JIIMS final.cdr 44 ORIGINAL ARTICLE ABSTRACT Objective: To determine the age range, gender distribution, histological types, sites, neck node involvement, and surgery as modality of treatment in diagnosed cases of oral cavity tumours in a tertiary care centre. Study Design: Descriptive Study Place and Duration of Study: The study was carried out in ENT Department, CMH Rawalpindi for the duration from Dec 2008- Dec 2011. Materials and Methods: Data of 113 biopsy proven cases of oral cavity tumors who underwent surgery at CMH Rawalpindi, were retrieved from Armed Forces Institute of Pathology's Tumour Registry and from Head and Neck Oncology Forum Registry, and were evaluated. Results: Out of 113 patients with oral cavity tumours, 87 (77%) were male, while 26 (23%) were female, the male: female ratio being 3:1. The mean age of the patients was 59.4 years, ranging from 40 to 75 years. Site distribution of the tumours was: Tongue: 61(54%), buccal mucosa 24 (21%), floor of mouth 18 (16%), and hard palate 10 (9%). The histology of tumours showed Squamous cell carcinoma in 102 (90%) and tumours of Salivary gland origin in 11(10%). Sixty four (56%) of these patients had N disease, 10 (9%) had N disease, 8 (7%) had N0 1 2a disease, 27 (25%) had N disease, 3(2%) had N disease, while 1 patient (1%) had N disease. Resection of the2b 2c 3 tumour along with Supra-omohyoid neck dissection was carried out in 64 (56%) patients, while resection with radical neck dissection was done in 49 (44%) patients. Primary closure was carried out in 62 (55%) patients, while secondary reconstruction was done in 51 (45%) patients. Conclusion: Presentation of oral cavity tumours occur at an advanced age with male preponderance in our population. Early presentation results in lesser local spread, leading to less aggressive surgical approach with selective neck dissection. Key Words: Oral cavity tumors, Squamous cell carcinoma, Surgical treatment. 7countries. Almost 90% of these tumours are squamous cell carcinomas, while rest comprise of salivary gland tumours, 8sarcomas and melanomas. Commonest site 9is the tongue, usually the lateral border, followed by the buccal mucosa and floor of mouth. Commonest presentation is of a non- healing ulcer. In 30-80% of the patients, cervical lymph nodes may be involved on 10presentation. Over the years the modalities of treatment has not significantly changed. Surgery and radiotherapy alone are the treatment modality in the early cases, while combined therapy with surgical resection followed by radiotherapy or chemo-radiotherapy is the standard treatment modality in advanced 11disease. Cervical lymph node metastasis is a main determinant in the staging and the 12choice of treatment modality. Introduction Head & neck cancers are the 6th commonest 1cancers. Making 3% of all the cancers while oral cavity cancers represent approximately 48% of them, majority being squamous cell 2carcinoma (SCC). Head neck cancers are considered to be the commonest cancers in countries like India, Pakistan, Bangladesh etc. They usually occur in middle aged and old people. Major risk factors are tobacco 3and alcohol intake. And both have a 4synergistic action. In South East Asia its 5incidence is high due to betel quid chewing. Generally incidence is 2-3 times higher in the 6males. But now almost equal gender distribution may be seen in many developed ------------------------------------------------- Oral Cavity Tumours, A Clinical Experience in a Tertiary Care Center Muhammad Ashfaq, Mirza Khizer Hameed, Zeeshan Ayub, Kamran Ashfaq Correspondence: Brig Mirza Khizer Hameed ENT Department, Combined Military Hospital, Rawalpindi 44 45 Consequently, neck dissection forms an integral aspect of the surgical treatment of Oral Squamous Cell Cancers, and has evolved from radical to more selective and functional procedures with our improved understanding of the distribution of 13regional metastasis. Recent studies have shown that selective neck dissection is oncologically safe for head neck cancers 14with clinically negative node necks. Successful reconstruction is mandatory for 15the success of any surgery for oral cancers. A descriptive study was carried out in ENT Department Combined Military Hospital Rawalpindi to determine the age range, gender distribution, histological types, sub- sites, neck node involvement, and surgery as modality of treatment in diagnosed cases of oral cavity tumours for the duration from December 2008 to December 2011. Data of 113 biopsy proven patients of oral cavity tumours, operated upon, in the duration from December 2008- December 2011, was retrieved from AFIP Tumor Registry and Head and Neck Oncology Forum Registry and was evaluated. The data was entered in SPSS version 12 and the cases were evaluated for the age of patient, gender, histology of tumor, tumor site, neck node involvement, and the surgical procedure done. Male to female ratio was found to be 3:1 as inferred from Figure 1.The mean age of presentation was found to be 59.4 years ranging from 40-75 years. With regards to site, more than half of the patients had tumors of tongue, followed by tumors of buccal mucosa, tumors of floor of m o u t h a n d t u m o r s o f h a rd p a l a t e Materials and Methods Results respectively as shown in Table I. The most common histological diagnosis was Squamous Cell Carcinoma followed by salivary gland tumours as shown in Figure 2. Neck nodes involvement in these 113 patients is shown in Table II. All these patients were staged according to TNM classification. Sixty four (56%) patients were grouped into early stage cancer of the oral cavity (Stage I & II), while 49 (44%) were grouped as advanced disease (Stage III & IV). Resection of the tumour along with Supraomohyoid neck dissection was carried out in 64 (56%) patients, while Resection with Radical neck dissection was done in 49 (44%) patients. Primary closure was carried out in 62 (55%) patients, while secondary reconstruction had to be carried out in 51 (45%) patients. With regards to secondary reconstruction, radial free forearm flap reconstruction was done in 27 (24%) cases, pectoralis major flap reconstruction in 14 (12%) patients, while osseo-cutaneous fibula flap reconstruction was carried out in 10 (9%) patients. Oral cancer is the eighth commonest cancer in the developing countries and sixteenth commonest in developed countries. It is diagnosed usually at an advanced stage and approximately 30% of the patients delay seeking help for more than 3 months following the self discovery of symptoms. In Pakistan, oral cavity cancers are found to be 17,18the leading tumours. In our study the mean age of the patients was found to be 59.4 years. Almost similar mean age has 19been shown in another study. And it is probably due to prolonged exposure of the mucosa to tobacco, alcohol etc. But now, the Discussion 45 46 incidence is increasing among relatively younger population. In our study the male to female ratio was 3:1 with 77% male and 23% female patients. Carvalho et al also showed a similar gender distribution in the 7developing countries. As ours is a developing country, the same pattern prevails. In our study, the tongue was found to be the commonest site involved, followed by the buccal mucosa and floor of mouth respectively. A study carried out by Razfer .et .al noted that 43.9% tumors involved the tongue, 27.3% involved the floor of mouth, 24.2% involved the alveolus and buccal 17mucosa while 3.8% involved hard palate. Another study also showed tongue (58%) as 9the leading site of oral cancers. Our results also showed a higher incidence of tongue tumours but with a higher percentage, and a relatively higher incidence of buccal mucosa tumours. Similarly, we had a higher incidence of hard palate tumours. Probably this slight difference is because of betel quid c h e w i n g a n d N a s w a r ( O r a l s n u ff ) placement. In our study commonest histological type of tumours was squamous cell carcinoma and it is similar to data given in a study by 17Bhurguri et al. Our results showed palpable cervical lymph nodes in 44% of the patients which are similar to a study by 10Fukano et al. Thus 56% patients presented to us at an earlier stage leading to expectation of a better prognosis as shown in 20study by Elwood & Gallagher. In patients with early stage disease, having N0 neck, tumour resection was carried out a l o n g w i t h S u p r a - o m o h y o i d n e c k dissection. It is very logical because of much extensive lymphatic network draining the oral cavity. In rest of the cases with advanced disease, the surgical resection was carried out along with radical neck dissection. Although there is recent trend for selective neck dissection even in advanced cases, but in our center, we adhere with radical neck dissection for better prognosis in advanced cases. 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