Study of prognostic factors in oral malignancy

INTRODUCTION: Squamous cell carcinoma is an aggressive neoplasm ranking sixth worldwide. Oral cavity malignancy is of squamous in origin and it accounts for 95% of head and neck malignancies. Most cases of oral malignancies are diagnosed at an advanced stage in the Indian subcontinent. Incidence of oral malignancies is more common in the Indian setup when compared to the western world. In developed countries, the incidence among the annually diagnosed neoplasms is 3% compared to Asia and India (developing countries) where it represents almost 30%. Various clinical and histopathological factors have been addressed in oral malignancies. AIMS AND OBJECTIVES: 1. To study the common sites of involvement in various subgroups. 2. To correlate FNAC and biopsy results in oral cavity lesions. 3. To study the various clinical and histopathological factors implicated in prognostication of oral malignancies. 4. To study the impact of histopathological grading on treatment and predictors of advanced disease. 5. To evaluate the response to treatment of oral malignancy with special reference to radiotherapy and chemotherapy. 6. To compare early and late oral malignancies and their response to treatment 7. To study oral cavity malignancy with special interest towards synchronous and metachronous head and neck malignancies. MATERIALS AND METHODS: Patients of oral malignancy admitted in TvMCH during the period from February, 2011 to August, 2012 has been considered as the study group, as per the inclusion and exclusion criteria given below Inclusion criteria: Age > 18 years, Previously diagnosed as a case of oral malignancy and on treatment, Patients with synchronous and metachronous head and neck malignancies. Exclusion criteria: Age < 18 years, Known serious medical comorbidities, Pregnancy, Major surgery within 14 days prior. Design of study: Prospective analysis of case series. Sample size: 98. Patients were evaluated based on questionnaires and the records were scrutinized for relevant clinical, pathological and treatment protocols. The various indicators which are under study are: age, sex, demographic data, risk factors, immune status, macroscopic appearance, size of lesion, surrounding induration, bony involvement, depth of invasion, regional lymph nodal involvement. A thorough history, clinical examination and investigations are carried out and patients are staged, treated and followed up during the study period. Histopathological grading and adequate resection margins are taken into consideration. Operative morbidity and mortality, various chemotherapeutic agents, radiation and their serious adverse effects, if any, are recorded. Samples (FNAC, biopsy- excision and wedge) are taken and are sent to pathology department for histopathology. CONCLUSIONS: Oral malignancies is predominantly seen in males though sex is not a risk factor. Mainly affects old male smokers, but younger age of onset may be seen which should be thoroughly evaluated. Tobacco and alcohol consumption are two most important risk factors. Association between various risk factors in not only additive but also synergistic. Cheek and tongue have almost similar rates of involvement. Well differentiated SCC is the most common histological variety. Most common morphologic type being ulcerative. Size of the lesion and resection margins important prognostic factors in determining local Recurrences. Grade of the tumour did not have a role in determining nodal spread in the study group. One case each of synchronous malignancy [cheek and lip] and recurrent cancer cheek, though statistically small can explain the concept of field cancerization. Early lesions have good response to treatment either in the form of RT or Surgery. Though stage of the disease is the major determinant of response to treatment independent of grade of tumour. Nodal disease has a bearing in the response rate and treatment option. More early lesions are found in males when compared to females probably due to early seeking of medical attention. Pre existing lesions were seen predominantly in the late lesions

[Allerbewährteste Mittel wider die Einbildung eines schnellen und unverhofften Todes Oder Gründlicher Unterricht, Wie ein jeder Mensch zu aller Zeit seinen GOtt solle recht erhörlich um ein seliges Ende bitten und täglich könne bereitet und gelassen leben]

Layoutgetreues Digitalisat der Ausg.: Dreßden : Harpeter, 1726 Standort: Universität Marburg, Bibliothek Religionswissenschaft (510) Signatur: 631 Vollständiger Titel nach Vorlage: Menandri Allerbewährteste Mittel wider die Einbildung eines schnellen und unverhofften Todes/ Oder Gründlicher Unterricht, Wie ein jeder Mensch zu aller Zeit seinen GOtt solle recht erhörlich um ein seliges Ende bitten/ und täglich könne bereitet und gelassen leben/ : Jn XXXIV. Betrachtungen über das unvergleichliche, geistreiche, schöne Lied: Wer weiß, wie nahe mir mein Ende? Hin geht die Zeit, her kömmt der Tod. Ehemals zu selbst eigenem Gebrauch erfunden, nunmehro aber mit Exempeln/ Gebeten/ Register und einem Anhange vermehret/ wie auch von den vorigen Druck-Fehlern gesaubert Nebst einer Vorerinnerung Valentin Ernst Löschers (Bibliothek Wittgenstein) Digitalisiert 201