system is not sufficient for optimal prognostication and must be supplemented by other reliable methods.Conventional light microscopic examination with routine hematoxylin and eosin stain is capable of identifying the various morphological changes that occur during apoptosis. Moreover at the same time counting of apoptotic bodies using light microscopy is much more feasible.The present study is used to to quantify and compare the Apoptotic Index in Hyperkeratosis with varying degree of dysplasia and varying grades of oral squamous cell carcinoma with that of normal tissue sections. In our study Apoptotic Index increased with increasing degrees of dysplasia compared with that of normal healthy tissue. On the contrary Apoptotic Index increased in well differentiated squamous cell carcinoma and was least in poorly differentiated squamous cell carcinoma which was even less than normal healthy tissue specimen. Thus we conclude that apoptotic count significantly increases in cases of dysplasia and squamous cell carcinoma when compared to normal mucosa.

Correlation between pathological tumour stage and lymph node involvement in oral cancers: a descriptive study

Background: Involvement of cervical lymph nodes is the single most important prognostic factor in oral carcinoma. This study was aimed to evaluate the correlation between tumour stage and lymph node metastasis.Methods: A descriptive study was planned in oral cancer patients who fall within the inclusion criteria. This was compared with the postoperative histopathologic status of cervical nodes. Correlation analysis was done between tumor stage and lymph node metastasis.Results: Total 106 patients were included in the study. The male female ratio was 1.4:1. Majority of the patients 37(34.9%) were in the sixth decade of life. Carcinoma of the tongue was present in 17 cases while only 4 had carcinoma of lower alveolus. Most of the patients with oral cancer presented at an early stage (T1-T2). Stage IV was the commonest with 51 (48.1%) patients. Level I was the most commonly involved lymph node station (78.1%) in squamous cell carcinoma of oral cavity. A weak significant positive correlation between tumor stage and lymph node metastases (r =0.298) was found (p = 0.002). There was a moderate significant (p = 0.0001) positive correlation (r = 0.435) between pathological tumour stage and level of lymph node involvement. But the positive correlation was not statistically significant in carcinoma of the lower alveolus (r = 0.387, p=0.112).Conclusions: Significant positive correlation between pathological tumor stage and level of lymph node involvement in oral cancer and carcinoma tongue. But, in carcinoma lower alveolus the positive correlation was not significant.

HABITS AND REASONS OF DELAYED PRESENTATION OF PATIENTS WITH ORAL CANCER AT A TERTIARY CARE HOSPITAL OF A THIRD WORLD COUNTRY

Background: Oral cancer accounts for nearly one-fifth of all cancers in males and one-tenth in females globally. Squamous cell carcinoma accounts for 90% of the oral cancer. The occurrence rate of oral cancer is higher in Sri Lanka, Bangladesh, Pakistan and India. In South Asia oral cancer constitutes 25% of all new cancer reported among males. The estimated incidence of oral cancer in Pakistan is 14.7%. Methods: A cross sectional observational study was carried out at a tertiary care hospital in Karachi with a sample of 145 patients with pathological diagnosis of squamous cell carcinoma of oral cavity. Patients were characterized into early stage (I and II) and advanced stage (III and IV), according to AJCC classification of tumors (2010). Data entry and analysis was carried out on SPSS 19. Qualitative data was expressed in percentages and results were accessed by Chi squared test. Results: The mean age was recorded 47.87 ± 12.50 years. Males participants were 63.4% and 36.6% females were incorporated in our study. More than half came with the Stage IV. 35.2% of participants became aware of their initial symptom before 6 months before pursuing any doctor. 83% patients presented with noteworthy habit of Tobacco or Chalia chewing. Bulk of the participants stated that they would have presented before if they had knowledge about the disease. 85% thought that increasing awareness of oral cancer through media may decrease the time in seeking help from qualified doctor. Conclusion: The study concludes that most of the participants presented late to the professional because of lack of knowledge about signs and symptoms of oral malignancy.

Second Primary Spindle Cell Carcinoma of Oral Cavity and Oropharynx: A Case Report and Literature Review

Spindle cell squamous cell carcinoma (SpCC) is a poorly differentiated subtype of squamous cell carcinoma (SqCC). We report a case with second primary oropharyngeal SpCC after seven years of complete treatment of SqCC. The patient underwent surgery and adjuvant chemoradiotherapy. Relevant literature about SpCC was reviewed.

Multinucleated Giant Cell Reaction in Well-differentiated Squamous Cell Carcinoma of Oral Cavity

Multinucleated Giant Cell Reaction in Well-differentiated Squamous Cell Carcinoma of Oral Cavity

Histomorphological Spectrum of Head and Neck Lesions: A Three Year Retrospective Analysis

Background: Lesions of head and neck are common in patients of all age groups. Head and neck cancers including thyroid lesions are the third commonest malignancy seen in both sexes across the globe. Aim: To study the histo-pathological spectrum of head and neck lesions in a tertiary care hospital of north India. Material and Methods: Three year retrospective study was conducted in Department of Pathology of tertiary care hospital. The head and neck cases including thyroid were retrieved from the data base of the department and analyzed with respect to age, gender, topography and histo-pathological diagnosis. Results: Out of 4092 biopsies received during a three year period, 158 biopsies were from the head and neck area. The age range was 4-86 years. Maximum number of cases were seen in the age group of 41- 60 years. The male female ratio was 2.5:1.89 cases were benign, 6 were borderline, 4 inconclusive and 59 were malignant. Commonest malignancy was squamous cell carcinoma of oral cavity and commonest benign lesion was epidermoid cyst. Conclusions: Information relating to site specific data forms a scientific basis for developing strategies to prevent and diagnose various lesions especially cancers.

The histologic risk model is a useful and inexpensive tool to assess risk of recurrence and death in stage I or II squamous cell carcinoma of tongue and floor of mouth

AbstractSurgery is the mainstay of treatment for low-stage (stage I/II, ie, T1N0/T2N0) squamous cell carcinoma of oral cavity. However, a significant percentage of low-stage squamous cell carcinoma of oral cavity will develop local recurrence and disease-related mortality. In this study, we stratified 64 patients with low-stage of oral tongue and floor of mouth patients into high-, intermediate- and low-risk categories based on existing histologic risk model. The classification of these risk categories was based on presence or absence of perineural invasion and evaluation of tumor–host junction for worst pattern of invasion and lymphocytic host response. We correlated risk category and other variables with recurrence and death. In a univariate model, high-risk category tumors had a significantly higher rate of recurrence and death due to recurrence compared with low/intermediate-risk categories (P=0.000 and P=0.047, respectively). Controlling for margin status and T-stage, high-risk category had a 12.4 odds ratio of later recurrence when compared with low/intermediate-risk categories, with a P-value of 0.001. In conclusion, we found low-stage oral cavity squamous cell carcinoma patients with high-risk category have a significantly higher risk for recurrence when compared with patients in the low- or intermediate-risk category, even when controlling for margin status and T-stage. These patients may be suitable candidates for adjuvant treatment to decrease morbidity and mortality associated with a recurrence. Our results indicate that the histologic risk model is a useful and simple tool to assess risk of recurrence in stage I or II squamous cell carcinoma of oral cavity.

Correlation of CD133 and Oct-4 expression with clinicopathological and demographic parameters in oral squamous cell carcinoma patients.

Objective:Squamous cell carcinoma of oral cavity is one of the most common cancers of Indian subcontinent with the 5-year survival rate of 50% despite the recent advances in the treatment. The aim of the present study was to study cancer stem cell markers CD133 and Oct-4 in oral squamous cell carcinoma (OSCC) patients and their correlation with clinicopathological variables.Materials and Methods:This was a prospective study which included 50 cases of histopathologically proven squamous cell carcinoma of oral cavity. Expression of CD133 and Oct-4 was evaluated by immunohistochemistry (IHC) and their expression was correlated with various clinicopathological and demographic parameters.Results:CD133 expression was seen in 20.6% cases of clinical Stage I–II and in 79.4% of clinical stage of III-IV OSCC patients, the difference being statistically significant with the P = 0.048. There was no statistically significant association between CD133 expression and any other clinicopathological or demographic variable. Oct-4 was expressed only in one case.Conclusions:CD133 expression was significantly seen higher in Stage III–IV tumors, the stem cells may be responsible for the aggressiveness of the OSCCs and these stem cells can be potential prognostic markers and targets for the future targeted therapy.