|Year : 2020 | Volume
| Issue : 2 | Page : 124-131
Reporting frequency of potentially malignant oral disorders and oral cancer: A 10-year retrospective data analysis in a teaching dental institution
Namburu J Ramya1, Poosarla C Shekar2, Baddam V. Ramana Reddy2
1 SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Oral Pathology and Microbiology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
|Date of Submission||12-Jan-2020|
|Date of Decision||09-Mar-2020|
|Date of Acceptance||15-Jun-2020|
|Date of Web Publication||18-Jul-2020|
Dr. Poosarla C Shekar
Department of Oral Pathology and Microbiology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Incidence of oral potentially malignant and malignant lesions is increasing, thereby escalating the burden of cancer on our nation. Oral cancer and preceding lesions are of utmost importance for the present scenario. Various risk factors predominantly, consumption of tobacco with other synergetic products affect the oral mucosa. Registry of these lesions at a hospital-level and national level shall bring awareness in the public sector. Categorization of cases would lead to pooling of the overall data for oral potentially malignant disorders (OPMDs) and oral cancer (OC). The present study aimed to report the frequency of patients affected with potentially malignant oral disorders and oral cancer and to articulate the data at a teaching dental institution.
Materials and Methods: A retrospective study was conducted in the department of Oral Pathology from the archives between 2009 and 2019. Data were manually retrieved year-wise concerning age, sex, site involved, and histopathological findings. Cases were evaluated to segregate OPMDs and OC.
Results: Overall, 3223 oral biopsies were reviewed and analyzed. Six-hundred eighty-three (21.16%) patients were segregated, out of which OPMDs were 205 (6.38%) and 478 (14.8%) were oral cancer. Oral leukoplakia 3.2% constituted the highest number of patients in OPMDs group, followed by oral lichen planus (1.6%) and oral submucous fibrosis (1.36%). The most frequent lesion in the oral cancer group was oral squamous cell carcinoma (12.9%) followed by verrucous carcinoma (1.86%). The average age range affects the most common lesions was fifth decade in case of oral leukoplakia and sixth decade in case oral squamous cell carcinoma. The most frequently involved site in the oral cavity was buccal mucosa.
Conclusion: Studies evaluating the prevalence rate of the OPMDs and oral carcinoma of the oral cavity are beneficial for general dental practitioners in making early diagnosis and treatment. Awareness programs on preventive and diagnostic measures at public and health sectors shall help in understanding the latest scenario. This is possible only after the registry of the lesions at various programmed levels.
Keywords: Diagnosis, leukoplakia, lichen planus, oral cancer, screening
|How to cite this article:|
Ramya NJ, Shekar PC, Reddy BV. Reporting frequency of potentially malignant oral disorders and oral cancer: A 10-year retrospective data analysis in a teaching dental institution. J NTR Univ Health Sci 2020;9:124-31
|How to cite this URL:|
Ramya NJ, Shekar PC, Reddy BV. Reporting frequency of potentially malignant oral disorders and oral cancer: A 10-year retrospective data analysis in a teaching dental institution. J NTR Univ Health Sci [serial online] 2020 [cited 2020 Aug 11];9:124-31. Available from: http://www.jdrntruhs.org/text.asp?2020/9/2/124/289894
| Introduction|| |
Oral cancer is one of the most fatal health problems faced by mankind today. According to GLOBOCAN 2018, oral cancer is one of the top five cancers that affect the Indian population. India has one-third of oral cancer cases in the world. It accounts for 30% of all cancers in India, posing a significant challenge to both preventive and diagnostic health services. Due to the cultural, ethnic, geographic factors and the popularity of addictive habits, a probable track toward oral cancer is high. To decrease the high mortality and morbidity associated with this cancer, one way forward is to improve early detection of oral cancer by organized screening programs. There are few precancerous lesions and conditions that precede cancer. According to WHO (2005), some of the oral potentially malignant disorders (OPMDs) are leukoplakia, erythroplakia, oral submucous fibrosis, lichen planus, lichenoid reaction, smokers palate, graft vs. host disease, epidermolysis bullosa, actinic cheilitis, discoid lupus erythematosus and some of the most common oral carcinomas are squamous cell carcinoma, verrucous carcinoma, and melanoma. More than 90% of all oral cancers are oral squamous cell carcinomas, which is often preceded by an OPMD. The malignant transformation rate of most of the potentially malignant disorders is high. Among the above mentioned OPMDs, leukoplakia, erythroplakia, oral submucous fibrosis, and lichen planus are commonly seen in India. Hence, there is a need for knowledge about the prevalence rate and early detection of these OPMDs to decrease the burden of cancer incidence. Aim: This study aims to estimate the frequency of oral potentially malignant disorders and oral carcinomas referred to teaching dental institution for a period of 10 years (2009–2019). Objectives: To determine the frequency of OPMDs and oral carcinomas among other oral lesions. To analyze most common lesion, age, gender predilection, and the most common site involved among the common OPMDs and oral carcinomas.
| Materials and Methods|| |
The data was collected retrospectively year wise for a period of 10 years from 2009 to 2019 from the archives of the teaching dental institution. Ethical approval for this study (protocol no. 30/IEC/SIBAR/UG/2018) was obtained from the Institutional Ethical Committee of Sibar Institution of Dental Sciences, Guntur 12th NOV 2018. All the reported biopsies involving the oral cavity were utilized to analyze the precise sample. The subjects with a histopathological diagnosis of OPMDs and oral carcinomas were included in the study. Periapical lesions, odontogenic cysts, odontogenic tumors, tumors arising from the soft tissue, salivary gland, bone, and secondary tumors were excluded from the study. Descriptive statistics were utilized for plotting parameters of the study sample on chronological distribution, age, gender, and site involved.
| Results|| |
A total of 3223 oral biopsies were reported during the study period that is from 2009 to 2019. Six-hundred eighty-three (21.1%) cases were OPMDs (6.36%) and oral carcinomas (14.8%). Distribution of different OPMDs and oral cancers were as follows: 103 were reported as oral leukoplakia (3.2%), 51 as oral lichen planus (1.6%), 44 as oral submucous fibrosis (1.36%), 7 as lichenoid reaction (0.2%), 60 as verrucous carcinoma (1.86%), and 418 as oral squamous cell carcinoma (12.9%) [Table 1].
Age-wise distribution revealed that a majority of cases were reported in fifth decade for oral leukoplakia, fourth decade for oral lichen planus, third decade for oral submucous fibrosis, sixth decade for lichenoid reaction, verrucous carcinoma, and oral squamous cell carcinoma [Table 2]. Gender-wise distribution in cases of oral leukoplakia, oral submucous fibrosis, verrucous carcinoma, and oral squamous cell carcinoma, a higher male predilection was noticed. In the contrary, a higher female predilection was seen in cases of oral lichen planus and lichenoid reaction [Table 3]. The most common site involved with these cases was the buccal mucosa and buccal vestibule (57%), followed by the tongue (10%), maxilla and palate (9%), retromolar area (9%), labial mucosa and labial vestibule (7%), alveolar ridge and gingiva (6%), and floor of the mouth (2%) [Graph 1].
| Discussion|| |
Rates of oral cancer in India are high, that is, 20 per 100,000 population and accounts for over 30% of all cancers in the country. It has been well established by researchers that virtually all oral cancers are preceded by visible clinical changes in the oral mucosa in the form of white or red patches which may or may not be associated with additional features of significant discomfort. They have a higher risk of malignant transformation unless diagnosed early and treated. Information about the real prevalence of OPMDs among the general population worldwide is scarcely available. However, it is reported to be from 1% to 5%.
Different forms of tobacco usages (smokeless and smoking), UV radiations, and nontobacco oral squamous cell carcinoma are related with human papillomavirus, and genetic effects can be the common risk factors that cause OPMD or oral squamous cell carcinoma. Surgery and chemotherapy along with radiation are the few treatment modalities which show promising results in prolonging the survival rate for early diagnosed patients. Past decade statistics show a 5-year survival rate of 50% cases with advanced treatments.
The frequency of OPMDs was (6.36%) in the present study which is in accordance with Byakodi et al. (2.5%–8.4%), Hassona et al. (2.8%), Mello et al. (4.47%), and Kumar et al. (5.6%) but in contrary to studies done by Al Attas et al. (10.5%). The overall frequency of oral cancer in the present study was (14.8%) which is congruence to the studies conducted by Bhatnagar et al. (16.8%) and Kumar et al. (18.8%) but in the contrary to the studies conducted by Patil et al. (26.88%) and Rooban (25%). Previous studies pondered various parameters and demographic factors to indicate the prevalence of OPMDs and oral cancers while evaluating the sample population.
Oral leukoplakia being the most common OPMD was first defined by World Health Organization in 1978 as “A white patch or plaque which cannot otherwise be characterized clinically or pathologically as any other disease. It can be diagnosed as a flat to slightly elevated, gray/white translucent plaque which was either fissured/wrinkled.” “Malignant transformation rate of oral leukoplakia on an average is 1% in diverse populaces and topographical areas with the greater risk reported by 43%.”
According to our study, the most common OPMD was leukoplakia (3.2%) with a similar data in studies conducted by Axell (3.4%), Kovac-Kavcic and Skaleric (3.6%), Saraswathi et al. (0.2%–5.2%), Petti (1.7%–2.7%), Al Attas et al. (2.8%), and Mello et al. (4.11%) but in contrary to the study conducted by Warnakulasuriya (15.1%). Cross-sectional studies state that the prevalence of oral leukoplakia in Indian subcontinent has been on a constant raise. Various etiological factors like smoking and chewing tobacco would lead to a hyperkeratotic lesion on the oral mucosa.
Oral Lichen planus (OLP) being the second most common OPMD in this study was first described in 1869 by Erasmus Wilson as “leichen planus,” “An eruption of pimples remarkable for their color, their figure, their structure, their habits of isolated and aggregated development, their habitat, their local and chronic character and for the melasmic stains which they leave behind them when they disappear.” “The etiology and pathogenesis of OLP are not clearly understood. Some potential external and internal etiologic events such as genetic background, autoimmunity, hepatitis C virus, and psychological stress have been suggested to trigger OLP.” Present study indicates the frequency of lichen planus (1.6%) which is in accordance with studies done by Pindborg et al. (0.1%–1.5%), Mathew et al. (1.20%), Patil et al. (0.9%), Hassona et al. (1.8%), and Ghom (0.1%–2.2%) but in contrary to study conducted by Saraswathi et al. (0.15%).
Oral submucous fibrous (Pindborg in 1966) defined as “an insidious chronic disease affecting any part of the oral cavity and sometimes pharynx. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with juxta-epithelial inflammatory reaction followed by fibroblastic changes in the lamina propria, with epithelial atrophy leading to stiffness of the oral mucosa causing trismus and difficulty in eating.” “OSMF is regarded as a condition as it affects different regions of the oral cavity as well as pharynx. Genomic instability and altered keratinocyte phenotype have been reported to play an important role in malignant transformation.” Prevalence of OSMF is 2.01% and malignant transformation rate of 2.3%–7.6% has been reported in the literature.
Prevalence of OSMF in the present study (1.36%) which is in analogous to studies done by Mehta et al. (0.03% and 3.2%), Mathew et al. (2.01%), Chatterjee et al. (2.7%), and Sachdev et al. (0.03%–6.4%). This is in contrary to the studies done by Al Attas (0.50%) and Saraswathi et al. (0.55%)
Oral lichenoid reactions are “disease conditions with definite identifiable etiology. It can occur either due to intake of drug, i.e., lichenoid drug eruptions, or due to contact with some potential irritants which majority of times are dental materials.” Various terminologies have been used to describe this condition, as oral lichenoid lesions, oral lichenoid reaction, oral lichenoid tissue reaction, lichenoid contact stomatitis, or lichen-planus-like lesions, due to the similar clinical and histological aspects of OLL and oral lichen planus.
The present study plotted a prevalence of 0.2% in the study sample which does not match the with the study done by Robledo-Sierra et al. (2.4%). The frequency of lichenoid reactions plotted in the study sample is sufficient lesser than the global prevalence rate as its diagnosis resembles oral lichen planus. A thorough clinical history can help in segregation of patients in this category.
Oral verrucous carcinoma is a rare tumor first described by Ackerman. It is a special form of well-differentiated squamous cell carcinoma with specific clinical and histological features. Various names are used in the literature to describe this entity, including Ackerman's tumor, Buschke-Loewenstein tumor, florid oral papillomatosis, epithelioma cuniculatum, and carcinoma cuniculatum. The tumor grows slowly and locally, invasive in nature and unlikely to metastasize. The present study showed a frequency of verrucous carcinoma (1.86%), which is likewise to the study conducted by Franklyn et al. (2%), Chaisuparat et al. (2%), and Bouquot (3%).
Oral Squamous cell carcinoma is defined as “a malignant neoplasm exhibiting squamous differentiation as characterized by the formation of keratin and/or the presence of intercellular bridges.” It is the most common oral malignancy, representing up to 80%–90% of all malignant neoplasms of the oral cavity. Although oral cancer incidence is highly variable worldwide, it is accepted that oral cavity ranges from the sixth to the ninth most common anatomical location for cancer, depending mostly on the country (and even specific region in some countries) and gender of the patients. Despite this mean incidence, it can represent the most common location for cancer in some specific regions, especially in southeastern Asia.
The present study showed that oral squamous cell carcinoma 12.9% is the most frequent tumor of the oral cavity, which is in accordance with the study conducted by Bhatnagar et al. (16.8%) and Kumar et al. (18.8%) but in contrary to the studies conducted by Patil et al. (26.88%) and Rooban (25%), and Tandon et al. (39.4%).
Various lesions in OPMDs and OC revealed the highest frequency in the age groups they prevailed. Oral leukoplakia in the present study reveals the highest frequency of oral leukoplakia in the fifth decade of life which is in accordance with Liu et al., warankulasuriya et al., and Gopinath et al. Oral lichen planus showed a peak age in fourth to fifth decade of life, which is in consistent with Mathew et al., Fernández-González et al., and Lauritano et al. Oral submucous fibrosis revealed a peak age of occurrence in third decade of life which is similarly stated by Ali et al., Sabarinath et al., Rajendran, and Kumar et al. Cases of lichenoid reaction showed the peak age in sixth decade of life which is analogous to the Bernardes et al. Oral verrucous carcinoma showed a peak age in sixth decade of life which is in accordance with Alkan et al., Rodrigues et al., and Sonalika et al. Oral squamous cell carcinoma cases showed a peak age frequency around sixth decade of life which is similar to studies done by Tandon et al.,Lin et al., Gaitán-Cepeda et al., Tandon et al., Sharma et al., Johnson et al., Misra et al., and Kumar et al.
The present study plotted a higher male predilection in cases with oral leukoplakia. This is in accordance with the study conducted by Lapthanasupkul et al., Gopinath et al., Liu et al., Parlatescu et al., and Sivakumar et al. Higher female predilection was plotted for cases of oral lichen planus which is in accordance with Parashar, Chatterjee et al., Omal et al., Ingafou et al., and Xue et al. Higher male predominance was seen in oral submucous fibrosis which is comparable to studies reported by Rajendran, Vinay et al., Rooban et al., Ali et al., Sarode et al., and Mathew et al. Cases of oral lichenoid reaction also showed higher female predilection which is similar to studiesofBernardes et al., Cortés-Ramírez et al., and Ramalingam et al. Oral verrucous carcinoma showed a higher male predilection which is similar to the studies of Alkan et al., Franklyn et al., Garcia et al., and Sonalika and Anand. The study sample showed a higher male predilection in cases with oral squamous cell carcinoma which is analogous to the studies conducted by Tandon et al., Tandon et al., Kumar et al., Singh et al., Jayasooriya et al., and Shah et al.
The present study showed that the most common site involved in the oral cavity was buccal mucosa in cases of oral leukoplakia which is in accordance with Lapthanasupkul et al., Gopinath et al., Liu et al., Parlatescu et al., Sivakumar et al. and Starzyńska et al. Study sample showed that the cases of oral lichen planus affected most commonly buccal mucosa. This is in accordance with the study conducted by Mohan et al., Gupta et al., Fernández-González et al., Rajendran et al., and Varghese et al. Oral submucous fibrosis cases showed site predilection of buccal mucosa which is consistent to studies reported by Chatterjee et al., Sachdev et al., Mathew et al., Al Attas, and Saraswathi et al. Buccal mucosa was the commonest site for cases of lichenoid reactions which is similarly stated by Cortés-Ramírez et al., Ramalingam et al., and Mallo Pérez and Díaz Donado. The most frequent site for oral verrucous carcinoma is buccal mucosa, which is similar to the studies of Franklyn et al.,Yeh, and Waskowska et al. Similar site predilection was noticed in cases with oral squamous cell carcinoma, in which the chiefly affected site is nonkeratinized mucosa, i.e., buccal mucosa, as described by numerous authors. Our study also goes in congruence with Tandon et al., Pathak et al., Tandon et al., Shah et al., More and D'Cruz, Mehrotra et al., Shenoi et al., Addala et al., Gowhar et al., and Naga et al.
Evaluation of OPMDs and oral carcinomas frequency would add a minimal data of a region, which shall contribute to the national registry on cancer and precancer.
| Conclusion|| |
Studies evaluating the prevalence and incidence rates of these lesions help us conducting awareness programs at community centers. These are also beneficial for oral pathologists and general dental practitioners in making early and better diagnosis and treatment. Based on the knowledge, early detection of these lesions minimizes the potential complications and enhances the life expectancy of the patient.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]