|Year : 2014 | Volume
| Issue : 5 | Page : 13-16
Prevalence of oral potentially malignant and malignant lesions at a tertiary level hospital in Hyderabad, India
Shyam Naragani Durga Venkata Naga1, Kiran Kumar Gundamaraju1, Sridhar Reddy Bujunuru1, Prasad Navakoti1, Lalith Prakash Chandra Kantheti2, Chandrashekar Poosarla2
1 Department of Oral and Maxillofacial Pathology, GDCH, Hyderabad, A.P., India
2 Sibar Institute of Dental Sciences, Guntur, A.P., India
|Date of Web Publication||10-Mar-2014|
Kiran Kumar Gundamaraju
H.No: 1-5-166, New Maruthinagar, Road No. 11A, Kothapet, Hyderabad 500 060, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: To study the prevalence of potentially malignant and malignant oral lesions in Hyderabad, India.
Materials and Methods: An institutional retrospective study of biopsies sent to the department of general pathology in Osmania General Hospital (OGH), Hyderabad. The data was collected year-wise for a period of 5 years from 2007 to 2011 with reference to age, sex, site involved, and final diagnosis based on the histopathological findings.
Results: A total of 1005 oral biopsies were reviewed. Of these, cases were categorized into benign, potentially malignant, and malignant. Buccal mucosa was the most frequently involved site followed by tongue. Lichen planus constituted the highest number of patients in potentially malignant group, while in malignant group, squamous cell carcinoma was most prevalent.
Conclusion: This study showed that potentially malignant and malignant oral lesions were widespread in the patients of this region.
Keywords: Lichen planus, oral lesions, prevalence, submucous fibrosis
|How to cite this article:|
Naga SD, Gundamaraju KK, Bujunuru SR, Navakoti P, Kantheti LC, Poosarla C. Prevalence of oral potentially malignant and malignant lesions at a tertiary level hospital in Hyderabad, India. J NTR Univ Health Sci 2014;3, Suppl S1:13-6
|How to cite this URL:|
Naga SD, Gundamaraju KK, Bujunuru SR, Navakoti P, Kantheti LC, Poosarla C. Prevalence of oral potentially malignant and malignant lesions at a tertiary level hospital in Hyderabad, India. J NTR Univ Health Sci [serial online] 2014 [cited 2020 Nov 24];3, Suppl S1:13-6. Available from: https://www.jdrntruhs.org/text.asp?2014/3/5/13/128484
| Introduction|| |
Oral cancer is a major health problem in world, particularly in developing countries like India. Studies have shown that worldwide, the annual incidence exceeds 3,000,000 cases.  Incidence rates per 100,000 population in India were found to be 12.8 in men and 7.5 in women.  The main risk factors are tobacco in the form of chewing and smoking and alcohol consumption. , It typically occurs in the elderly men during the fifth to eighth decade of life and is rarely seen in young people. But, due to the emergence of ghutkas and pan masalas, which are packed attractively and easily available, incidence of cancer in young individuals is increasing.  Literature suggests that oral cancers in young patients show a general trend of aggressive course and poor prognosis.  Female smokers were found to be at higher risk for oral cancer than male smokers.  Prognosis of oral cancer depends on site of the lesion; carcinoma of lip has a much better prognosis than of tongue or of floor of mouth. Prognosis of oral cancer is generally poor, with a 5-year survival of less than 50%. Local recurrences as well as lymph node metastases occur in a significant percentage of patients, while distant metastases are less common. 
Potentially malignant conditions like oral submucous fibrosis, leukoplakia, erythroplakia, and lichen planus are commonly seen in Indian sub-continent, and they carry an increased risk for malignant transformation in the oral cavity.
The spectrum of oral malignancy varies from place to place within the country. The prevalence rate of oral cancer is high in Hyderabad of Andhra Pradesh, and patients come from the surrounding areas to the tertiary level referral OGH. This study was planned to study the spectrum of potentially malignant and malignant oral lesions referred to OGH, Hyderabad for a period of 5 years from 2007 to 2011.
| Materials and Methods|| |
This is an institutional retrospective study from 2007 to 2011. Data was collected year-wise in the context of age, sex, site involved, and final diagnosis given based on histopathological features. Patient records maintained in the department of general pathology were retrieved manually.
| Results|| |
A total of 19988 biopsies were reported in this Institute during the study period. Of these biopsies, 1,005 (5%) were from the oral region. Of the oral biopsies, 123 (12.23%) patients were reported to be potentially malignant, 293 (29.15%) were malignant, and 589 (58.6%) were others. The year-wise trends of prevalence revealed that the maximum rate of these oral biopsies were, in 2011, with 256 biopsies, followed by during 2010 with 238 biopsies [Table 1], [Figure 1]. Of the total cases, 586 were males and 419 were females. Of the malignant cases, 183 were males and 110 were females. Of the potentially malignant cases, 88 were males and 35 were females [Table 2], [Figure 2]. In the group of 293 patients with malignancy, 234 were diagnosed as squamous cell carcinoma, of which 182 (62%) had well-differentiated carcinoma, 42 (14%) had moderately-differentiated carcinoma, and 10 (3.4%) had poorly-differentiated carcinoma. In the potentially malignant group, 65 were reported as lichen planus (52.8%), 43 were reported as OSMF (34.95%), and 12 were reported as leukoplakia (9.75%) [Table 3], [Figure 3].
According to the age-wise distribution, majority of the patients were reported in the age group of 21-30 years [Table 4], [Figure 4]. On the basis of the site of involvement, the buccal mucosa was most frequently involved in 218 patients, followed by the tongue in 73 patients.
| Discussion|| |
In the last 5 years, 1005 oral biopsies were studied in this institute. 293 malignant and 123 potentially malignant cases were recorded. 234 (23.3%) of oral biopsies were diagnosed as oral squamous cell carcinoma (OSCC). Padmakumary et al. in their study have shown that OSCC constituted 14% of all cancers at the Regional Cancer Center, Kerala, India.  The male to female ratio reported in our study was 1.4:1, whereas 2.3:1 ratio was reported by Iype et al. 2001.  Gangane et al. reported that majority of oral malignancies in their study were reported in the 50-59 year age group.  However, Saraswathi et al. reported maximum patients in the 40-61 year age group. 
Interpretation of data from a single institution has clear limitations. The data reflects the specific patient population reporting to this hospital and not the community as a whole. In this study, year-wise trends of prevalence of malignancy revealed maximum number in 2011 followed by 2010. However, Mehrotra et al., analyzing the results from 2003-2007, did not observe any clear-cut trends in prevalence, although a hint of a gradual increase could be discerned. This could reflect increasing usage of chewing gutka and paan masala.  What was the cause of the sudden increase in 2011 cannot be easily explained. Could it be due to the induction of enthusiastic oral surgeons in the hospital or to a spurt in awareness about oral health coupled with awareness campaigns launched by the hospital is not known.
Histopathological diagnosis revealed that 589 cases were benign lesions and comprised 58.6% of total cases. Of the 123 potentially malignant lesions, 12 were reported as leukoplakia (9.75%), 65 were reported as lichen planus (52.8%), and 43 were reported as OSMF (34.95%). In the 293 oral malignancies, well-differentiated carcinoma constituted 182 (62.1%), while moderately-differentiated carcinoma constituted 42 (14.3%), and 10 (34.1%) were poorly-differentiated carcinoma. Iype et al. in their study also reported that 52.6% of their patients had well-differentiated tumors.  On the bases of site of involvement, buccal mucosa 218 (47.7%) was found to be most frequently involved site followed by tongue (27.6%). Bhurgri suggested in her report from South Karachi, Pakistan that the buccal mucosa was the most frequently involved site (55.9%), followed by tongue (28.4%). 
Since the oral cavity is more accessible to complete examination, it could be used in early detection of pre-cancerous and cancerous lesions, but either due to ignorance or inaccessibility of medical care, the disease usually gets detected in later stages. Use of screening and detection aids such as vital stains, visualization aids like Vizylite® and VELscope® as well as Oral CDX® brush biopsy have been reported to increase the number of cases diagnosed at an early stage, or even in the pre-malignant stage. Development of molecular markers may improve the early diagnosis and help in predicting treatment response. New treatment modalities including tumor-specific antibodies, and gene therapy are emerging, giving more hope for patients with oral cancer. There is an urgent need for appropriate prevention and cessation strategies for smoking and smokeless tobacco products. Study of prevalence patterns from different parts of India may help in devising such strategies.
Further, such studies for longer time periods at different levels of referral centers may help us in identifying the prevalence patterns of this dreadful disease so that prevention activities can be carried out in order to decrease the incidence and mortality rates due to oral cancers.
| References|| |
|1.||Mehrotra R, Pandya S, Chaudhary AK, Kumar M, Singh M. Prevalence of Oral Pre-malignant and Malignant Lesions at a Tertiary Level Hospital in Allahabad, India. Asian Pac J Cancer Prev 2008;9:263-6. |
|2.||Kuruvilla J. Utilizing dental colleges for the eradication of oral cancer in India. Indian J Dent Res 2008;19:349-53. |
|3.||Dikshit RP, Kanhare S. Tobacco habits and risk of lung, oropharyngeal and oral cavity cancer; a population - based case-control study in Bhopal, India. Int J Epidemiol 2000;29:609-14. |
|4.||Nandakumar A, Thimmasetty KT, Sreeramareddy NM, Venugopal TC, Rajanna, Vinutha AT, et al. A population-based case-control investigation on cancers of the oral cavity in Bangalore, India. Br J Cancer 1990;62:847-51. |
|5.||Gangane N, Chawla S, Anshu, Gupta SS, Sharma SM. Reassessment of Risk Factors for Oral Cancer. Asian Pacific J Cancer Prev. 2007;8:243-8. |
|6.||Iype EM, Pandey M, Mathew A, Thomas G, Sebastian P, Nair MK. Oral cancer among patients under the age of 35 years. J Postgrad Med 2001;47:171-6. |
|7.||Muscat JE, Richie JP Jr, Thompson S, Wynder EL. Gender Differences in Smoking and Risk for Oral Cancer. Cancer Res 1996;56:5192-7. |
|8.||Padmakumary G, Varghese C. Annual Report. 1997. Hospital Cancer Registry. Thiruvananthapuram, India: Regional Cancer Centre; 2000. p. 3-7. |
|9.||Iype EM, Pandey M, Mathew A, Thomas G, Sebastian P, Nair MK. Oral cancer among patients under the age of 35 years. J Postgrad Med 2001;47:171-6. |
|10.||Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Cross-sectional study in South India. Indian J Dent Res 2006;17:121-5. |
|11.||Mehrotra R, Singh M, Kumar D, Pandey AN, Gupta RK, Sinha US. Age specific incidence rate and pathological spectrum of oral cancer in Allahabad. Indian J Med Sci 2003;57:400-4. |
|12.||Bhurgri Y. Cancer of the oral cavity- trends in Karachi South (1995-2002). Asian Pac J Cancer Prev 2005;6:22-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]