Survival of second and multiple primary tumors in patients with oral cavity squamous cell carcinoma in the betel quid chewing area

e17002 Background: Squamous cell carcinoma of oral cavity (SCCOC) is characterized by marked geographical differences in frequency and site distribution. Pakistan is situated within the high risk zone on the global oral cancer map. However, no reliable data exists on oral cancer in this area. Our aim was to determine clinicopathological features and patterns at presentation of primary SCCOC in a comprehensive cancer centre in Pakistan. Methods: Demographic, risk factors, pathological and AJCC staging data for SCCOC treated at Shaukat Khanum Memorial Hospital for the period November 2003-October 2008 were obtained from the head and neck unit database. Results: The database identified 666 patients with biopsy proven primary SCCOC. Mean age was 53 years (range 12 - 90 years). Male (428): Female (238) ratio was M64%:F36%. The occurrence of major risk factors for oral cancer specifically smoking, betel quid chewing, naswar (smokeless tobacco) and alcohol use in males (428) was 45% (193), 28% (118), 29% (126), 3% (13), and in females (238) was 8% (20), 29% (68), 13% (30), 0% (0), respectively. Thirty-eight percent (411/666) had no association with tobacco, betel quid or alcohol use. Subsite within oral cavity; anterior tongue 41.1% (274), buccal mucosa 26.6% (177), lower gingival and alveolus 19.5% (130), upper gingival and alveolus 4.1% (27), lips 3.6% (24), retromolar trigone 2.9% (19), hard palate 1.7% (11), and floor mouth 0.6 (4). Broder's/World Health Organization histological grade; grade I 52% (334), grade II 34% (226), grade III 7% (49), and unknown 5% (36). According to AJCC 2002 system 0.2% (1), 10.8% (72), 12.2% (81), 13.2% (88), and 63.7% (420) had stage 0, I, II, III, and IV, respectively. Conclusions: Approximately 80% of patients with primary SCCOC present with stage III or IV disease with anterior tongue as the most common subsite in our hospital. While tobacco and betel quid chewing can be attributed to development of SCCOC in a significant proportion of patients, nearly 38% are unlinked to typical risks factors suggesting other environmental and genetic agents as etiological factors in this region. No significant financial relationships to disclose.

Download Full-text

Squamous cell carcinoma of the esophagus and multiple primary tumors of the upper aerodigestive tract

Arquivos de Gastroenterologia ◽

10.1590/s0004-28031999000400006 ◽

1999 ◽

Vol 36 (4) ◽

pp. 195-200 ◽

Cited By ~ 8

Author(s):

Ulysses RIBEIRO Jr. ◽

Ivan CECCONELLO ◽

Adriana Vaz SAFATLE-RIBEIRO ◽

Bruno ZILBERSTEIN ◽

Henrique Walter PINOTTI

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Aerodigestive Tract ◽

Second Primary ◽

Upper Aerodigestive Tract ◽

Primary Tumors ◽

Carcinoma Of The Esophagus ◽

Multiple Primary Tumors ◽

Multiple Primary

Squamous cell carcinoma of the esophagus is frequently associated with other, synchronous or metachronous tumors, in the upper aerodigestive tract. All 264 patients with squamous cell carcinoma of the esophagus, treated in the Gastrointestinal Surgery, Esophagus section, of the "Hospital das Clínicas" (São Paulo University Medical School, Brazil), between 1979 and 1989 were analyzed retrospectively with regards to the occurrence of multiple primary tumors in the upper aerodigestive tract. Multiple primary tumors were encountered in 10 (3.8%) patients. All patients were male and the mean age at the time of the first primary was 52.2 years. Tobacco smoke and alcohol were the principal carcinogens in these patients (n = 10). The sites of the tumors were: larynx (n = 4), tongue (n = 4), lung (n = 2), and oral cavity (n = 1). Two simultaneous, three synchronous and five metachronous multiple primary carcinomas were detected. The esophagus was the second primary tumor in nine patients. The mean overall survival after the diagnosis of the second primary was 2.8 months (SD = 0.89). Inquiry regarding other malignancies, associated with panendoscopy should be carry out prior to the treatment of the first primary to diagnose simultaneous or synchronous primary tumors, and careful follow-up should be performed after treatment of the first primary to detect new tumors in these high-risk patients.

Download Full-text