Clinicopathological Study of Oral Carcinoma

Background: Oral carcinoma is the 6th most common carcinoma worldwide. The 5 year survival rate for oral carcinoma is only 50%. Patients of oral carcinoma are at high risk from secondary neoplasm. Over 90% of all primary malignant tumour of the oral cavity is squamous cell carcinoma. Aim: To find out the difference of clinical presentation and pathological aspects of oral cancer. Methods: In this cross sectional study 30 patients with carcinoma oral cavity from the department of otolaryngology and Head neck surgery, Bangabandhu Sheik Mujib medical University, Dhaka Medical College hospital and National Institute of cancer research & hospital, Mohakhali, Dhaka were included , period from march 2009 to September 2009. The patients were examined after admission into Hospital pre-operatively and in the post-operative period. The surgical specimen were sent for Histopathology. Results: Majority of the patients were at 6th decade where female outnumbered the male with male female ratio is 5:4. Out of 30 patients majority of the patients complains of soreness/ irritation and ulceration in the oral cavity followed by difficulty in mastication, foul breath, pain in the lesion, dysphagia, spitting of blood and excessive salivation. About the site of the lesion maximum patients having the lesion in buccal mucosa(30%) then anterior 2/3rd of tongue (23.33%), retromolar area (13.33%) in decreasing frequency. Conclusion: Oral carcinoma usually a disease of middle age and elderly people. Irritation or soreness is the commonest symptom. Most affected sites are buccal mucosa and anterior 2/


Introduction
Oral carcinoma is the 6th most common carcinoma worldwide.It is one of the common cancer in man in high risk countries like Srilanka, India, Pakistan, Bangladesh and accounts up to 30% of all new cases of cancer compared to 2% in UK and 8% in France 1 .The 5 year survival rate for oral carcinoma is only 50%.Patients of oral carcinoma are at high risk from secondary neoplasm.Up to 30% of patients later develop another tumour.During its earliest stage, oral cancer may be totally asymptomatic or it may present with mild irritation.Pain usually occurs when the lesion becomes more advanced and ulcerated.So oral cancers are notorious for their late presentations.Oral intake may worsen the pain and lead to malnutrition and dehydration.Associated symptoms include bleeding, poor dental fit, Dysphagia, odynophagia and trismus.Comprehensive examination of the head and neck should be conducted with a focus on oral cavity.Mucosa of all the sub sites of the oral cavity and oropharynx should be examined systemically.Over 90% of all primary malignant tumour of the oral cavity is squamous cell carcinoma.Approximately 5% of tumours are minor salivary glands origin & less then 1-2% being melanoma, lymphoma or sarcoma.Approximately 30% of patients present with palpable metastatic nodes and from the rest another 25% will develop nodal metastasis within 2 years.Up to 30% of patients with T 1 (<2 cm diameter) tumours have occult metastasis at presentation 3 .Carcinoma of tongue accounts for around 35% of squamous cell carcinoma of oral cavity.Most common site of carcinoma tongue is its lateral margin or ventral surface.Carcinoma floor of the mouth normally presents in the lateral and anterior aspect.Carcinoma of tongue appears to have a higher risk of metastasis to the regional lymph nodes and subclinical nodal metastasis may be found in up to 30% of T 1 and T 2 oral tongue carcinoma.For early diagnosis thorough clinical examination & imaging techniques like USG, CT scan, MRI, FNAC is helpful.Biopsy confirms the diagnosis.
Treatment modalities of oral cancer are surgery and radiotherapy.Photodynamic therapy and chemotherapy have occasional applications.Surgery includes removal of primary tumour with or without neck dissection and reconstructive surgery.

Aims and objectives 1) To find out different clinical presentations of oral cancer.
2) To reveal the pathological aspects of oral cancer.Above table shows that highest percentage of patients (76.66%)complains of soreness in the oral cavity followed by ulceration in the oral cavity(70%), difficulty in mastication (60.00%), foul breath56.66%etc.

Discussion
Oral carcinoma is one of the common cancers in high risk counties like Srilanka, India, Pakistan, Bangladesh and accounts up to 30% of all new cases of cancer compared to 2% in UK and 8% in France.It is the sixth most common cancer worldwide 1 .
In the present study, 30 cases of oral cavity carcinoma were studied in 03 Hospitals of Dhaka city from March 2009 to September 2009 and highest incidence (50%) was found in the 6th decade followed by 5th decade (40%) and only 01 patient (3.33%) below 40 years of age.This corresponds to the age incidence found in the Zimbabwean population 2 .Another study at Netherland reveals less than 4% incidence in the age group below 40 years 3 .The study shows increased incidence in female patients (57%) than male patients(43%) might be due to the habit of chewing betel nut with tobacco in these females Which differs from other studies but One study at Nigeria shows male female ratio1.4:1 4 .Almost all the patients presented with multiple symptoms & 76.66% of the patients complain of soreness or irritation in the oral cavity, 70% complain of ulceration in the oral cavity, 60% complain of difficulty in mastication, 56.68% foul breath, 26.66% mild pain in the lesion, 23.33% Spitting of blood, 20% excessive salivation, 23.33% Dysphagia and odynophagia which is almost equal with other studies 5,6,7 In this study it was found that 60% of the lesions were ulcerative in type followed by 36.66%exophytic and 33% infiltrative in nature.The figures are in similarity with that found by Martinez-Conde-R et al 8 .
Regarding site of primary tumor, it was found that most of the lesions were at buccal mucosa (30%), followed by ant.2/3rd of tongue (23.33%), retromolar area (20%), lower gingiva (13.33%) and each of the hard palate, lower lip is equal being 6.66%.Maximum incidence at buccal mucosa is consistent with the findings of study at Ayub Medical college 9 .But Tabbir AA et al found tongue as the most affected site of oral carcinoma 10 .
In the pesent study, 90% of the lesions were squamous cell carcinoma, 6.66% were verrucous carcinoma and 3.33% was adenoid cystic carcinoma.Study at Ayub medical college, Abottabad showed that 94% of the all oral malignancies were squamous cell carcinoma 9 which is consistent with our findings.
In this series, analysis of the histopathological report of the patients reveals that 80% of the lesions were grade I, 10% were grade II and 6.66% were grade III.None of the lesions was grade IV.In a Zimbabwean study, 64.8% were well differentiated and 24.8% moderately differentiated and 10.4% were poorly differentiated carcinoma 2 .

Conclusion
Carcinoma oral cavity usually presents at 5 th and 6 th decade & is commoner in female then male.The commonest site of lesion was buccal mucosa.Squamous cell carcinoma was around 90% of all malignant neoplasm.

Table - III
Clinical Features

Table - V
Site of primary tumour (n=30)