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Oral cancer in the United Arab Republic
Oral cancer in the United Arab Republic Report
of
135
cases
T
he incidence of cancw of spwific organ sites varies strikingly in different geographic regions of the worltl. In India and the Philippine Islands, oral ant1 pharyngeal cancer is 1)s far the most common neoplasm cwountcred. The (‘anccl Institute of Madras reported that 48 per c,ent of all malignant lesions were oral or pharyngeal in 0rigin.l In contrast to this estremrly high rate 01’ oral incaidcnee, oral cavity cancer accounted for only 2 per rent of all cancer eases in Norway.’ Few epidemiologic studies ol’ oral ~nucous membrane diseases front Africa are available. The same geographic diffcrenres exist with resycct to the 1’w~rumcy Jvith which the different parts of the mouth arc affected. For example, canwr oi’ the lip comprised about 30 per cent of all malignant tumors of the mouth at the A1emorial IIospital in Kcw York (liQ+ lmt represented only 1.7 1x3~ rent 01’ all oral cancer cases seen at the Tata Memorial Hospital in Bombay.’ Marked differences in se’s ratios in different countriw wcrc also ohsr~~c~l. III France the oral cancer mortality rate is 6.8 tirncs higher in men than iii wom(Ln. On the other hand, in Venczucla and (‘olomhiil tlwrc> is a higher ItloH:llity I*atc among w0men.j
The present report, conwrns ;I study oi’ 13.5 caonsccuti\-cx cases ot’ Ill;llignant oral lesions examined at Cairo I’niversit;C’ollege 01’ T>entistry clnring a 33 month period from .January, 1961, to August, 196:3. The S~III‘~TS ot’ this material included patients from the Wntal Clinic, together witlt patients referred I’or ronsultation from Cairo I’nirrrsity Hospitals, ot,hcr hospitals! and private I)ractitioners. 240
The patients examined represented a miscd civilian population from different age groups. Diagnosis was reached on the basis of clinical and histologic c~samination . All the patienb were csamincd 1)~ me. The oral lesions wvw cor1sidewcl to hc those occurring from tlrc rcrmiliorr horder of the lips to tlw anierior tonsillar pillars, inclnding the soft palate and 111~hsc of the tongw. Tlw lesions iiic~lndetl lierc~ were primary malignancies of the 01x1 carity. ~laliglialit. lyn~phonras and metastatic lwions w’re csclnded. The sites of th 1~Gorrs w’r( tlivicled iI~bitl?r~il~ into the following regions : toriguc~? Iloot~ ol’ 1hc>lllollt 11,lips, Iu~~al m~~c’osa,ginpivac, arid palate. FINDINGS
In this series, cancer of the oral cavity occurred in patic>rits between tlic ages of 2-k and 70 ?-cays (Table I). For the total group, tlw average age at the time of c~satrrination was 47.3 years. Of 13.5 patients, 127 had sr~~~a~r~ous-cell carcinoma arid air average age of 1X !-cars. Tlic average ages of paticnts with sqnamous-ccl1 c~awinoma according to tlrc site wew as follows : tongue. 15.2 yc‘ars; I ips, 50.X yrars: gingivae, 47 y3irs; l~wcaI murosa, .‘,I .‘3 )‘CiIYS; fh)Ol- Of the tllotltli,
-IT,.:3 paw.
01’ the 135 patients in this study, 74 per writ wcrc meii and 26 per writ were wonw~i. ()1’ the 127 casts of syuamous-cell carcinoma, 75..5 per writ oc~urretl in 111(‘11 illl(l 24.6 per 0.Wt in women. Of’ the paticrits with s~]llall~0L~s-c~~ll ~‘ill’(‘iltOlllil of I lie tongue, 52 per cent were men and 48 per cent were women. On tlic 0th han(1, 4.5 l)ci’ cent, 0E the cases of cai~cinorna of the lilts, occwrwl in woni~ii and !)5.5 J~V writ in men. Intraoral squamous-ccl1 cii rciriotna, generally, slrowed an iiiciclcnw of 7 1.-I per writ. in men and 2X.6 per cent, in women (Tahlr 11 ). ~IIow than one third of t,lic 0121 squanrons-ccl1 carcinoma lesions wax: locatctl in the tongue. The anterior third of the tongucl was involred in l’onr cases, t 11~post~crior two thirds in nineteen cases, and tlic tJilW of tlic torg~ic in foursleer1 cases, while in the remaining seven cases tlio Iwions involvc4 the cntirc tongue. JIost of’ tlic lesions develop4 on the lattrral or vc9itral sui~t’ace 01’ tlic t oll~~lc.
In this wries, tlic incidence 0C carcinoma of the gili~ivac and alveolar 1llUCOSiI was sec~tritl in freclueiicy only to carcinoma of the Iori~L‘ne. ()1’ thirty-two cwcs 01 s~~uamoi~scc>11carrinoma. twcwty occurred on the nranclilnrtar gingiva aird twlv(’
Table
I. Ihtribut~iorr
of casts according to age
O.S., 0.M. 6.zO.P. .\11gust, 1967
Tongue Lips
“:I L’1
“1 I
44 “2
Ruccal mucosa Gingivae Floor of mouth Palate
13 “T (i 6
:! 5 :!
15 32 s 6
18.1
16.5 10.2 21.2 -I.; 4.7
10.5
0,s I .; 3.I) I.7
34.6
17.3 II.9 20. -1 6.4 4.7
on the maxillary gingiva. One case of cc>ntr*al rnucoepidermoid carcinoma of the lower alveolar process was diagnosed. All of these lesions occnrred in tlrcl posterior part of the mouth (the molar and premolar area). Twenty-two lesions of squamous-ccl1 carcinoma \vcre locatcd on the lips-nineteen on the lower lip, two on the upper lip, and one on the labial commissures. Thirteen cases of squamous-cell carcinoma occurred on the buccal niucosa, togcthr~r wit,17 orit’ case of mucoepidcrnioid carcinoma and one case of fibrosarcorna. Nine malignant lesions occurred on the palate : these included six CRAWol’ squamous-ccl1 carcinoma and three of adcnocystic carcinoma. Eight of ten lesions of the floor of tht> mouth were squamous-cell carcinoma, and the other t\vo were rr777cocpitlcrrnoid carcinoma. There was a considrrablc varia,tion in the clinical appcarxncc of oral squamous-cell carcinoma lcsionx ; the majority wttrc ulcc~rs, but cxopliytic~ growths, kerat,oses, and swellings occnrred as well. The size of the Itlsions varied considerably bct,ween a few millimeters and more than 10 cm. Table III shows rnetastasrs according to site of origin. DISCUSSION
X review of the literature in this type of study prtIst>nts certain difYiculties. Opinions as to what constituted oval lesions varied i’rom one a7rthor to another. Tumors of the lips, orophnry7s. tonsils, maxillary sinuses, and parotid and submaxillary glands were included with oral lesions by some aathorx and not by
oth?m.
The predominant type of’ cancer found in the oral cavity is squamous-cell carcinoma. In this study, the finding that squamous-ccl1 carcinoma rcprescnted 92.6 per cent of all cases of oral cancer was in general agrecmcnt with findings of sirnilar studies in thcb I!nitctl States.“-’ Generally speaking, cancer of the month is considered more common in men. In our series we had a inan-to-womarl ratio of about> 3 :l. In the ITnit& States the man-to-wornan ratio \vas rcportcd as 9 :I,” 1 :I,” and 3 :l.” In (:r*cat Britain it was reported to be 10 :11” and 6 : 1,I1 and in Canada the ratio was 2001.*~ The ratio was 2 :1,13in Norway and 5 :3 in India.‘” Various figures have been given by different. authors regarding the f~cquer~c)
I. 2. 3. 4. .i. Ii. 7. s. !I. IO. 11.
It’. Pinsomtcsult, G., and Gill, Cr.: Oral Cancer in Female, (‘anad. JI. Ak. .J. 62: 14S, l!)Dl. 13. Also% T.: Cancer of the Oral Cavity Treated at the Sor~rc~giatt Rallittttt Hwr)ital. (‘ancer 13: 431. 1960. Study of 6% (‘;rrv.c: in Imliittt 14. Paynaster, .J. (1.: Cancer of nuccal Mucosa; (‘littical Patients, (‘ancer 9: -531 1956. 15. Pack, (+. T., ant1 Le &ewe, R. C.: The Age and Hex ltistriI,tttion :tttrl I trci~li~tt?!~ of Seoplaslic T)iseaees at the Memorial Hospital, New Yforl-\ (‘ity, .I. (‘attcrr 11~. 14: Ifii. l’)?O. <. 16. I)a;.is, G. G.: IJuyo Cheek (‘sneer .J. A. fir. 64: 71 1, 1915. 17. Romerwell, T. H.: Cancer of the Mouth and .Jrtws, Trtdian .r. Rttrg. 5: 5, 1’14::. IX. Ash, (‘1. l,., and i!lillartl, 0. H.: Ratliothcrapy of (‘:tttrcr of the ‘l’otrgttc at111 F’loor of the Mouth, Am. J. Roentgenol. 73: (ill, 19.35. at I-ttivewit? flw]tital, 19. Elkins, Ii. Ii.: Carcinoma of Tongue; ,Stttlly of Reports ‘t’rwtetl Iowa City, Iowa, I’last. & Reconstruct. Surfi. 9: 424, 195% L’O. Sltelltl, I). I’:, Bchtnitlt, Xi. I,., and Chang, C. H.: kS’iur\-ey of Totlgtte Cartcot Ovtar. 1.5 \-eax Periotl 111General Hospital, Surg. Gynec. R- Obst. 106: 15, 19%~ 21. Shafer, W. G., Hitte, M. I<., ant1 Lex-y, B. I\I.: A ‘~rstlx~r~lc of Oral I’:~tholog~~. I’hil:rtlelphia, 1958, \V. 1% Hauntlers Company. 22. i’lemnrr~sen, .r., anil Nielsen, A.: Cancer Tttcidence in Jkttmark. 1943 to 1!)5::, I):lttish nr. Jittll. 3: 33, 136, 249, 1956.
of
135
cases
T
he incidence of cancw of spwific organ sites varies strikingly in different geographic regions of the worltl. In India and the Philippine Islands, oral ant1 pharyngeal cancer is 1)s far the most common neoplasm cwountcred. The (‘anccl Institute of Madras reported that 48 per c,ent of all malignant lesions were oral or pharyngeal in 0rigin.l In contrast to this estremrly high rate 01’ oral incaidcnee, oral cavity cancer accounted for only 2 per rent of all cancer eases in Norway.’ Few epidemiologic studies ol’ oral ~nucous membrane diseases front Africa are available. The same geographic diffcrenres exist with resycct to the 1’w~rumcy Jvith which the different parts of the mouth arc affected. For example, canwr oi’ the lip comprised about 30 per cent of all malignant tumors of the mouth at the A1emorial IIospital in Kcw York (liQ+ lmt represented only 1.7 1x3~ rent 01’ all oral cancer cases seen at the Tata Memorial Hospital in Bombay.’ Marked differences in se’s ratios in different countriw wcrc also ohsr~~c~l. III France the oral cancer mortality rate is 6.8 tirncs higher in men than iii wom(Ln. On the other hand, in Venczucla and (‘olomhiil tlwrc> is a higher ItloH:llity I*atc among w0men.j
The present report, conwrns ;I study oi’ 13.5 caonsccuti\-cx cases ot’ Ill;llignant oral lesions examined at Cairo I’niversit;C’ollege 01’ T>entistry clnring a 33 month period from .January, 1961, to August, 196:3. The S~III‘~TS ot’ this material included patients from the Wntal Clinic, together witlt patients referred I’or ronsultation from Cairo I’nirrrsity Hospitals, ot,hcr hospitals! and private I)ractitioners. 240
The patients examined represented a miscd civilian population from different age groups. Diagnosis was reached on the basis of clinical and histologic c~samination . All the patienb were csamincd 1)~ me. The oral lesions wvw cor1sidewcl to hc those occurring from tlrc rcrmiliorr horder of the lips to tlw anierior tonsillar pillars, inclnding the soft palate and 111~hsc of the tongw. Tlw lesions iiic~lndetl lierc~ were primary malignancies of the 01x1 carity. ~laliglialit. lyn~phonras and metastatic lwions w’re csclnded. The sites of th 1~Gorrs w’r( tlivicled iI~bitl?r~il~ into the following regions : toriguc~? Iloot~ ol’ 1hc>lllollt 11,lips, Iu~~al m~~c’osa,ginpivac, arid palate. FINDINGS
In this series, cancer of the oral cavity occurred in patic>rits between tlic ages of 2-k and 70 ?-cays (Table I). For the total group, tlw average age at the time of c~satrrination was 47.3 years. Of 13.5 patients, 127 had sr~~~a~r~ous-cell carcinoma arid air average age of 1X !-cars. Tlic average ages of paticnts with sqnamous-ccl1 c~awinoma according to tlrc site wew as follows : tongue. 15.2 yc‘ars; I ips, 50.X yrars: gingivae, 47 y3irs; l~wcaI murosa, .‘,I .‘3 )‘CiIYS; fh)Ol- Of the tllotltli,
-IT,.:3 paw.
01’ the 135 patients in this study, 74 per writ wcrc meii and 26 per writ were wonw~i. ()1’ the 127 casts of syuamous-cell carcinoma, 75..5 per writ oc~urretl in 111(‘11 illl(l 24.6 per 0.Wt in women. Of’ the paticrits with s~]llall~0L~s-c~~ll ~‘ill’(‘iltOlllil of I lie tongue, 52 per cent were men and 48 per cent were women. On tlic 0th han(1, 4.5 l)ci’ cent, 0E the cases of cai~cinorna of the lilts, occwrwl in woni~ii and !)5.5 J~V writ in men. Intraoral squamous-ccl1 cii rciriotna, generally, slrowed an iiiciclcnw of 7 1.-I per writ. in men and 2X.6 per cent, in women (Tahlr 11 ). ~IIow than one third of t,lic 0121 squanrons-ccl1 carcinoma lesions wax: locatctl in the tongue. The anterior third of the tongucl was involred in l’onr cases, t 11~post~crior two thirds in nineteen cases, and tlic tJilW of tlic torg~ic in foursleer1 cases, while in the remaining seven cases tlio Iwions involvc4 the cntirc tongue. JIost of’ tlic lesions develop4 on the lattrral or vc9itral sui~t’ace 01’ tlic t oll~~lc.
In this wries, tlic incidence 0C carcinoma of the gili~ivac and alveolar 1llUCOSiI was sec~tritl in freclueiicy only to carcinoma of the Iori~L‘ne. ()1’ thirty-two cwcs 01 s~~uamoi~scc>11carrinoma. twcwty occurred on the nranclilnrtar gingiva aird twlv(’
Table
I. Ihtribut~iorr
of casts according to age
O.S., 0.M. 6.zO.P. .\11gust, 1967
Tongue Lips
“:I L’1
“1 I
44 “2
Ruccal mucosa Gingivae Floor of mouth Palate
13 “T (i 6
:! 5 :!
15 32 s 6
18.1
16.5 10.2 21.2 -I.; 4.7
10.5
0,s I .; 3.I) I.7
34.6
17.3 II.9 20. -1 6.4 4.7
on the maxillary gingiva. One case of cc>ntr*al rnucoepidermoid carcinoma of the lower alveolar process was diagnosed. All of these lesions occnrred in tlrcl posterior part of the mouth (the molar and premolar area). Twenty-two lesions of squamous-ccl1 carcinoma \vcre locatcd on the lips-nineteen on the lower lip, two on the upper lip, and one on the labial commissures. Thirteen cases of squamous-cell carcinoma occurred on the buccal niucosa, togcthr~r wit,17 orit’ case of mucoepidcrnioid carcinoma and one case of fibrosarcorna. Nine malignant lesions occurred on the palate : these included six CRAWol’ squamous-ccl1 carcinoma and three of adcnocystic carcinoma. Eight of ten lesions of the floor of tht> mouth were squamous-cell carcinoma, and the other t\vo were rr777cocpitlcrrnoid carcinoma. There was a considrrablc varia,tion in the clinical appcarxncc of oral squamous-cell carcinoma lcsionx ; the majority wttrc ulcc~rs, but cxopliytic~ growths, kerat,oses, and swellings occnrred as well. The size of the Itlsions varied considerably bct,ween a few millimeters and more than 10 cm. Table III shows rnetastasrs according to site of origin. DISCUSSION
X review of the literature in this type of study prtIst>nts certain difYiculties. Opinions as to what constituted oval lesions varied i’rom one a7rthor to another. Tumors of the lips, orophnry7s. tonsils, maxillary sinuses, and parotid and submaxillary glands were included with oral lesions by some aathorx and not by
oth?m.
The predominant type of’ cancer found in the oral cavity is squamous-cell carcinoma. In this study, the finding that squamous-ccl1 carcinoma rcprescnted 92.6 per cent of all cases of oral cancer was in general agrecmcnt with findings of sirnilar studies in thcb I!nitctl States.“-’ Generally speaking, cancer of the month is considered more common in men. In our series we had a inan-to-womarl ratio of about> 3 :l. In the ITnit& States the man-to-wornan ratio \vas rcportcd as 9 :I,” 1 :I,” and 3 :l.” In (:r*cat Britain it was reported to be 10 :11” and 6 : 1,I1 and in Canada the ratio was 2001.*~ The ratio was 2 :1,13in Norway and 5 :3 in India.‘” Various figures have been given by different. authors regarding the f~cquer~c)
I. 2. 3. 4. .i. Ii. 7. s. !I. IO. 11.
It’. Pinsomtcsult, G., and Gill, Cr.: Oral Cancer in Female, (‘anad. JI. Ak. .J. 62: 14S, l!)Dl. 13. Also% T.: Cancer of the Oral Cavity Treated at the Sor~rc~giatt Rallittttt Hwr)ital. (‘ancer 13: 431. 1960. Study of 6% (‘;rrv.c: in Imliittt 14. Paynaster, .J. (1.: Cancer of nuccal Mucosa; (‘littical Patients, (‘ancer 9: -531 1956. 15. Pack, (+. T., ant1 Le &ewe, R. C.: The Age and Hex ltistriI,tttion :tttrl I trci~li~tt?!~ of Seoplaslic T)iseaees at the Memorial Hospital, New Yforl-\ (‘ity, .I. (‘attcrr 11~. 14: Ifii. l’)?O. <. 16. I)a;.is, G. G.: IJuyo Cheek (‘sneer .J. A. fir. 64: 71 1, 1915. 17. Romerwell, T. H.: Cancer of the Mouth and .Jrtws, Trtdian .r. Rttrg. 5: 5, 1’14::. IX. Ash, (‘1. l,., and i!lillartl, 0. H.: Ratliothcrapy of (‘:tttrcr of the ‘l’otrgttc at111 F’loor of the Mouth, Am. J. Roentgenol. 73: (ill, 19.35. at I-ttivewit? flw]tital, 19. Elkins, Ii. Ii.: Carcinoma of Tongue; ,Stttlly of Reports ‘t’rwtetl Iowa City, Iowa, I’last. & Reconstruct. Surfi. 9: 424, 195% L’O. Sltelltl, I). I’:, Bchtnitlt, Xi. I,., and Chang, C. H.: kS’iur\-ey of Totlgtte Cartcot Ovtar. 1.5 \-eax Periotl 111General Hospital, Surg. Gynec. R- Obst. 106: 15, 19%~ 21. Shafer, W. G., Hitte, M. I<., ant1 Lex-y, B. I\I.: A ‘~rstlx~r~lc of Oral I’:~tholog~~. I’hil:rtlelphia, 1958, \V. 1% Hauntlers Company. 22. i’lemnrr~sen, .r., anil Nielsen, A.: Cancer Tttcidence in Jkttmark. 1943 to 1!)5::, I):lttish nr. Jittll. 3: 33, 136, 249, 1956.