Oral Squamous Cell Carcinoma: A 6-Month Clinico-Histopathologic Audit in a Kenyan Population

Penny Muange^1*, Mark Chindia¹, Wambeti Njiru¹, Elizabeth Dimba¹, Regina Mutave²

¹Department of Oral and Maxillofacial Surgery Oral Pathology and Oral Medicine, School of Dental Sciences, University of Nairobi, Nairobi, Kenya.
²Department of Periodontology/Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, Nairobi, Kenya.

DOI: 10.4236/ojst.2014.410064                

Abstract

Objective: To determine the clinico-histopathologic variations and etiological factors associated with oral squamous cell carcinoma (OSCC). Methods: A descriptive cross-sectional hospital based study was conducted at the University of Nairobi Dental Hospital (UNDH) and Kenyatta National Hospital (KNH) between September 2008 and February 2009. Eighty-two (82) patients presenting with lesions confirmed as OSCC were evaluated for habits identified as risk factors such as tobacco use, alcohol use and betel quid chewing. Demographic features including age and gender as well as clinical parameters such as site of the primary lesion, tumour size and nodal involvement were documented. Incisional biopsies were performed for all patients to confirm the diagnosis and histopathological features noted. Results: The mean age of the patients was 58.49 (range = 14 to 90 years), with a male to female ratio of 1.6:1. Remarkably, 13.4% of the patients were aged 40 years and below. The peak incidence was found to have been in the 6^th - 7^th decades. Tobacco use was the main associated etiological factor (73.2%) followed by alcohol use (57.3%). Notably, 25.6% of the cases had no identifiable risk factor. The tongue was the most common site (35%) followed by the palate (22%) (p = 0.03). The least commonly affected site was the floor of the mouth (10%). The most common stage at presentation was stage IV (52.4%) and; the poorly differentiated OSCC was the most common histopathologic variant (48.8%) followed by the well differentiated (30.5%) and moderately differentiated OSCC (20.7%). Conclusion: In the present investigation it is evident that OSCC has a male predilection with a peak incidence in the 6^th - 7^th decades and most commonly manifests in the tongue at stage IV with the poorly differentiated subtype being the most common. Of the cases diagnosed 13.4% were aged 40 years and below.

Keywords

Oral, Squamous Cell Carcinoma, Clinico-Histopathologic, Aetiological Factors

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	International Agency for Research on Cancer (IARC). Lyon (France): The Agency 2006.
[2]	Onyango, J.F., Omondi, B.I., Njiru, A. and Awange, O.O. (2004) Oral Cancer at Kenyatta National Hospital, Nairobi. East African Medical Journal, 81, 318-321. http://dx.doi.org/10.4314/eamj.v81i6.9182
[3]	Parkins, G.E., Armah, G. and Ampofo, P. (2007) Tumours and Tumour-Like Lesions of the Lower Face at Korle Bu Teaching Hospital, Ghana—An Eight Year Study. World Journal of Surgical Oncology, 5, 48. http://dx.doi.org/10.1186/1477-7819-5-48
[4]	Olajumoke, A.E., Wasiu, L.A., Olufemi, G.O., Mubarak, M.E. and Olalekan, M.G. (2008) Oral Squamous Cell Carcinoma: A Clinicopathologic Review of 233 Cases in Lagos, Nigeria. Journal of Oral and Maxillofacial Surgery, 66, 1595-1599. http://dx.doi.org/10.1016/j.joms.2007.12.025
[5]	Arotiba, G.T., Ladeinde, A.L., Oyeneyin, J.O. and Nwawolo, C.C. (2006) Malignant or Facial Neoplasms in Lagos, Nigeria. East African Medical Journal, 83, 62-68. http://dx.doi.org/10.4314/eamj.v83i3.9399
[6]	Otoh, E.C., Johnson, N.W., Olasoji, H.O., Danfillo, I.S. and Adeleke, O.A. (2005) Intra-Oral Carcinomas in Maiduguri, North-Eastern Nigeria. Oral Diseases, 11, 379-385. http://dx.doi.org/10.1111/j.1601-0825.2005.01134.x
[7]	Chidzonga, M.M. (2006) Oral Malignant Neoplasia: A Survey of 428 Cases in Two Zimbabwean Hospitals. Oral Oncology, 42, 177-183. http://dx.doi.org/10.1016/j.oraloncology.2005.07.003
[8]	Chidzonga, M.M. and Mahomva, L. (2006) Squamous Cell Carcinoma of the Oral Cavity, Maxillary Antrum and Lip in a Zimbabwean Population: A Descriptive Epidemiological Study. Oral Oncology, 42, 184-189. http://dx.doi.org/10.1016/j.oraloncology.2005.07.011
[9]	Dimba, E.A.O., Gichana, J., Limo, A.K., Wakoli, K.A., Chindia, M.L. and Awange, D.O. (2007) An Audit of Oral Diseases at a Nairobi Centre, 2000-2004. International Dental Journal, 57, 439-444.
[10]	Onyango, J.F. and Macharia, I.M. (2006) Delays in Diagnosis, Referral and Management of Head and Neck Cancers Presenting at Kenyatta National Hospital. East African Medical Journal, 83, 85-91.
[11]	Warnakulasuriya, S. (2009) Global Epidemiology of Oral and Oropharyngeal Cancer. Oral Oncology, 45, 309-316. http://dx.doi.org/10.1016/j.oraloncology.2008.06.002
[12]	Sparano, A., Weinstein, G., Chalian, A., Yodul, M. and Weber, R. (2004) Multivariate Predictors of Occult Neck Metastasis in Early oral Tongue Cancer. Otolaryngology-Head and Neck Surgery, 131, 472-476. http://dx.doi.org/10.1016/j.otohns.2004.04.008
[13]	Liao, C., Chang, J., Wang, H., Ng, S.H., Hsueh, C., Lee, L.Y., et al. (2007) Salvage Therapy in Relapsed Squamous Cell Carcinoma of the Oral Cavity: How and When? Cancer, 112, 94-103.
[14]	Freier, K., Engel, M., Lindel, K., Fletchtenmacher, C., Mühling, J., Hassfeld, S. and Hofele, C. (2008) Neoadjuvant Concurrent Radiochemotherapy Followed by Surgery in Advanced Oral Squamous Cell Carcinoma (OSCC): A Retrospective Analysis of 207 Patients. Oral Oncology, 44, 116-123. http://dx.doi.org/10.1016/j.oraloncology.2007.01.006
[15]	Brown, J.S., Blackburn, T.K., Woolgar, J.A., Lowe, D., Errington, R.D., Vaughan, E.D. and Rogers, S.N. (2007) A Comparison of Outcomes for Patients with Oral Squamous Cell Carcinoma at Intermediate Risk of Recurrence Treated by Surgery Alone or with Post-Operative Radiotherapy. Oral Oncology, 43, 764-773. http://dx.doi.org/10.1016/j.oraloncology.2006.09.010
[16]	Mehrotra, R., Singh, M., Kishore Gupta, R., Singh, M. and Kapoor, A.K. (2005) Trends of Prevalence and Pathological Spectrum of Head and Neck Cancers in North India. Indian Journal of Cancer, 42, 89-93. http://dx.doi.org/10.4103/0019-509X.16698
[17]	Moshy, J. and Chindia, M.L. (2003) Clinical Characteristics of Oral Squamous Carcinoma at Muhimbili National Hospital, Tanzania. African Journal of Health Sciences, 4, 170-172.
[18]	Liu, L., Kumar, S.K.S., Sedghizadesh, P.P., Jayakar, A.N. and Shuler, C.F. (2008) Oral Squamous Cell Carcinoma Incidence by Subsite among Diverse Racial and Ethnic Populations in California. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, 105, 470-480. http://dx.doi.org/10.1016/j.tripleo.2007.07.007
[19]	Guneri, P., Cankaya, H., Yavuzer, A., Guneri, A., Erisen, L., Ozkul, D., et al. (2005) Primary Oral Cancer in a Turkish Population Sample: Association with Sociodemographic Features, Smoking, Alcohol, Diet and Dentition. Oral Oncology, 41, 1005-1012. http://dx.doi.org/10.1016/j.oraloncology.2005.06.002
[20]	Stewart, B.W. and Kleihues, P. (2003) World Cancer Report. IARC Press, Lyons, 232-236.
[21]	Sherin, N., Simi, T., Shameena, P.M. and Sudha, S. (2008) Changing Trends in Oral Cancer. Indian Journal of Cancer, 45, 93-96. http://dx.doi.org/10.4103/0019-509X.44063
[22]	Pathak, K.A., Nason, R., Talole, S., Abdoh, A., Pai, P., Deshpande, M., Chaturvedi, P., Chaukar, D., D’Cruz, A. and Bhalavat, R. (2009) Cancer of the Buccal Mucosa: A Tale of Two Continents. International Journal of Oral and Maxillofacial Surgery, 38, 146-150. http://dx.doi.org/10.1016/j.ijom.2008.07.009
[23]	Iamaroon, A., Pattanaporn, K., Pongsiriwet, S., Wanachantararak, S., Prapayasatok, S., Jittidecharaks, S., Chitapanarux, I. and Lorvidhaya, V. (2004) Analysis of 587 Cases of Oral Squamous Cell Carcinoma in Northern Thailand with a Focus on Young People. International Journal of Oral and Maxillofacial Surgery, 33, 84-88. http://dx.doi.org/10.1054/ijom.2003.0503
[24]	Ribeiro, A.P., Silva, A.S., Simonato, L.E., Salzedas, L.P., Sundefeld, M.M. and Soubhia, A.P. (2009) Clinical and Histopathological Analysis of Oral Squamous Cell Carcinoma in Young People: A Descriptive Study in Brazilians. British Journal of Oral and Maxillofacial Surgery, 47, 95-98. http://dx.doi.org/10.1016/j.bjoms.2008.05.004
[25]	Muwonge, R., Ramadas, K., Samkila, R., Thara, S., Thomas, G., Vinoda, J. and Sankaranaryanan, R. (2008) Role of Tobacco Smoking, Chewing and Alcohol Drinking in the Risk of Oral Cancer in Trivandrum, India: A Nested Case-Control Design Using Incident Cancer Cases. Oral Oncology, 44, 446-454. http://dx.doi.org/10.1016/j.oraloncology.2007.06.002
[26]	O’Regan, E.M., Timon, C., Sheils, O., Codd, M., O’Leary, J.J. and Toner, M. (2006) Squamous Cell Carcinoma of the Head and Neck in Young Irish Adults. British Journal of Oral and Maxillofacial Surgery, 44, 203-206. http://dx.doi.org/10.1016/j.bjoms.2005.05.011
[27]	Siriwardena, B.S., Tilakaratne, A., Amaratunga, E.A. and Tilakaratne, W.M. (2006) Demographic, Etiological and Survival Differences of Oral Squamous Cell Carcinoma in the Young and the Old in Sri Lanka. Oral Oncology, 42, 831-836. http://dx.doi.org/10.1016/j.oraloncology.2005.12.001
[28]	Shah, J.P., Johnson, N.W. and Batsakis, J.G. (2003) Aetiology and Risk Factors for Oral Cancer. In: Dunitz, M., Ed., Oral Cancer, 38-42.
[29]	Schmidt, B.L., Dierks, E.J., Homer, L. and Potter, B. (2004) Tobacco Smoking History and Presentation of Oral Squamous Cell Carcinoma. Journal of Oral and Maxillofacial Surgery, 62, 1055-1058. http://dx.doi.org/10.1016/j.joms.2004.03.010
[30]	Castellsague, X., Quintana, M.J., Martinez, M.C., Nieto, A., Sanchez, A., Juan, A., Monner, A., Carrera, M., Agudo, A., Quer, M., Munoz, N., Herrero, R., Franceschi, S. and Xavier Bosch, F.X. (2004) The Role of Type of Tobacco and Type of Alcoholic Beverage in Oral Carcinogenesis. International Journal of Cancer, 108, 741-749. http://dx.doi.org/10.1002/ijc.11627