CARCINOMA CHEEK: REGIONAL PATTERN AND MANAGEMENT
AbstractBackground: Oral cancer varies globally and regionally, and is closely linked with geographical,social, economical, biological, ethnic, dietary and environmental factors. In western countries itaccounts for about 2–5% while in the south-east Asia for about 40% of all cancers. In Pakistan it issecond commonest tumour after bronchogenic carcinoma in males and breast carcinoma infemales. The objectives of this study were to find out the pattern of carcinoma cheek in our region,its etiological associations, management and prognosis. This study was conducted in theOtolaryngology and Head and Neck Surgery Department of Civil Hospital, Karachi from April 1995to December 1998. It was prospective study. Methods: Forty-five cases of primary carcinoma cheekwere diagnosed and investigations including OPG and CT scan were carried out along with otherrequired investigations to evaluate the extension of tumour, bony erosion and metastasis. TNMstaging was done. All patients were treated surgically, sent for post-operative radiotherapy orchemoradiation and followed up for 3 years. Result: Among 45 cases of oral cancer, 28 werefemales and 17 were males. Common presenting symptom was growth or ulcer. It was morecommon in 41–50 years of age. Squamous cell carcinoma (SCC) was found in 95.5% of the cases.Most of the patients 31 (68%) were in T4 stage. Surgical excision was done in all cases withreconstructuion in 23 cases and neck dissection in 39 cases. In the follow up for 3 years, 30 patientremained disease free. Conclusion: Carcinoma cheek is a common entity in our region and now it isseen in relatively younger patients. Oral cancer is a self preventable disease. What is required is todevelop awareness of oral hygiene and discourage the habit of social carcinogens use. Earlydiagnosis and treatment offers better chance of cure whereas advance disease has a poor prognosis.Keywords: Oral cavity squamous cell carcinoma (OSCC), supraomohyoid neck dissection.
Wang CC, Kelly J, August M, Donoff B, Early carcinoma of
the oral cavity. A conservative approach with radiation
therapy. J Oral Maxillofac Surg 1995;53:687–90.
Lamey PJ, Douglas PS, Napier SS. Secretor status and oral
cancer. Br J Oral maxillofac Surg 1994;32:214–7.
Jafarey NA, Zaidi SHM. Cancer in Pakistan. J Pak Med
Bhurgri Y, Bhurgri A, Parvez S, Bhurgri M, Kayani
N, Ahmed R, et al. Cancer profile of Hyderabad, Pakistan
–2002. Asian Pac J Cancer Prev 2005;6:474–80.
Rehman M, Jaferi J. Carcinoma of oral cavity and oropharynx
in Pakistan. An appraisal. Trop Doct 1976;6:63–7.
Jayant K. Balakrishnan V. Sanghvi LD, Jussawalla DJ.
Quantification of the role of smoking and chewing tobacco in
oral, pharyngeal and oesophageal cancers. Br J Cancer
Shimkage M, Horii K, Tempaku A Kakudo K, Shirasaka
T, Sasagawa T. Association of epstein-Barr virus with oral
cancers. Hum Pathol 2002;33(6):608–14.
Kobayashi I, Kaori S, Saito I, Kiyoshima T, Matsuo K, Ozeki
S, et al. Prevalence of Epstein-Barr virus in oral squamous
cell carcinoma. J Pathol 1999;189(1):34–9.
Miller CS, Johnstone BM. Human paillomavirus as a risk
factor for oral squamous cell carcinoma: a meta-analysis,
–1997. Oral Surg Oral Med Oral Pathol Oral Radiol
Kreimer AR, Clifford GM, Snijders PJ Castellsagué
X, Meijer CJ, Pawlita M, et al. HPV16 semiquantitative viral
load and serologic biomarkers in oral and oropharyngeal
squamous cell carcinoma. Int J Cancer 2005;115:329–32.
Guha N, Boffetta P, Wünsch Filho V, Eluf Neto J, Shangina
O, Zaridze D, et al. Oral health and risk of squamous cell
carcinoma of the head and neck and esophagus: results of
two multicentric case-control studies. Am J Epidemiol.
Zaidi SH. A clinical monograph on oral cancer. Karachi:
Royal book company Karachi; 1995. pp. 41,47,133,136,141,
Hameed A. Rehabilitaion of patients with oral carcinoma. PL
Grant Report, department of surgery, Jinnah Postgradute
Medical Centre, Karachi 1979.
Zakai MA, Ali SM, Mansoorul Aziz, Tauqeerul Islam.
Etiology of Oral cancer/Squamous Cell carcinoma in oral
cavity. Ann Abbasi Shaheed Hosp Karachi Med Dent Coll
Qureshi S, Trimizi S, Hussian A, Behman A. Is supraomohyoid neck dissection effective in clinically negative node
in T3 and T4 oral tumor. Pak J otolaryngol 2007;23:71–3.
Chhetri DK, Rawnsley JD, Calcaterra TC. Carcinoma of the
buccal mucosa. Otolaryngol Head Neck Surg. 2000;123:566–71.
Noonan VL, Kabani S. Diagnosis and management of
suspicious lesions of the oral cavity. Otolaryngol Clin North
J Ayub Med Coll Abbottabad 2009;21(3)
Klass CM, Shin DMCurrent status and future perspectives of
chemoprevention in head and neck cancer. Curr Cancer Drug
Parkins DM, Pisani P, Perlay J. Estimate of worldwide
incidence of 18 major cancers in 1985. Int J
Khan M, Salam A, Qaim ud Din. Niswar as a risk factor in
the aetiology of oral cavity cancer. J Pak Dent Assoc
Bhurgri Y, Bhurgri A, Hussainy AS, Usman A, Faridi N,
Malik J, et al. Cancer of the oral cavity and pharynx in
Karachi--identification of potential risk factors. Asian Pac J
Cancer Prev. 2003;4(2):125–30.
Macek MD, Reid BC, Yellowitz JA. Oral cancer
examinations among adults at high risk:findings from the
National Health Interview Survey. J Public Health Dent
Shiu MN, Chen TH. Impact of betel quid, tobacco and
alcohol on three stage disease natural history or leukoplakia
and cancer: implication for prevention of oral cancer. Eur J
Cancer Prev 2004;13:39–45.
Reis LAG, Eisner MP, Kosari CL, Edwards Bk. SEER cancer
statistics review, Bathseda (MD): National cancer institute;
Qureshi S, Tirmizi S, Hussain A. Is supraomohyoid neck
dissection is effective in clinically negative node in T3 and
T4 oral tumors. Pak J Otolaryngol 2007;23:71–3.
Kadar AA, Hashmi A. Squamous cell carcinoma of tongue:
Management of 25 cases at tertiary care referral center. Med
Conley J, Sadoyama J. Squamous cell carcinoma of buccal
mucosa: a review of 90 cases. Eur Arch Otolaryngol
Clayman GL, Frank DK. Selective neck dissection of
anatomically appropriate levels is as efficacious as modified
radical neck dissection for elective treatment of the clinically
negative neck in patients with squamous cell carcinoma of
upper respiratory and digestive tracts. Arch Otolaryngol
Head Neck Surg 1998;124:348–52.
Ahmed MU, Khawar A, Ahmed J, Ajmal M, Bangash WA,
Akhter MR. Occult metastasis in carcinoma of oral cavity.
Wahid A, Ahmad S, Sajjad M. Pattern of carcinoma of oral
cavity reporting at dental department of Ayub Medical
college. J Ayub Med Coll Abbottabad 2005;17:65–6.
Bhurgri Y, Bhurgri A, Rahim A, Butto K et al. The pattern of
malignancies in Karachi 1995–1996. J Pak Med Assoc
Majoufre C, Faucher A, Larcoche C, de Bonofils C,
Siberchicot F, Renauds-Salis JL, et al. Supraomohyoid neck
dissection in cancer of the oral cavity. Am J Surg
Shah JP, Anderson PE. The impact of patterns of nodal
metastasis on modifications of neck dissection. Ann Surg
Asif M, Muzafar K. The carcinoma tongue-oncidence of risk
factors, presentation and treatment. J Coll Physicians Surg
Kroll SS, Goepfert H, Jones M, Guillamondegui
O, Schusterman M.. Analysis of complications in 168
pectoralis major myocutaneous flap used in head and neck
reconstruction. Ann Plastic Surg 1990;25:93–7.
Shah JP. Haribaklin V, Loree TR, Sutaria P. Complications
of pectoralis major myocutaneous flap in head and neck
reconstruction. Am J Surg 1990;160:352–5.
American Cancer Society. Cancer facts and figures 2005.
Atlanta (GA): American Cancer Society 2005.p. 4. available at:
Medina JE, Byers RM. Supraomohyoid neck dissection:
rationale, indications and surgical technique. Head Neck