Prevalence and Incidence of Types of Oral Malignancy- 5 Year Institutional Study

Nivedha Srinivasan, Dr. Gheena. S

1^st BDS Year, Saveetha Dental College, Chennai

*Corresponding Author E-mail: patelbhumi198@gmail.com

ABSTRACT:

AIM:- The aim of the research is to understand the prevalance and incidence of types of oral malignancy in Chennai population. OBJECTIVE:- India has the highest number of cases of oral malignancy in the world. The burden is not fully appreciated even within India, despite the high incidence and poor survival associated with the disease. The objective is to find the epidemiological variations with relation to oral malignancy in south Indian population. BACKGROUND:- Oral malignancy is a major problem in the subcontinent where it ranks among the top three types in the country. It is significant for public health importance in India. In India, due to cultural, ethnic, geographic factors and the popularity of addictive habits, the frequency of oral malignancy increases. Buccal mucosa is more common followed by tongue. Gutkha- the smokeless tobacco, is a very common cause of oral malignancy. It is known, about two-third of deaths due to oral malignancy occur in developing world, out of which, one- third occur in Indian subcontinent. REASON:- Public health officials, private hospital, academic medical centers within India have recognized oral malignancy as a grave problem. Epidemiological studies on a certain set of population will help us building the data base and to address the people.

KEYWORDS:

INTRODUCTION:

The aim of the research is to understand the prevalence and incidence of types of oral malignancy in Chennai population for the past 5 years. India is known to have the highest number of cases of oral malignancy in world. The burden is fully appreciated even within India, despite the high incidence and poor survival, associated with the disease. The objective is to find the epidemiological variations with relation to oral malignancies in Chennai. Oral malignancy is a major problem in the subcontinent where it ranks among the top three types in the country. Gutkha- the smokeless tobacco, chewing pan and chewing betel nut are a very common cause of oral malignancy.

Although the use of tobacco and alcohol are risk factors for the development of oral cancer, researchers at the Harvard School of Public Health and other institutions have found that smoking was by far the biggest culprit, causing 21percent of overall deaths. The incidence of oral cancer in women has increased significantly, largely due to an increase in women smoking. The chewing of gutka, paan, zarda etc. has increased the incidence of oral cancer within the Asian sub-continent. Over the past decade, an increasing number of young, non-smokers have developed mouth and throat cancer associated with the human-papillomavirus (HPV). Chewing tobacco has always been seen as socially acceptable in India. Unaware of the danger of cancer, tobacco is offered at the end of a meal, regarding it as little more than mouth freshener. Similarly, chewing of the betel nut causes Oral Sub mucous Fibrosis (OSF), a pre - malignant condition associated with oral cancer causing the permanent thickening and hardening of the inner lining of the mouth. The sensation of taste is gradually lost and the ability to tolerate spicy foods diminishes. The condition is not reversible, nor does it have an effective cure. it also causes a risk factor for cardiovascular diseases and asthma. There is more common treatment involves chemotherapy and radiograph. But preventive measures can be taken for a greater chance of recovery and a good quality of life and function.

· the best way to prevent oral cancer is to avoid tobacco and alcohol use

· Cut down on chewing betel leaves (paan with areca nut) and avoid using tobacco.

· Regular check-ups, including an examination of the entire mouth, are essential in the early detection of cancerous and pre-cancerous conditions.

· Many types of abnormalities can develop in the oral cavity in the form of red or white spots,hence finding and removing tissues before they become cancerous can be one of the most effective methods for reducing the incidence of the disease.

MATERIALS AND METHOD:

For this research, data was collected from KKR cancer institute and Dr. Rai Memorial cancer center. Around 102 patients (male-80 and female-22) were examined and their diagnosis and treatment made were taken into account. From the data collected, oral malignancy according to the year, treatment of the various oral malignancy and diagnosis of various oral malignancy in men and women were observed.

Table 1. Oral malignancy in Chennai according to the year

NO. OF PATIENTS	YEAR
29	2011
11	2012
12	2013
33	2014
17	2015

Table 2. Treatment of the oral malignancy-

TREATMENT	No. of PATIENTS
RADIATION	30
CHEMOTHERAPY	17
BOTH	55

Figure 1

Figure 2

Figure 3

RESULT:

The study taken for the past 5 years had a variation in the number of patients with oral malignancy in both the cancer institutes.

Table-4

No. of patients in percent	Year
28.40%	2011
10.70%	2012
11.70%	2013
32.35%	2014
16.67%	2015

The year 2014 had seen the most number of patients with oral malignancy [table-4].

Fig 4

The treatment to these patients involved radiography, chemotherapy or even both.- Table 5

Table-6

Table 5.

TREATMENT	TREATMENT IN PERCENT
RADIATION	29.40%
CHEMOTHERAPY	16.67%
BOTH	53.92%

Figure 5. 53.92% of patients undergo both radiation and chemotherapy as their treatment

Diagnosis in the male and female population had a small variation. Carcinoma of tongue, palate, alveolar, buccal and labial mucosa were diagnosed- Table 6

GENDER	TONGUE	ALVEOLAR MUCOSA	PALATE	LOWER LABIAL MUCOSA	BUCCAL MUCOSA	FLOOR OF THE MOUTH
MALE	17.50%	18.75%	22.50%	6.25%	30%	3.75%
FEMALE	27.27%	18.18	4.54%	9.09%	31.81%	9.09%

Figure 6. It was hence found out that, most of them were diagnosed with oral malignancy of buccal mucosa as 30% and 31.81% in male and female respectively.

DISCUSSION:

Oral cancers are heterogeneous group of cancers that arise in various sub sites of the oral cavity with differing predisposing factors, prevalence and outcomes. It is the sixth most common cancer reported globally with an annual incidence of over 300,000 cases, of which 62% arise in developing countries [2]. The etiology of oral cancer is associated with well-established risk factors such as tobacco, betel quid chewing and alcohol. Tobacco-related cancers accounted for 40%–45% of all cancers in men and 15%–20% of all cancers in women in Chennai. The incidence of these cancers in Chennai is showing a rising trend, particularly among men, and the trend in Tamil Nadu may be similar as statistics on the prevalence of tobacco habits reveal little difference between urban and rural areas in Tamil Nadu. Lung cancer incidence is increasing in both sexes in Chennai as observed in other registries in India. Curiously, oral cancer incidence in Chennai is falling among women but rising among men, with no let-up in the number of cases predicted for both sexes. This may be related to the new wave of increased tobacco use in urban areas of India and the high prevalence of the use of smokeless tobacco among younger adult men than women [1].

Sex-specific incidence rates are calculated to provide an estimate of the risk of oral cancer in defined groups in India. Figure3 and table 3 shows the age specific incidence rates for oral cancer between 2011 and 2015; by gender and location (based on 2 cancer registries) in Chennai. An increasing trend based on age; however, lower incidence recorded amongst females as compared to males is indicative of gender differences in the lifestyle and behavioral patterns associated with incidence of oral cancer [3]. According to a study made in a cancer hospital in Chennai, A total of 266 oral cancer patients aged 21-60 years and above comprised the study population. Most of the study subjects belonged to the lower socio economic classes. About 48.5% of rural subjects had agriculture as a source of occupation and 28.6% of urban subjects were unskilled laborers. The difference in the prevalence of oral cancer among different levels of literacy and occupation was found to be significant statistically [4].

Oral cancer is associated with genetic mutations which occur due to the exposure to tobacco, alcohol, betel quid, etc. [5]. It occurs in people who are aged 50 years or over. However, about 6% of the cases occur in young people who are under the age of 45 years [6, 7]. It is a malignant disorder in which the genes that control cell growth and apoptosis are mutated and this results in an uncontrolled proliferation of the cells in the tumor [8]. Gene therapy is an attractive tool in the treatment of oral squamous cell carcinoma and pre-cancer, because it targets cancer cells only. At present, the use of adenoviruses altered gene therapy technique with chemotherapy or immunotherapy and radiograph appears to be the most promising approach in the management of oral cancer and pre-cancer [9].[ Table-2] suggests that radiation and chemotherapy are the most common treatment (based on 2 cancer registries) in Chennai with 54%.

CONCLUSION:

Public health officials, private hospital, academic medical centers within India have recognized oral malignancy as a grave problem. Epidemiological studies on a certain set of population will help us building the data base and to address the people. Despite the fact that oral cancer and consequences can be prevented, treated, and controlled, there exists a significant gap in the Indian public’s knowledge, attitudes, and behaviors. Efforts must be made to introduce a suite of preventive measures that has the potential to significantly reduce the burden and to help bridge the gap between research, development and public awareness.

REFRENCES:

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2. Arvind Krishnamurthy, Vijayalakshmi Ramshankar; Early Stage Oral Tongue Cancer among Non-Tobacco Users - An Increasing Trend Observed in a South Indian Patient Population Presenting at a Single Centre; Asian Pac J Cancer Prev, 14 (9), 5061-5065.

3. Ken Russell Coelho; Challenges of the Oral Cancer Burden in India

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Received on 18.06.2015 Modified on 24.06.2015

Research J. Pharm. and Tech. 8(12): Dec., 2015; Page 1615-1618

DOI: 10.5958/0974-360X.2015.00289.9