Abstract OBJECTIVE:
To evaluate the clinical and pathological profile of young patients with squamous cell carcinoma of tongue.  METHODS:
The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of patients20.  RESULTS:
Of the 29 patients, 17(58.6%) were men and 12(41.3%) were women. The overall mean age at presentation was 29.6+/-4.4 years. All patients (100%) had some sort of addiction, with 15(51.7%) having more than one addiction. Of the total, 20(68.9%) patients had moderately differentiated carcinoma. At presentation, 20(68.9%) had advanced stage (III-IV) disease. Surgery was the primary modality used in all the patients (100%). Median follow-up period was 36 months (range: 1-6 years). During follow-up, 7(24.1%) patients developed recurrence.  CONCLUSIONS:
Squamous cell carcinoma of the tongue was more commonly seen in males, and multiple addictions were a common risk factor

Adeel, Muhammad

Shakeel Uz Zaman,

Suhail, Anwar

English

eCommons@AKU

eCommons@AKUDepartment of Surgery Department of SurgeryFebruary 2016Squamous cell carcinoma of oral tongue in youngpatients — A 10 years tertiary care experienceShakeel Uz ZamanAga Khan UniversityMuhammad AdeelAga Khan University, doc.adeel.khan@gmail.comAnwar SuhailAga Khan University, anwar.suhail@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surgPart of the Otolaryngology CommonsRecommended CitationShakeel Uz Zaman, ., Adeel, M., Suhail, A. (2016). Squamous cell carcinoma of oral tongue in young patients — A 10 years tertiarycare experience. JPMA: Journal of Pakistan Medical Association, 66(2), 155-158.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surg/161IntroductionOral cancer is the sixth most common cancer in the worldand is relatively uncommon under 40 years of age.1,2 InPakistan, it is the second most common cancer and itsincidence has been reported as 18%.3 This undoubtedly isamongst the highest reported incidences globally.Aetiologically, it is linked to smoking, tobacco chewing,alcohol, genetic factors, dietary factors, immunedeficiency and different types of viruses.4-7 Apart from theabove-mentioned factors, bad chewing habits liketobacco, areca nuts, betel quid, various forms of mixtureof tobacco and areca nuts (locally named as paan, chalia,gutka, naswar, main-puri) are resulting in ever increasingincidence of this cancer, especially in young patients.8-11The mutagenic effect of tobacco, alcohol, betel quid orareca nut depends on dose, frequency and usage, and theeffect is amplified upon using two ormore of these agentsconcurrently. Even though there are no studies availablefrom our region on the dose and frequency of chewinghabits, anecdotal data suggests that use of these productsis very high in Karachi.The current study was planned to determine the clinicaland pathological profile, the treatment methods adopted,and the outcome among young patients with squamouscell carcinoma (SCC) of the tongue.Patients and MethodsThe retrospective study was conducted at Aga KhanUniversity Hospital (AKUH), Karachi, and comprised recordof patients <35 years presenting with SCC of the tonguebetween 2001 and 2011. Patients agedmore than 35 yearsand those who received treatment outside our hospitalwere excluded. The patients with previously untreated SCCwere completely staged according to the American JointCommittee on Cancer (AJCC) staging system 7th edition.12Medical records of all patients were reviewed. Patientswith SCC are followed at AKUHmonthly in the first year, 2-monthly in the second year, quarterly in the third year andhalf-yearly in the last 2 years.Variables analysed for each patient included age at thetime of diagnosis, gender, addictions, tumour type,clinical and pathological staging, surgical margins andcomplications. Local, regional and distant failures wererecorded. Data was analysed using SPSS 20.ResultsThere were 35 SCC patients, but 6(17%) did not meet theinclusion criteria. Of the 29(83%) patients in the study,17(58.6%) were male and 12(41.3%) were female patients.The overall mean age was 29±4.4 years. All the 29(00%)patients had some sort of addiction, and 15(51.7%) hadJ Pak Med Assoc155ORIGINAL ARTICLESquamous cell carcinoma of oral tongue in young patients — A 10 years tertiarycare experienceShakeel Uz Zaman,1 Mohammad Adeel,2 Anwar Suhail3AbstractObjective: To evaluate the clinical and pathological profile of young patients with squamous cell carcinoma oftongue.Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised recordof patients <35 years presenting with squamous cell carcinoma of tongue between 2001 and 2011. Data wasextracted from the electronic database of the hospital for site and age. Clinico-pathological variables were analysedusing SPSS 20.Results: Of the 29 patients, 17(58.6%) were men and 12(41.3%) were women. The overall mean age at presentationwas 29.6+/-4.4 years. All patients (100%) had some sort of addiction, with 15(51.7%) having more than oneaddiction. Of the total, 20(68.9%) patients had moderately differentiated carcinoma. At presentation, 20(68.9%) hadadvanced stage (III-IV) disease. Surgery was the primary modality used in all the patients (100%). Median follow-upperiod was 36 months (range: 1-6 years). During follow-up, 7(24.1%) patients developed recurrence.Conclusions: Squamous cell carcinoma of the tongue was more commonly seen in males, and multiple addictionswere a common risk factor.Keywords: Squamous cell carcinoma, Addictions, Recurrence, Betel nut. (JPMA 66: 155; 2016)1,3Section of ENT, 2Department of Otolaryngology, Head & Neck Surgery, AgaKhan University Hospital, Karachi.Correspondence: Mohammad Adeel. Email: doc.adeel.khan@gmail.commore than one addiction. On clinical tumour (T) staging,T2 was the most common in 15(51.7%) patients, followedby T1 7(24.1%)Advanced stage lesions (stages III and IV)were seen in 20(68.9%) patients and early stage lesions(stages I and II) in 9(31%) (Table-1).Histologically most common grade was that ofmoderately differentiated carcinoma seen in 20(68.9%)patients. On pathological staging, 20(68.9%) hadadvanced stage (III and IV) lesions, while 9(31%) had earlylesions (stages I and II).Majority of the patients had clear surgical margins of >5mm, seen in 22(75.8%) patients and none (0%) hadinvolved margins. Extracapsular spread and muscleinvasion was found in 8(27.5%) patients (Table 2).All patients (100%) underwent surgery as the primarymodality of treatment, which included both wide localexcision of primary tumour along with neck dissection.Postoperative radiotherapy (64Gy) was received by13(44.8%) patients and 9(31%) underwent chemo-radiation (cisplatin) and 7(24.1%) received no adjuvanttreatment. Overall, 20(68.9%) patients underwentipsilateral neck dissection, while 9(31%) had bilateral neckdissection (Table 3).The most common surgical complication was wounddehiscence, in 5(17.2%) patients followed by woundinfection in 3(10.3%), while 1(3.4%) patient developedsecondary haemorrhage and 1(3.4%) establishedorocutaneous fistula.Median follow-up was 36 months (range: 1-6 years).During follow-up, 7(24.1%) patients developedrecurrence. Among these, 4(13.7%) had recurrence at theregional site, 2(6.8%) had local recurrence, whereas1(3.4%) developed distant metastasis. All the follow-upsVol. 66, No. 2, February 2016Squamous cell carcinoma of oral tongue in young patients— A 10 years tertiary care experience 156Table-1: Clinical characteristics.Number (n=29) %GenderMale 17 58.6Female 12 41.3AddictionsSmoking 4 13.7Tobacco 1 3.4Paan* 1 3.4Chahlia* 1 3.4Ghutka* 3 10.3Naswar* 4 13.7More than one 15 51.7Tumour (T) stageT1 7 24.1T2 15 51.7T3 6 20.6T4 1 3.4N stage (Nodes spread)N0 10 34.4N1 4 13.7N2 15 51.7N3 0AJCC stageI - II 9 31III - IV 20 68.9*Various forms of chewable tobaccoAJCC: American Joint Committee on Cancer.Table-2: Histopathological characteristics.Number (n=29) %GradesWell differentiated 7 24.1Moderately differentiated 20 68.9Poorly differentiated 2 6.8Pathological stagingPathological stage I-II 9 31Pathological stage III-IV 20 68.9Surgical margins<5mm 7 24.1>5mm 22 75.8Extracapsular spread 8 27.5Muscle invasion 8 27.5Table-3: Treatment and outcome.Number (n=29) %Primary treatmentSurgery 29 100Radiotherapy 0Chemotherapy 0Adjuvant treatmentSurgery 0Radiotherapy 13 44.8Chemoradiation 9 31None 7 24.1Neck dissectionIpsilateral 20 68.9Bilateral 9 31RecurrenceLocal 2 6.8Regional 4 13.7Distant 1 3.4Status at last follow-upDead 7 24.1Alive with disease 2 6.8Alive with no disease 20 68.9were recorded from the charts of the patients, and onlythose patients were contacted through phone who hadstopped coming for follow-up. At the latest follow-up,7(24.1%) patients had died, 2(6.8%) were alive withdisease, and 20(68.9%) were alive without any evidence ofthe disease.DiscussionThe incidence of oral SCC in young patients is relativelylow and is reported to be 4% to 6%.13-15 The reportedmedian age at the time of diagnosis of cancer of the oraltongue is 61 years and approximately 9% of patients arediagnosed before the age of 45 years, while 2% arediagnosed before age 35.16 In our study the mean age ofpresentation was 29 years.Oral SCC is more common in men than in women,15,17-19but there have been conflicting reports in literature. alonestudy20 on patients with oral SCC aged below 35 yearsreported a higher proportion of females. In the presentstudy, 17 (58.6%) cases were of men and only 12(41.3%) inwomen.In an earlier review of 197 consecutive patients treated fororal tongue cancer in Kerala, India, 82% patients below 30years did not have addictions.21 Another reportcomparing tongue cancer in young and older patients inIndia concluded that in younger patients, SCC of thetongue was associated with fewer aetiological factors,and in older patients it was always seen in associationwith smoking, alcohol or chewing tobacco. In contrast, allof our patients had some sort of addiction andmajority ofthem actually had more than one addiction. Previously itwas mentioned that development of SCC depends onusage and duration of chewable tobacco, but due to theretrospective nature of our study, exact details regardinguse of addictions in terms of duration and frequencycould not be ascertained.One study on young patients with oral SCC showed that61% patients had stage III-IV disease at the time ofpresentation,22 whereas another study had only 36%patients in advanced stage III-IV.23 We found that 72.4%were in advanced clinical stages at the time of diagnosis,which was higher than the ones quoted above.In our study the most common histological grade wasmoderately differentiated carcinoma seen in 20(68.9%)patients. Poorly differentiated cancer was seen in2(6.8%) patients only. In contrast, one study15 found 66%well differentiated tumours in the young patients itreviewed. Another study24 reported 59% well-differentiated and 23% moderately differentiatedtumours in young patients.A review of 152 patients below 40 years of age withtongue cancer23 reported a failure rate of 57%. Anotherstudy reported recurrence in 58.3%.25 In our study a fairlylower recurrence rate of 24% was noted, with most of thepatients having regional recurrence.A study25 on young patients with SCC reported that 42.7%patients died of the disease in the first two years of follow-up. On the other hand, we had 7(24.1%) patients whosuccumbed to the disease. Even in these patients, theexact cause of death could not be ascertained because ofthe retrospective nature of the study and the fact thatmost of these patients sought treatment from the nearbyhospitals in their last stages of disease.ConclusionSCC of the tongue was found more commonly in males.Multiple addictions were a common risk factor in youngpatients. Even though oral tongue SCC happensinfrequently in younger individuals, doubtful lesionsshould not be overlooked, and histopathologicallyverified tumours should be managed belligerently withregular follow-up. Additional studies are required toilluminate the biological influences underlying thedevelopment of tongue cancer in young individuals.References1. Shah JP, Gil Z. Current concepts in management of oral cancer-surgery. Oral Oncol. 2009; 45:394-401.2. Wang C, Kelly J, August M, Donoff B. Early carcinoma of the oralcavity: a conservative approach with radiation therapy. J OralMaxillofac Surg. 1995; 53: 687-90.3. Bhurgri Y. Cancer of the oral cavity-trends in Karachi South (1995-2002). Asian Pac J Cancer Prev. 2005; 6:22-6.4. Fialka F, Gruber RM, Hitt R, Opitz L, Brunner E, Schliephake H, et al.CPA6, FMO2, LGI1, SIAT1 and TNC are differentially expressed inearly-and late-stage oral squamous cell carcinoma-A pilot study.Oral Oncol. 2008; 44:941-8.5. AsakageT, Yokoyama A, HanedaT, Yamazaki M, MutoM,YokoyamaT, et al. Genetic polymorphisms of alcohol and aldehydedehydrogenases, and drinking, smoking and diet in Japanesemen with oral and pharyngeal squamous cell carcinoma.Carcinogenesis. 2007; 28:865-74.6. Hatagima A, Costa EC, Marques CF, Koifman RJ, Boffetta P, KoifmanS. Glutathione S-transferase polymorphisms and oral cancer: acase-control study in Rio de Janeiro, Brazil. Oral Oncol. 2008;44:200-7.7. Pintos J, Black MJ, Sadeghi N, Ghadirian P, Zeitouni AG, Viscidi RP,et al. Human papillomavirus infection and oral cancer: a case-control study in Montreal, Canada. Oral Oncol. 2008; 44:242-50.8. Randhawa T, Shameena P, Sudha S, Nair R. Squamous cellcarcinoma of tongue in a 19-year-old female. Indian J Cancer.2008; 45:128-30.9. Mazahir S, Malik R, MaqsoodM, Merchant KA, Malik F, Majeed A, etal. 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Llewellyn CD, Johnson NW, Warnakulasuriya KA. Risk factors fororal cancer in newly diagnosed patients aged 45 years andyounger: a case-control study in Southern England. J Oral PatholMed. 2004; 33:525-32.15. Sasaki T, Moles DR, Imai Y, Speight PM. Clinico?pathologicalfeatures of squamous cell carcinoma of the oral cavity in patients<40 years of age. J Oral Pathol Med. 2005; 34:129-33.16. Horner M, Ries L, KrapchoM, Neyman N, Aminou R, Howlader N, etal. SEER Cancer Statistics Review, 1975-2006, National CancerInstitute. Bethesda, MD. 2009.17. Massano J, Regateiro FS, Januário G, Ferreira A. Oral squamous cellcarcinoma: review of prognostic and predictive factors. Oral Surg,Oral Med, Oral Pathol, Oral Radiol, Endod. 2006; 102:67-76.18. Scully C, Felix DH. Oral Medicine-Update for the dentalpractitioner Orofacial pain. Br Dent J. 2006; 200:75-83.19. Bsoul SA, Huber MA, Terezhalmy GT. Squamous cell carcinoma ofthe oral tissues: a comprehensive review for oral healthcareproviders. 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Squamous cell carcinoma of oral tongue in young patients — A 10 years tertiary care experience

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Squamous cell carcinoma of oral tongue in young patients — A 10 years tertiary care experience

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