Oral Cavity Carcinoma Research Articles

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.

Experience of radiotherapy in head and neck

Abstract Objective: The aim of this manuscript was to understand and describe the experience of radiotherapy on the perspective of a woman with oral cancer. Methods: This is a qualitative, exploratory, descriptive study, with theoretical reference of medical anthropology and instrumental case study methodology. Data collection was performed in the oncology sector of a public university hospital in the Southeast region of Brazil, State of Minas Gerais, Brazil and at the participant’s residence, during from March to August, 2016. The case selected was of a female patient, diagnosed with Spinocellular Carcinoma in oral cavity, submitted to radiotherapy. Five semi-structured interviews and participant observation were performed and audio-taped. Results: Three thematic units are presented: the radiotherapy trajectory, family support and refuge in God and the importance of the multiprofessional team. The adverse reactions such as odynophagia, dysgeugia and weight loss were the ones that stood out the most, being causes of the social isolation of the participant, nonetheless the patient showed optimism and hope, despite the social isolation. Conclusion: The qualitative methodology allowed the whole trajectory of radiotherapy follow-up which made it possible to understand the treatment experience from the perspective of the participant. Despite the adverse reactions, no negative experience with radiotherapy was found. New studies using the qualitative methodology are suggested with groups presenting similar characteristics of the participant, thus providing a better understanding of the topic addressed, as well as the identification and adoption of strategies that aim at improving care and the quality of life of this population, as well.

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

Concurrent chemoradiation with paclitaxel in locally advanced head and neck cancer: A feasibility study from tertiary cancer care center

Background: In India, the majority of the head and neck squamous cell carcinoma (SCC) of head and neck (60–80%) presented in locally or locoregionally advanced stage but non-metastatic disease as compared to 40% in developed nations. Uncontrolled local and/or locoregional disease causes most fatalities and predominant failure pattern is local and/or locoregional. Concurrent chemoradiation (CRT) is now standard of care. However, regarding either the optimal scheduling of chemotherapy regimen or radiotherapy (RT) dose fractionation scheme, no consensus exists. Paclitaxel is also active agents against squamous cell carcinoma of head and neck. Weekly paclitaxel appeared to be equivalent to weekly cisplatin with concurrent radiation in the treatment of locally advanced SCC of head and neck cancer (HNC). Concurrent chemoradiotherapy with paclitaxel in locally advanced head and neck malignancy is recommended in NCCN Guideline. Objectives: The aim of our study is feasibility and efficacy of CRT with paclitaxel for the treatment locally advanced HNC in our institute, Nil Ratan Sircar Medical College and Hospital, Kolkata. Material and Methods: Between January 2014 and December 2018 ninety eight (98) previously untreated patients with locally advanced histologically confirmed carcinoma oral cavity, oropharynx, and hypopharynx treated with CRT. Chemotherapy consisted of paclitaxel at a dose 40 mg/m2 over 1 h given once weekly from 1st week of RT, up to 4–6 cycles. RT consisted of 66 Gy/33#/61/2 weeks, 2 Gy/fraction, delivered by two parallel opposed lateral face and neck and low anterior neck portal, in cobalt 60 machines. Toxicity was graded using Common Terminology Criteria for Adverse Events v3. To assess response to therapy contrast-enhanced computed tomography (CECT) head and neck and/or magnetic resonance imaging head and neck; CECT chest or whole-body fluorodeoxyglucose and positron emission tomography computed tomography scan were done. Results: Overall complete response (CR) rate seen in 68% and partial response seen in 32% patients. Two-year disease-free survival, progression free survival, and overall survival were 59%, 72% and 85%, respectively. Grade II acute skin reaction seen in 45% patients and Grade III acute skin reaction seen in 55% patients. Similarly, Grades II and III mucosal reaction is seen in 48% and 52% patients. All patients experience Grade II dysphagia and managed conservatively. Conclusions: CRT with paclitaxel in locally advanced HNC is safe and confers high CR rate with acceptable toxicity. However, more randomized study with large number of patients is needed to come to conclusions regarding its efficacy.

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.

Neck Nodes at Level IIB in Oral Cavity Carcinoma: Can We Leave Behind Visible Nodes?

Neck Nodes at Level IIB in Oral Cavity Carcinoma: Can We Leave Behind Visible Nodes?

Data Set for the Reporting of Oral Cavity Carcinomas: Explanations and Recommendations of the Guidelines From the International Collaboration of Cancer Reporting.

The International Collaboration on Cancer Reporting is a nonprofit organization whose goal is to develop evidence-based, internationally agreed-upon standardized data sets for each cancer site for use throughout the world. Providing global standardization of pathology tumor classification, staging, and other reporting elements will lead to the objective of improved patient management and enhanced epidemiologic research. Carcinomas of the oral cavity continue to represent a significant oncologic management burden, especially as changes in alcohol and tobacco use on a global scale contribute to tumor development. Separation of oral cavity carcinomas from oropharyngeal tumors is also important, as management and outcome are quite different when human papillomavirus association is taken into consideration. Topics such as tumor thickness versus depth of invasion, pattern of invasive front, extent and size of perineural invasion, and margin assessment all contribute to accurate classification and staging of tumors. This review focuses on the data set developed for Carcinomas of the Oral Cavity Histopathology Reporting Guide, with discussion of the key elements developed for inclusion.

387P - Radiation dose to contralateral parotid during treatment of carcinoma buccal mucosa

Background: To compare the contralateral parotid gland dose during radiation treatment of carcinoma buccal mucosa with 3 Dimensional Conformal Radiotherapy (3D-CRT) vs. Parotid sparing Intensity Modulated Radiotherapy (IMRT). Methods: Ten consecutive lateralized carcinoma of the oral cavity patients treated with a prospective management using ipsilateral irradiation were studied. This included 4 radical and 6 postoperative oral cavity carcinomas, with Stage T1-T2, N0-N2b disease. Five patients were treated with 3D-CRT and five with IMRT. The dose received by contralateral parotid gland was assessed by volumetric analysis. Results: Dose-volume histograms (DVH) showed the mean dose to contralateral parotid was 896.6 cGy (range: 0.5-10 Gy) with 3D-CRT and 503.8cGy (range: 0.4-4 Gy) with IMRT. With IMRT 97%-105% of the prescribed dose was received by 95% of the target volumes. Mean dose to the PTV Primary site was 67.8 Gy (range, 65-71 Gy) for primary RT and 60.5 Gy (range: 55-66 Gy) for post-operative RT. The mean dose to the PTV Node (ipsilateral lymph nodes) was 50.8 Gy (range: 49-53 Gy). Conclusions: There is a considerable increase in the mean dose of contralateral parotid in 3DCRT compared to IMRT. Parotid sparing IMRT helps reducing the radiation dose received by salivary glands. Legal entity responsible for the study: CBCC-Chennai, Saveetha University, Chennai. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Role of adverse pathological features in surgically treated early oral cavity carcinomas with adequate margins and the development of a scoring system to predict local control.

The purpose of this study was to determine the factors affecting local control in patients with T1N0 squamous cell carcinoma (SCC) of the tongue. We conducted a retrospective analysis of 144 patients with pT1N0 SCC of the tongue who underwent wide excision and neck dissection without adjuvant therapy. The adverse pathological features associated with local control were least margin 5 mm (P = .004), infiltrative margin (P = .403), depth >4 mm (P = .136), lymphovascular invasion (P = .301), and perineural invasion (P = .342). We derived a scoring system of 10 points based on the hazard ratio for local failure; those with scores >5 points had a 5-year local control of <60%. This study suggests patients having a margin of 5 mm need revision, however, if they do not have additional adverse pathological features (score ≤4), local control is 88% at 5 years, and they may be observed. Those who have margins over 5 mm with a total score >5 may still benefit from adjuvant therapy. Those with margins over 5 mm have improved local control (P = .029).

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.

The Role of Palliative Care in Oral Cavity Carcinoma

Purpose of Review The purpose of this study is to review the current and future role of palliative care in relation to oral cavity carcinoma (OCC).

Early-Stage Oral Cavity and Oropharyngeal Carcinoma in the Elderly: An Evolving Proposition.

Early-Stage Oral Cavity and Oropharyngeal Carcinoma in the Elderly: An Evolving Proposition.

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 Frequency and Distribution of Female Genital Tract Malignancies in a Multispecialty Hospital,in Delhi

Background: The most common malignancy in women is breast carcinoma worldwide. However cancers of the female genital tract are still an important cause of cancer morbidity and mortality. They are the next commonest malignancy after breast cancer in women. Aim: A hospital based study was conducted to determine the type and frequency of genital tract malignancies in women in multispecialty hospital in Delhi Material and methods: Data from records of surgical biopsy & resection specimens along with demographic data for 3yrs of all the female patients with malignant lesions were included in the study. The distribution and prevalence of malignancies of female genital tract were analyzed. Results: A total of 118 female patients diagnosed with malignancy were included in this study. Of these 50 cases had breast carcinoma, 48 cases had carcinoma of genital tract and 20cases had others including carcinoma of oral cavity, salivary gland, thyroid, lymphomas, and GIT carcinoma. Cervical carcinoma (83.3%) was the most common gynecological malignancy followed by the ovary (10.4%) & then endometrial carcinoma (6.25%). Most common age group affected by cervical carcinoma was 51-60yrs. Moderately differentiated squamous cell carcinoma was the most common grade of cervical carcinoma noted. Conclusion: Cervical carcinoma was the most common gynecological malignancy in our study. Efforts should be made to reduce cancer burden by focus on health education of the masses, routine screening programmes for detection of cancers in females & establishing centres for monitoring & evaluation of these programmes.

WEE1 kinase inhibition reverses G2/M cell cycle checkpoint activation to sensitize cancer cells to immunotherapy

ABSTRACTIntrinsic resistance to cytotoxic T-lymphocyte (CTL) killing limits responses to immune activating anti-cancer therapies. Here, we established that activation of the G2/M cell cycle checkpoint results in tumor cell cycle pause and protection from granzyme B-induced cell death. This was reversed with WEE1 kinase inhibition, leading to enhanced CTL killing of antigen-positive tumor cells. Similarly, but at a later time point, cell cycle pause following TNFα exposure was reversed with WEE1 kinase inhibition, leading to CTL transmembrane TNFα-dependent induction of apoptosis and necroptosis in bystander antigen-negative tumor cells. Results were reproducible in models of oral cavity carcinoma, melanoma and colon adenocarcinoma harboring variable Tp53 genomic alterations. WEE1 kinase inhibition sensitized tumors to PD-1 mAb immune checkpoint blockade in vivo, resulting in CD8+-dependent rejection of established tumors harboring antigen-positive or mixed antigen-positive and negative tumor cells. Together, these data describe activation of the G2/M cell cycle checkpoint in response to early and late CTL products as a mechanism of resistance to CTL killing, and provide pre-clinical rationale for the clinical combination of agents that inhibit cell cycle checkpoints and activate anti-tumor immunity.

Frequency of Follow-up of Oral Cavity and Oropharynx Patients and Appropriate Use of Imaging and Other Surveillance Methodology

The treatment paradigm for oral cavity and oropharyngeal cancer is shifting. As our treatment strategies change, it calls into question whether surveillance strategies warrant change as well. Therefore, the goal of this paper is to critically review the literature with respect to the current pattern and timing of surveillance and the use of post-treatment imaging in patients with oral cavity and oropharyngeal carcinoma. Recent studies suggest that routine surveillance does not improve overall survival, but it does improve locoregional control. Imaging does play an important role in post-operative surveillance. Survival following treatment for head and neck cancer is improving. While routine surveillance may not improve overall survival, it still has benefit for patients, particularly in detecting and managing anxiety and post-operative complications.

Prospective Evaluation of Surgical Outcome After Transoral CO2 Laser Resection of Potentially Malignant and Early Oral Malignancy.

A prospective observational study was done at the Regional Cancer Centre, Thiruvananthapuram, a tertiary referral center for cancer care in India with an aim to assess the surgical outcomes of CO2 laser resection of oral lesions in terms of operative time, blood loss, hospital stay, postoperative pain, time to re-epithelization, pathological margins achieved and the postoperative scar. The excision was performed in 30 patients with a diagnosis of either potentially malignant lesions (leucoplakia, erythroplakia) or early cancers, i.e., carcinoma in situ or T1/T2 squamous cell carcinoma of the anterior oral cavity (tongue, buccal mucosa), adhering to standard oncological principles, and the resultant defect was left for secondary healing.

Role of MRI in evaluation of oral cavity cancers from central India

Introduction: Squamous cell carcinoma of oral cavity ranks in the top three types of all cancer in the India. The diagnosisof it is basically clinical and bioptic, preoperative imaging is crucial for tumor staging that helps to decide appropriate therapeutic strategy and indicate prognosis. Objectives: To evaluate the diagnostic accuracy of Magnetic resonance imaging (MRI) in staging of oral cavity cancers and to correlate the results with clinical and pathological data. Methodology: This was a prospective study of 60 patients of oral cavity squamous cell carcinomas (SCC) where MRI was performed preoperatively to determine the tumor staging, tumor thickness, infiltration of surrounding structures and bone invasion. These findings were correlated with final pathological staging. Results: Accurate correlation of T stages (TNM system) was obtained in 51 out of 60 cases on MRI. One lesion was classified as T2 on MRI but was found to be T4 on histopathology as MRI failed to detect subtle infiltration of the cortical bone. The accuracy of clinical data in T stage evaluation was 62 % (K- 0.470), however the MRI accuracy found to be 82 % (k 0.740). The sensitivity, specificity and accuracy of MRI in the detection of mandibular involvement were 94.1%, 60% and 81.5%, respectively. Conclusion: MRI plays an important role in the evaluation of oral cavity carcinomas. MRIaccurately demonstrates the tumor size, depth of invasion, bone marrow involvement, perineural spread and lymphnode metastasis which are essential for treatment planning.