Management of Oral Cancers [1st ed.] 9789811564987, 9789811564994

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Management of Oral Cancers Sudhir Bahadur Subramania Iyer  Editors

123

Management of Oral Cancers

Sudhir Bahadur  •  Subramania Iyer Editors

Management of Oral Cancers

Editors Sudhir Bahadur Former Professor of Otolaryngology All India Institute of Medical Sciences New Delhi, India

Subramania Iyer Centre for Plastic and Reconstructive Surgery Amrita Institute of Medical Sciences and Research Centre Kochi, Kerala, India

ISBN 978-981-15-6498-7    ISBN 978-981-15-6499-4 (eBook) https://doi.org/10.1007/978-981-15-6499-4 © The Editor(s) (if applicable) and The Author(s) 2021 This work is subject to copyright. All rights are reserved by the Publishers, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publishers, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publishers nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publishers remain neutral with regard to jurisdictional claims in published maps and institutional affiliations. Co-publishing partnership between Byword Books Private Limited and Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Preface

The incidence of oral cavity cancer is high worldwide, making it among the most common cancers. The incidence is particularly high in Southeast Asian countries due to widespread consumption of tobacco and alcohol. Despite increasing awareness, most patients still are diagnosed with advanced disease (stage III and IV) and thus pose considerable challenge in management. The tumor board consisting of multidisciplinary team including head and neck surgeons and radiation and medical oncologists has become a standard practice to discuss the initial workup and diagnosis and to implement the treatment protocol. However, decision making is complex and demanding. Prognosis is largely based on the site, stage, nodal metastasis, and final histopathology of disease. Surgery, either alone or with adjuvant radiation or chemo-radiation, is the mainstay of treatment, though radiation alone has been used to treat early lesions in some centers. Since there is a high incidence of occult metastasis even in early cancer, the role of elective neck dissection has been established in the treatment of No necks. However, the key to surgery for the primary neoplasm depends upon whether mandible can be preserved or needs to be resected based on the clinical and radiological assessment of the bone. There are several parameters which would decide subsequent quality of life. These include adequacy of tumor resection, integrity of mandible, and subsequent reconstruction of soft tissue and bone (in case it needs to be resected). There has been significant improvement in reconstructive techniques in recent years including the use of free vascular flaps to improve quality of life in patients in terms of appearance aesthetics and functions including swallowing. However, numerous problems still remain: (a) selection of patients for precise surgery despite improved imaging, (b) diagnosis of residual and recurrent disease, assessment and extent of salvage surgery, and consequent morbidity, (c) technical expertise and surgical skills of the treating team, and (d) cost and surveillance of treatment protocol. The editors and other authors have combined their efforts to produce this textbook to provide guidelines for the diagnosis and update management of oral carcinoma patients with appropriate pathology, imaging, surgical procedures, radiation/chemo-radiation techniques, and rehabilitation including quality of life assessment. This textbook should be of significant value to the

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Preface

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residents, young teaching faculty, and practicing specialists in the fields of otolaryngology, head and neck surgery, general surgery, plastic surgery, ­radiation and medical oncology, pathology, radiology, and basic sciences. The book is dedicated to our patients. New Delhi, India Kochi (Kerala), India 

Sudhir Bahadur Subramania Iyer

Contents

1 Epidemiology������������������������������������������������������������������������������������   1 Yogesh Dokhe, Vidhydharan Sivakumar, Krishnakumar Thankappan, and Subramania Iyer 2 Molecular Biology of Oral Squamous Cell Carcinoma����������������  23 Aanchal Kakkar, Mukin Kumar, and Siddhartha Datta Gupta 3 Recent Advances in Oral Cancer Research ����������������������������������  27 Deepika Mishra, Muzafar A. Macha, Harpreet Kaur, Mohammad A. Zargar, and Shyam S. Chauhan 4 Potential Malignant Disorders��������������������������������������������������������  41 Sudhir Bahadur, Aanchal Kakkar, and Siddhartha Datta Gupta 5 Imaging ��������������������������������������������������������������������������������������������  51 Mukesh Kumar and Sanjay Thulkar 6 Oral Cavity: Surgical Anatomy and Tumour Spread������������������  69 Sudhir Bahadur 7 Tumours of the Oral Cavity: Diagnosis, Assessment and Staging ��������������������������������������������������������������������������������������  83 Sudhir Bahadur 8 Metastatic Neck Disease������������������������������������������������������������������  97 Manisha Patnayak and Sudhir Bahadur 9 Guidelines in Management of Carcinoma of the Gingivobuccal Complex�������������������������������������������������������� 113 Sudhir Bahadur 10 Guidelines in Management of Carcinoma of the Tongue and Floor of Mouth�������������������������������������������������� 133 Sudhir Bahadur 11 Residual/Recurrent Tumours���������������������������������������������������������� 149 Sudhir Bahadur

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12 Surgical Approaches for Oral Cavity – Case Studies ������������������ 159 Chirom Amit Singh and Alok Thakar 13 Reconstruction of Soft Tissue Defects of Buccal Mucosa and Tongue: Choice of Flap������������������������������������������������������������ 175 Khyati Jani, Deepak Balasubramanian, Krishnakumar Thankappan, and Subramania Iyer 14 Lip Reconstruction�������������������������������������������������������������������������� 187 Khyati Jani, Deepak Balasubramanian, Krishnakumar Thankappan, and Subramania Iyer 15 Reconstruction of the Mandible and Choice of Flap�������������������� 195 Ridhi Sood, Janarthanan Ramu, Krishnakumar Thankappan, and Subramania Iyer 16 Surgical Complications and Management������������������������������������ 211 Sudhir Bahadur 17 Complications of Flap Surgery ������������������������������������������������������ 221 Nisha Akali, Krishnakumar Thankappan, and Janarthanan Ramu 18 Radiotherapy in Management of Oral Cancer ���������������������������� 231 Ramaiah Vinay Kumar, Suman Bhasker, and K. S. Sabitha 19 Role of Systemic Therapy���������������������������������������������������������������� 255 Shalabh Arora and Atul Sharma 20 Quality of Life in Head and Neck Cancer ������������������������������������ 273 Priyank V. Rathod, Nisha Akali, Krishnakumar Thankappan, Subramania Iyer, and Nageshwara Rao Noothanapati

Contents

About the Editors and Contributors

About the Editors Sudhir Bahadur, MS, FAMS, PhD  Dr. Bahadur has worked at the All India Institute of Medical Sciences, New Delhi, as a Professor of Otolaryngology, Head and Neck Surgery. His areas of interest have been head and neck surgery (oncology) and surgery of the skull base. Dr. Bahadur is the past president of the Foundation for Head and Neck Oncology as well as the Skull Base Surgery Society of India. He has published nearly 200 research papers and textbook chapters. Dr. Bahadur has received numerous honors including from the Association of Otolaryngology of India, Foundation for Head and Neck Oncology, and Indian Council of Medical Research, New Delhi. He is also one of the principal editors of the monograph on carcinoma of the larynx and hypopharynx. Subramania Iyer, MS, FRCS, Mch  Dr. Iyer is the Professor and Head of Plastic and Reconstructive Surgery at the Amrita Institute of Medical Sciences Kochi, Kerala. Earlier he occupied a similar position at the Trichur Cancer Hospital. Dr. Iyer is the past secretary and President of the Foundation for Head and Neck Oncology. He is also the past President of the Society of Plastic and Reconstructive Surgeons of India. Dr. Iyer has published a number of research publications and has received numerous honors including the award from BMJ.

Contributors Nisha  Akali Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Shalabh Arora  Department of Radiation Oncology, Institute Rotary Cancer Hospital, AIIMS, New Delhi, India Sudhir Bahadur  Former at Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India

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About the Editors and Contributors

Suman  Bhasker Department of Radiation Oncology, Institute Rotary Cancer Hospital, New Delhi, India Deepak  Balasubramanian Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Shyam  S.  Chauhan Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India Yogesh  Dokhe Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Siddhartha  Datta  Gupta  Department of Pathology, All India Institute of Medical Sciences, New Delhi, India Subramania  Iyer  Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Khyati Jani  Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Aanchal Kakkar  Department of Pathology, All India Institute of Medical Sciences, New Delhi, India Harpreet  Kaur  Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India Mukesh Kumar  Department of Radiology, Institute Rotary Cancer Hospital, AIIMS, New Delhi, India Mukin  Kumar Department of Pathology, All India Institute of Medical Sciences, New Delhi, India Ramaiah Vinay Kumar  Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India Muzafar  A.  Macha Department of Biotechnology, Central University of Kashmir, Ganderbal, Jammu and Kashmir, India Deepika Mishra  Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India Nageshwara  Rao  Noothanapati Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Manisha Patnayak  Department of Surgical Oncology, Jolly Grant Medical College, Dehradun, India

About the Editors and Contributors

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Janarthanan  Ramu Department of Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Priyank V. Rathod  Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India K. S. Sabitha  Department of Oral Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India Chirom Amit Singh  Otolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India Vidhydharan  Sivakumar Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Atul  Sharma Department of Medical Oncology, Institute Rotary Cancer Hospital, AIIMS, New Delhi, India Ridhi Sood  Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Alok  Thakar Head & Neck Oncology, All India Institute of Medical Sciences, New Delhi, India Krishnakumar Thankappan  Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India Sanjay Thulkar  Department of Radiology, Institute Rotary Cancer Hospital, AIIMS, New Delhi, India Mohd  A.  Zargar Department of Biotechnology, Central University of Kashmir, Ganderbal, J&K, India

1

Epidemiology Yogesh Dokhe, Vidhydharan Sivakumar, Krishnakumar Thankappan, and Subramania Iyer

1.1

Introduction

Epidemiology is the study of frequency and pattern of health-related states to identify the causative factors that bring about change in the health state in specified populations. This finds application in public health to design appropriate control measures for health problems [1]. Cancer epidemiology utilizes the epidemiological methods to study the distribution of cancer, identify the environmental risk factors and host factors, and behavioral factors associated with cancer to promote insight into the mechanisms of carcinogenesis. This is useful to assess the efficacy of available cancer treatment and to investigate the predictors of survival. The Global monitoring framework on Non-communicable diseases approved by the WHO member states has committed to report on cancer type and incidence for monitoring the progress over time within a region. The main source of cancer data is Cancer Registry, GICR, Globocan 2018. The International Agency for Research on cancers has laid down the principles of cancer registration

and guides uniform classification and coding as per the International Classification of Diseases (ICD). The Global Initiative for Cancer Registry Development (GICR) by the International Agency for Research on Cancer is an effort to consolidate data from low- and middle-income countries to drive region-specific policies to reduce the cancer burden.

1.2

Cancer Registration

Cancer registration is the process of continuing, systematic collection of data on the occurrence and characteristics of reportable neoplasms. The registry data can be used for etiological research and formulation of preventive measures and patient care in health care planning. The knowledge thus gained helps to assess the efficacy of preventive measures deployed by the health agencies within a region [2]. The cancer registry can be based on a defined geographical area or hospital data. There are certain key differences in both types of registration which are tabulated below.

Y. Dokhe · V. Sivakumar · K. Thankappan (*) S. Iyer Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India © The Editor(s) (if applicable) and The Author(s) 2021 S. Bahadur, S. Iyer (eds.), Management of Oral Cancers, https://doi.org/10.1007/978-981-15-6499-4_1

1

Y. Dokhe et al.

2

1.3

Cancer Registry Types

Population-based cancer registry (PBCR) Records all neoplasms in a defined population (usually within a geographical area). This data aids in epidemiology and public health. Helps analyze and compare the incidence of cancer in a defined population. And thus helps formulate appropriate measures to reduce the cancer burden in the community. It provides a holistic profile of the cancer burden and its dynamics over some time in light of existing control measure. Permits descriptive and analytical epidemiology.

Hospital-based cancer registry (HBCR) Records all cases in a given hospital, usually without the knowledge of the background population. This data aids in the audit of clinical care and hospital administration. Helps in the review of clinical performance and introduce appropriate administrative reforms to aid improved quality of cancer care.

It is incomplete data and influenced largely by the infrastructure and expertise available within institutions. May permit descriptive epidemiological data if adequate medical record storage.

In India, The National Center for Disease Informatics and Research (NCDIR) based in Bangalore runs the National Cancer Registry Programme (NCRP) which was initiated by the Indian Council of Medical Research (ICMR) in 1982. The NCRP has now expanded to 27 PBCRs providing information from 34 geographical areas. National Cancer Registry Programme has published a 3-year report on PBCR and HBCR in 2014. Global cancer observatory is an interactive web-based platform, developed by the International Agency for Research consolidating cancer statistics available from the International Association of Cancer Registries. GLOBOCAN 2018 published by the IARC in September 2018 is a detailed report of the estimates of cancer incidence and mortality and the burden of cancer in the member states. The statistical record in the chapter is based on GLOBOCAN 2018 and NCRP report India 2014. A total of 354,864 new cases of lip and oral cavity cancer cases have been recorded making it

the 16th most common cancer in the world with as many as 177,384 deaths, with 5 year prevalence of 11.97 (GLOBOCAN world data Fig.  1.1). But when age-standardized world rates are taken into consideration, lip and oral cavity cancer cases were ranked third with the incidence of 9.1 and mortality of 5.6 (Fig.  1.2), while ASIR world of 13.9 in males and 4.3 in females making it first and fourth amongst the top 10 most common cancers (Fig. 1.3). The ASIR is highest in Melanesia with 21.2% in males and 12% in females followed by Southcentral Asia with ASIR 12.9% in males and 4.5  in females (Fig.  1.4). In Asia, lip oral cavity cancers stand 11th with 2.6% incidence and 2.4% of mortality rate. Overall, Asia leads in the incidence and mortality with 227,906 (64.2%) new cases and 129,939 (73.3%) deaths due to oral cancers (GLOBOCAN Asia fact sheets Fig. 1.5). WHO SEAR southeast Asia region accounted for 42% of new cases in 2018 (Fig.  1.6a). Of these new cases, India (42%), China (10.5%), Pakistan (6.9%), and Bangladesh (4.9%) shared the burden of more than 50% of new cases recorded (Fig. 1.6b).

1.4

I ndian Oral and Lip Cancer Epidemiology

In India, lip and oral cavity cancers account for 11.54% of new cases and 10.16% deaths for both sexes and all ages behind only to breast cancer with 15.62% new cases and 12.19% deaths. In males, lip and oral cavity is the leading cancer with 92,011 new cases (16.1%) while in females it stands fourth with 27,981 (4.8%). As per NCDIR NCRP report published in 2016, the incidence of tongue cancer in males (ICD-10: C01-­ C02) (Fig. 1.7a, b) is highest in East Khasi Hills District (Meghalaya), which had the highest AAR (11.7), followed by Ahmedabad Urban PBCR (10.4), while in Females: Bhopal PBCR had the highest AAR (3.7) followed by Ahmedabad Urban PBCR (3.4). The registries of Nagpur and Kamrup Urban District share third place with an AAR of 3.2. For Mouth (ICD-10: C03-C06) (Fig.  1.8a, b) in Males: Ahmadabad Urban PBCR showed the highest AAR (18.1),

3.31 3.21

11 12

1 033 701 841 080

567 233 549 393 509 590

Stomach

Rectum

Oesophagus

Cervix uteri

Thyroid

Bladder

569 847

184 799 60 712 165 087 94 771

0.72 0.35 0.25 0.25

1.73 1.72 1.68 1.28 1.04

19 20

72 987

0.16 0.13 0.11

0.54

22 23 24 25 26

177 422 159 985 129 079 92 887

Larynx

Multiple myeloma

Nasopharynx

Oropharynx

17 600 18 078 957

All cancer sites

Fig. 1.1  GLOBOCAN world data

30 443

0.24

33

Mesothelioma Vagina

0.26

32

44 235 41 799

0.28

31

48 541

Anus

34 475

0.31

30

Penis

0.41

29

52 799

Testis

Salivary glands

Vulva Kaposi sarcoma

0.06

0.47

28

-

8 062

-

9 555 027

0.04

0.10

36

20.2

29 36

25 576 0.04

0.18

35 -

31 34 19 902 15 138

0.09

33

15 222

0.20

32

30

28 35

27

25

22

19

20

24 18

15

13

16

21

88 379 93 850 31 250

0.03 -

0.09

0.29

10.63

0.02

0.04

0.02 0.17

43 841 302

43 877

132 269 0.22

127 599

123 460

284 073

275 947

280 508 119 130

362 219

376 005

574.38

1.16

0.41

2.44

1.16

3.50

1.67

1.62

7.38

1.56 3.62

3.68

4.75

4.93

6.41

3.06 488 900

12.65 233 820

20.17

10.10

11.97

33.93

13.44

15.39

3.70

17.73

21.60

762 663 965 623

913 514 771 110

1 283 348

1 174 433 1 025 730

1 353 273 282 574

1 648 482

0.03

0.02

0.03

0.02

0.05 0.03

0.07

0.10

0.12

0.13

7.17 38.98 26.17

547 104 1 474 265 1 997 846

24.58

8.85

20.83

68.23

36.49

96.73

181.78

27.91

Prop.

1 876 453

5 207 882 1 589 752 675 210

0.21 0.17

0.25

0.11

0.29

0.39

0.82 0.57

1.19

1.06

1.85

0.68

0.18

0.45 0.07

2.08

2.71

0.23 0.30

1.97

17 1.99

0.20

3.47

11

0.21

0.50 0.33

4.85

1.01

0.27

7

0.18

0.05

0.46 2.79

0.77

0.67

3.50 2.25

14 12

26

6 9

5.71

0.35

3.49

10

0.98

8.78

0.06 0.95

8.79

0.09 0.04

34

3 724 658 2 785 583

0.60 0.54

6 875 099

2 129 964

1.41

2.22

3

0.73

6.19

4.03

7.04

19.78

5-year prevalence (all ages) Cum.risk Number

2

19 129

9 507 22 176

0.06

34 984 26 167

0.14

0.08

0.47

27

80 608 79 990 71 105

Hypopharynx

Hodgkin lymphoma

51 005

106 105

0.20

0.93 0.75

21

219 420

Gallbladder

Melanoma of skin

295 414 287 723

241 037

177 384

Ovary

0.36

0.46

2.07

18

354 864 296 851

Lip, oral cavity

Brain, nervous system

89 929

2.23

175 098

0.52 1.01

2.35

16 17

403 262

309 006

248 724 432 242

382 069

0.55 0.48

0.61

199 922

0.65

Kidney

2.55

2.97 2.68

311 365 41 071

508 585

781 631 310 394

782 685

1.36 0.68

0.78

0.91

1.31 1.08

23

5

65 155

8

Corpus uteri

Leukaemia

14 15

458 918 437 033

13

3.32

3.34

9 10

704 376 572 034

8

4.91 4.11

6.03

0.97

6.08

7

6

5

Pancreas

Non-Hodgkin lymphoma

Liver

1 042 056

Non-melanoma skin cancer

1.31

6.40

551 269

4

1 096 601

358 989

3

1 276 106 3.73

4

626 679

5.03

12.19 7.44

2

Prostate Colon

1

1 761 007

2.75

Deaths Rank (%)

12.22

Number

1

Lung Breast

Cum.risk

2 093 876 2 088 849

Number

Cancer

New cases Rank (%)

Incidence, Mortality and Prevalence by cancer site

1 Epidemiology 3

40

30

20

Fig. 1.2  Age-standardized (World) incidence and mortality for the top 10 cancers

3.4

2.5

3.7

2.9

5.0 4.1

3.7

5.6

Mortality

0 ASR (World) per 100 000

3.2

4.2

Oesophagus

Leukaemia

4.4

10

4.5 4.4

Prostate

Colorectum

Stomach

5.4

9.1 5.5

14.7

Lung

24.7

Ovary

Lip, oral cavity

Cervix uteri

Breast

Incidence

10

9.2

Age-standardized (World) incidence and mortality rates, top 10 cancers

13.4

20

30

4 Y. Dokhe et al.

40

30

20

13.9

10

Fig. 1.3  Age-standardized (World) incidence rates per sex for the top 10 cancers

Larynx

Ovary

Leukaemia

Oesophagus

Colorectum

Stomach

Lung

Cervix uteri

Lip, oral cavity

Breast

4.2

3.8

0.4

2.7

2.9

3.1

2.9

3.0

4.3

5.5

Females

0 ASR (World) per 100 000

5.5

6.2 5.8

7.8

Males

Age-standardized (World) incidence rates per sex, top 10 cancers

10

14.7

20

24.7

30

1 Epidemiology 5

30

21.2

20

10

9.4 8.0 6.9 6.3 6.3 6.2 6.2 5.8 5.0 4.6 4.4 4.3 3.2 2.5 2.4 2.1 1.8 1.8 1.4 1.2 0

4.5 3.7 1.8 3.2 1.6 2.4 2.1 3.0 2.3 1.9 1.1 1.7 1.7 1.8 2.0 1.2 1.1 1.2 1.2 1.5 1.1 10

12.0

ASR (World) per 100 000

12.9

20

Females

30

Melanesia South-Central Asia Australia and New Zealand Western Europe Northern Europe Central and Eastern Europe North America Caribbean World Micronesia Southern Europe South America Polynesia Southern Africa South-Eastern Asia Eastern Africa Eastern Asia Western Asia Central America Northern Africa Middle Africa Western Africa 25

20

16.1

15

5.0

0

5.0

0.90 1.3 1.2 2.4 0.72 1.3 2.0 0.87 1.0 1.2 1.4 1.9 1.3 1.9 0.75 0.63 0.51 0.50 1.3 1.0 10

6.5 5.4

Mortality

ASR (World) per 100 000

10

8.7 6.5 5.0 4.5 4.5 4.3 4.1 4.0 3.8 3.4 3.0 2.9 2.9 2.5 2.2 1.8 1.6 1.5 1.5 1.5 1.1

Incidence

15

20

Age standardized (World) incidence and mortality rates, lip, oral cavity

Fig. 1.4  Age-standardized (World) incidence rates and mortality rates for lip and oral cavity tumors

Melanesia South-Central Asia Australia and New Zealand Central and Eastern Europe Western Europe Micronesia North America Caribbean Northern Europe World Southern Europe Polynesia Southern Africa South America South-Eastern Asia Eastern Africa Eastern Asia Western Asia Middle Africa Northern Africa Central America Western Africa

Males

Age standardized (World) incidence rates, lip, oral cavity, by sex

25

6 Y. Dokhe et al.

Asia Europe Africa *Latin America and the Caribbean North America Oceania Total

Fig. 1.5  GLOBOCAN Asia fact sheets

Population

227 906 61 885 27 112 19 898 13 613 4 450 354 864

129 939 24 063 9 314 7 874 5 198 996 177 384

Number

Asia (73.3%)

Number

Europe (13.6%)

Africa (5.3%)

Asia Europe North America *Latin America and the Caribbean Africa Oceania Total

Asia (64.2%)

North America (2.9%) LAC* (4.4%)

Mortality, both sexes Oceania (0.56%)

Population

North America (7.6%) Europe (17.4%)

LAC* (5.6%)

Africa (3.8%)

Oceania (1.3%)

Incidence, both sexes

Population Asia Europe North America *Latin America and the Caribbean Africa Oceania Total

Europe (21%)

North America (9.9%)

LAC* (5.9%)

Africa (3%)

Oceania (1.4%)

5-year prevalence, both sexes

536 185 192 094 90 258 54 182 27 560 13 235 913 514

Number

Asia (58.7%)

1 Epidemiology 7

Y. Dokhe et al.

8

a

Estimated number of new cases in 2018, lip, oral cavity, both sexes, all ages WHO Africa region (AFRO) 10 550 (3%)

WHO East Mediterranean region (EMRO) 25 934 (7.3%)

WHO Americas region (PAHO) 47 010 (13.2%)

WHO South-East Asia region (SEARO) 149 102 (42%)

WHO Western Pacific region (WPRO) 56 475 (15.9%)

WHO Europe region (EURO) 65 726 (18.5%) Data source: Globocan 2018 Graph production: Global Cancer Observatory (http://gco.iarc.fr)

b

Total: 27 112

Estimated number of new cases in 2018, lip, oral cavity, both sexes, all ages Italy

3 967 (1.4%)

Spain

4 526 (1.6%)

Thailand 4 572 (1.7%)

Indonesia 5 078 (1.8%)

United Kingdom 6 087 (2.2%)

France

India

7 322 (2.7%)

119 992 (43.7%)

Germany 7 656 (2.8%)

Russian Federation 9 680 (3.5%)

Japan

10 069 (3.7%)

Brazil

10 457 (3.8%)

Bangladesh 13 401 (4.9%)

Pakistan

18 881 (6.9%)

United States of America 24 229 (8.8%)

China

28 730 (10.5%)

Data source: Globocan 2018 Graph production: Global Cancer Observatory (http://gco.iarc.fr)

Total : 27 112

Fig. 1.6 (a) GLOBOCAN 2018 estimated new cases of lip and oral cavity (WHO; region-wise). (b) Burden of lip and oral cavity tumors country-wise

followed by Bhopal PBCR (14.3) and amongst Females: East Khasi Hills District (Meghalaya) had the highest AAR (9.1) [3]. On age-wise comparison trends in the oral cavity and pharyngeal cancer in males, there was a drastic increase in the rate to more than 100 per

100,000 in 2013 as compared to around 60–70 in 1983. But amongst females, a drop-in rate from 50 to 40 per 100,000 was observed for the age group 60–69  years while the rate was steady at around 50 per 100,000 for the age group above 70 years [3].

1 Epidemiology

9

a Males East Khasi Hills District

11.7

Ahmedabad Urban Delhi Meghalaya

10.4 9.3 9.2

Bhopal

8.4 7.4

Chennai Kamrup Urban District Thi’puram District Nagpur

7.0 6.5 6.4

Aizawl District Aurangabad

6.4 6.3

Cachar District Kolkata

5.9 5.4 5.1 5.1

Mumbai Kollam District Dibrugarh District

4.6

Patiala District Bangalore

4.4 4.3

Tripura State

4.2 4.0

Pune Mizoram State (MZ) Barshi Expanded

3.6 3.5

Nagaland

3.5

Wardha District Imphal West District Naharlagun (NH)

3.0 3.0 2.6 2.3

Barshi Rural MZ-Excl, Aizawl

1.9 1.8

Sikkim State Manipur State (MR) MR-Excl.Imphal West

1.5 1.1 0

2

4

6

8

10

12

14

Rate per 100,00

b Females Bhopal

3.7

Ahmedabad Urban

3.4 3.2

Nagpur Kamrup Urban District

3.2 3.0

Delhi Kolkata

2.4

Cachar District

2.4

Aurangabad

2.4

Thi’puram District

2.3

Kollam District

2.3 2.3

East Khasi Hills District Meghalaya

2.2 2.1

Mumbai 2.0

Chennai Pune

1.6 1.5

Barshi Expanded Nagaland

1.5

Dibrugarh District

1.4

Tripura State

1.2

Bangalore

1.2

Patiala District

1.2

Wardha District

1.2 0.8

Mizoram State (MZ) 0.5

Manipur State (MR) MR-Excl.Imphal West

0.5

0

1

2

3

4

Rate per 100,00

Fig. 1.7 (a) Comparison of Age-Adjusted Incidence Rates (AARs) of all PBCRs. TONGUE (ICD-10: C01-C02)

Y. Dokhe et al.

10

Males

a

Ahmedabad Urban Bhopal Nagpur East Khasi Hills District Kamrup Urban District Delhi Mumbai Wardha District Chennai Meghalaya Pune Aurangabad Cachar District Kolkata Thi’puram District Kollam District Dibrugarh District Nagaland Papumpare District Barshi Rural Aizawl District Tripura State Patiala District Sikkim State Bangalore Barshi Expanded Mizoram State (MZ) MZ-Excl.Aizawl Imphal West District Manipur State (MR) Naharlagun (NH) MR-Excl.Imphal West

18.1 14.3 12.8 11.6 10.5 9.5 9.1 8.6 8.5 7.9 7.7 7.4 7.1 6.8 6.6 6.6 6.3 5.4 5.4 5.1 4.5 4.4 4.4 4.3 3.9 3.8 3.0 2.0 1.9

1.4 1.4 1.3 0

10

5

Females

b

15

20

Rate per 100,000

East Khasi Hills District

9.1

Meghalaya Kamrup Urban District

7.7 6.8

Bhopal Bangalore

5.5 5.4

Nagpur

4.9

Chennai

4.0

Cachar District

4.0

Mumbai

3.8

Kollam District

3.7

Pune

3.7

Wardha District

3.7

Ahmedabad Urban

3.6

Delhi

3.3

Dibrugarh District

3.3

Thi’puram District

3.0

Kolkata

3.0

Tripura State

2.8

Aizawl District

2.6

Sikkim State

2.5

Aurangabad

1.9

Nagaland

1.9

Mizoram State (MZ)

1.7

Patiala District

1.3

Barshi Rural

1.3

Barshi Expanded

1.1

Manipur State (MR)

0.9

MR-Excl.Imphal West

0.9

0

2

4

6

8

Rate per 100,000

Fig. 1.8 (a) Comparison of Age-Adjusted Incidence Rates (AARs) of all PBCRs. MOUTH (ICD-10: C03-C06)

20

1 Epidemiology

1.5

11

International Comparison of ASIR and Mortality

The ASIR for oral cancers is highest for Papua New Guinea at 20 per 100,000 while India stands fourth with a rate of around 8 per 100,000 just behind its neighbor Pakistan and Bangladesh (Fig.  1.9). The mortality is highest for Pakistan

ASMR (age-standardized mortality rate) at around 8 per 100,000 followed by Papua New Guinea, Bangladesh with India as fourth highest with ASMR less than 6 (Fig.  1.9). But the estimated 5-year prevalence rate is highest in India at more than 260,000 cases followed by the USA with around 80,000 cases and then China with cases just below 80,000 (Fig. 1.10).

Papua New Guinea Pakistan Bangladesh India Sri Lanka Hungary Australia Afghanistan Latvia Incidence Mortality

France 4.0

0

8.0

Data source: Globocan 2018 Graph production: Global Cancer Observatory (http://gco.iarc.fr)

12 16 ASR (world) per 100 000

20

24

Fig. 1.9  ASIR world incidence and mortality for lip and oral cavity cancers Estimated number of prevalent cases (5-year) lip, oral cavity, both sexes all ages India United States of America China Pakistan Japan Brazil Russian Federation Bangladesh Germany France Data source: Globocan 2018 Graph production: Global Cancer Observatory (http://gco.iarc.fr)

0

40 000

80 000

120 000

160 000 Numbers

Fig. 1.10  Estimated 5-year prevalence for lip and oral cavity cancers

200 000

240 000

280 000

Y. Dokhe et al.

12

1.6

Risk Factors

ditions. And as many as 7.4% are exposed in public places, e.g., restaurants. With regards to the The carcinogenesis in the oral cavity is an intri- prevalence of current use of tobacco in our councate multistep process. The lifestyle and diet-­ try, the northeastern states were the worst, with related factors, environmental factors, infective Mizoram 34.4% smoking tobacco (compared to causes, or hereditary factors initiate the genetic India’s 10.7%) and Tripura 48.5% used smokealteration which further accumulates and pro- less tobacco (compared to India’s 21.4%). gresses to cancer. The important risk factors and Tobacco is derived from two main species relevant epidemiology are discussed in brief. Nicotiana tabacum and Nicotiana rustica. The most important ingredient from the leaves of these plants is nicotine—a volatile alkaloid. 1.6.1 Socioeconomic Status (SES) Nicotine is one of the most addictive and stimulant drugs. Nicotine affects all organs, but preThe socioeconomic status is deduced from the dominantly, it binds to a central nervous system occupational class, monthly household income, receptor and increases brain dopamine levels and the level of education. Conway et al. quanti- making it an addictive agent. The mechanism of tatively assessed each of these determinants of tobacco carcinogenesis is descibed in Fig. 1.12. SES for increased risk of oral cancers. A meta-­ analysis of 41 case–control studies comprising 1.6.2.1 Smoking of 15,344 oral cancer patients across the globe Hashibe et al. studied pooled data from 15 case– was done. The low-income category had a higher control studies and found dose–response relationrisk of oral cancer (OR 2.41, CI 1.59, 3.65, ship for pack-years of cigarette smoking and risk p