OBSERVATIONAL STUDY IN REFERENCE TO DEMOGRAPHIC PROFILE, CLINICAL PRESENTATION, TOBACCO ADDICTION, SITES AND SUBSITES OF HEAD & NECK SQUAMOUS CELL CARCINOMA AT A TERTIARY CARE CENTRE OF WESTERN RAJASTHAN
Main Article Content
Keywords
Head and neck squamous cell carcinoma, Oral cancer, Gingivo-buccal sulcus, Tobacco chewing, Epidemiology, Rajasthan, Advanced stage presentation.
Abstract
Head and Neck Squamous Cell Carcinoma (HNSCC) constitutes a significant portion of the global cancer burden, with a distinct and alarming prevalence in the Indian subcontinent. Unlike Western populations where alcohol and smoking are synergistic drivers, the Indian demographic is uniquely characterized by the rampant consumption of smokeless tobacco products, leading to a specific epidemiological profile often termed "Indian oral cancer." This study aims to provide a comprehensive analysis of the demographic variables, risk factor profiles, clinical presentations, and anatomical distribution of HNSCC in Western Rajasthan, a region with high usage of areca nut and tobacco mixtures.
Methods: A prospective, observational, descriptive cross-sectional study was conducted at the Department of Otorhinolaryngology, Mathuradas Mathur Hospital, Dr. S. N. Medical College, Jodhpur, from February 1, 2024, to May 1, 2024. The study included 92 histopathologically confirmed cases of squamous cell carcinoma involving the oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx. Data regarding age, gender, socioeconomic status, education, residence, addiction habits, and clinical symptoms were recorded. Tumors were staged according to the AJCC 8th Edition TNM classification. Statistical analysis was performed to determine frequency distributions and associations.
Results: The study identified a strong male preponderance (77.17%) with a male-to-female ratio of 3.4:1. The disease primarily affected the elderly, with 66.29% of patients aged above 50 years. A distinct socioeconomic gradient was observed; 86.95% of patients belonged to low-income or economically weaker sections, and 67.38% were either illiterate or had only primary education. Rural residents constituted 59.78% of the cohort. Tobacco addiction was near-universal (98.9%), with a stark dichotomy in usage patterns: smokeless tobacco was the exclusive habit in 94% of oral cancer cases, while smoking was predominant in laryngeal and pharyngeal cancers. The oral cavity was the most common primary site (55.43%), followed by the oropharynx (18.47%), larynx (14.13%), and hypopharynx (10.86%). The anterior two-thirds of the tongue and gingivo-buccal sulcus were the most affected oral subsites. Notably, 90.21% of patients presented with advanced-stage disease (Stage III or IV).
Conclusions: HNSCC in Western Rajasthan is inextricably linked to poverty, illiteracy, and specific tobacco chewing habits. The predominance of advanced-stage disease at presentation highlights a critical failure in early detection mechanisms. The distinct subsite distribution, favoring the gingivo-buccal complex, reinforces the etiological role of local carcinogen placement. Urgent public health interventions focusing on tobacco cessation and rural screening programs are mandated to mitigate this preventable epidemic.
References
2. NCI. Head and neck cancer. United States National Cancer Institute, National Institutes of Health 2018. Accessed March 22, 2021: www.cancer.gov/types/head-and-neck/head-neck-factsheet
3. Kulkarni MR. Head and Neck Cancer Burden in India. Int J Head and Neck Surg 2013;4(1):29-35
4. Head and Neck Cancer in India. Available from: http://www.veedaoncology.com/PDFDocument/HeadNeck%20Cancer%20In%20India.pdf. [Last accessed on: 2011 Dec 26].
5. Chaturvedi P. Head and neck surgery. J Can Res Ther 2009; 5:143.
6. Ward E.M., Sherman R.L., Henley S.J., Jemal A., Siegel D.A., Feuer E.J., Firth A.U., Kohler B.A., Scott S., Ma J., et al. Annual Report to the Nation on the Status of Cancer, Featuring Cancer in Men and Women Age 20–49 Years. J. Natl. Cancer Inst. 2019;111:1279–1297.
7. Dong M., Cioffi G., Wang J., Waite K.A., Ostrom Q.T., Kruchko C., Lathia J.D., Rubin J.B., Berens M.E., Connor J., et al. Sex Differences in Cancer Incidence and Survival: A Pan-Cancer Analysis. Cancer Epidemiol. Biomark. Prev. 2020;29:1389–1397.
8. Cook M.B., Dawsey S.M., Freedman N.D., Inskip P.D., Wichner S.M., Quraishi S.M., Devesa S.S., McGlynn K.A. Sex disparities in cancer incidence by period and age. Cancer Epidemiol. Biomarkers Prev. 2009;18:1174–1182
9. Neville BW, Day TA. Oral cancer and precancerous lesions. CA Cancer J Clin 2002;52:195-215.
10. Decker J, Goldstein JC. Risk factors in head and neck cancer. N Engl J Med 1982;306(19):1151–1155 7
11. Available at: WHO. Global Adult Tobacco Survey India; 2016–17. Accessed March 22, 2021: www.who.int/tobacco/surveillance/ survey/gats/ GATS_India_2016-17_FactSheet.pd. Accessed on December 10, 2021
12. Addala L, Pentapati CK, Reddy Thavanati PK, Anjaneyulu V, Sadhnani MD. Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India. Indian J Cancer 2012;49(02):215–219
13. Kekatpure V, Kuriakose MA. Oral Cancer in India: Learning from different populations. National newsletter and website from New York Presbyterian Hospital 2010;14.Availablefrom:http://www.nypcancerprevention.com/issue/14/cancer_prevention/ feature/india.shtml
14. Chaturvedi P. Head and neck surgery. J Can Res Ther 2009; 5:143.
15. Chauhan R, Trivedi V, Rani R, et al. A Study of Head and Neck Cancer Patients with Reference to Tobacco Use, Gender, and Subsite Distribution South Asian J Cancer 2022;11(1):46–51
16. Nair, D., Singhvi, H., Mair, M., Qayyumi, B., Deshmukh, A., Pantvaidya, G., Nair, S., Chaturvedi, P., Laskar, S., Prabhash, K. and DCruz, A., 2017. Outcomes of surgically treated oral cancer patients at a tertiary cancer center in India. Indian Journal of Cancer, 54(4), p.616.
17. Basu R, Mandal S, Ghosh A, Poddar TK. Role of tobacco in the development of head and neck squamous cell carcinoma in an eastern Indian population. Asian Pac J Cancer Prev. 2008;9(3):381-6.
18. Addala L, Pentapati CK, Reddy Thavanati PK, Anjaneyulu V, Sadhnani MD. Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India. Indian J Cancer. 2012;49(2):215-9.
19. Malik A, Mishra A, Garg A, Shetty R, Mair M, Chakrabarti S, et al. Trends of oral cancer with regard to age, gender, and subsite over 16 years at a tertiary cancer center in India. Indian J Med PaediatrOncol 2018;39:297-300.
20. Scott Brown’s otorhinolaryngology, head and neck surgery, 8th edition (2019), volume 3, 35-47.
21. Park JO, Nam IC, Kim CS, Park SJ, Lee DH, Kim HB, Han KD, Joo YH. Sex Differences in the Prevalence of Head and Neck Cancers: A 10-Year Follow-Up Study of 10 Million Healthy People. Cancers (Basel). 2022;14(10):2521.
22. Laprise C., Shahul H.P., Madathil S.A., Thekkepurakkal A.S., Castonguay G., Varghese I., Shiraz S., Allison P., Schlecht N.F., Rousseau M.C., Franco E.L., Nicolau B. Periodontal diseases and risk of oral cancer in Southern India: results from the HeNCe Life study. Int. J. Canc. 2016;139:1512–1519. doi: 10.1002/ijc.30201. [PubMed] [CrossRef] [Google Scholar]
23. Sharma S., Satyanarayana L., Asthana S., Shivalingesh K.K., Goutham B.S., Ramachandra S. Oral cancer statistics in India on the basis of first report of 29 population-based cancer registries. J. Oral Maxillofac. Pathol. 2018; 22:18–26.
24. Veluthattil A., Sudha S., Kandasamy S., Chakkalakkoombil S. Effect of hypofractionated, palliative radiotherapy on quality of life in late-stage oral cavity cancer: a prospective clinical trial. Indian J. Palliat. Care. 2019;25:383.
25. Ajay P., Ashwinirani S., Nayak A., Suragimath G., Kamala K., Sande A., Naik R. Oral cancer prevalence in Western population of Maharashtra, India, for a period of 5 years. J. Oral Res. Rev. 2018;10:11.
26. Malik A., Mishra A., Garg A., Shetty R., Mair M., Chakrabarti S., Nair D., Balasubramaniam G., Chaturvedi P. Trends of oral cancer with regard to age, gender, and subsite over 16 years at a tertiary cancer center in India. Indian J. Med. Paediatr. Oncol. 2018;39:297.
27. Ferlay J, Shin H, Bray F, et al.GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide:IARC CancerBase No. 10 [Internet]. Lyon,France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr
28. Hashibe M, Brennan P, Chuang SC, et al.Interaction between tobacco and alcoholuse and the risk of head and neck cancer:pooled analysis in the InternationalHead and Neck Cancer EpidemiologyConsortium. Cancer Epidemiol Biomarkers Prev 2009; 18: 541–50.
29. McCormack VA, Boffetta P. Today’slifestyles, tomorrow’s cancers: trends in lifestyle risk factors for cancer in low- andmiddle-income countries. Ann Oncol2011; 22: 2349–57.
30. Funk GF, Karnell LH, Robinson RA, et al.Presentation, treatment, and outcome oforal cavity cancer: a National Cancer DataBase report. Head Neck 2002; 24: 165–80.
31. Wee JT, Ha TC, Loong SL, Qian CN. Is nasopharyngeal carcinoma really a “Cantonese Cancer”? [J] Chin J Cancer. 2010;29(5):517–526.
32. Zheng YM, Tuppin P, Hubert A, et al. Environmental and dietary risk factors for nasopharyngeal carcinoma: a case-control study in Zangwu County, Guangxi, China [J] Br J Cancer. 1994;69(3):508–514.
33. Chang ET, Adami HO. The enigmatic epidemiology of nasopharyngeal carcinoma [J] Cancer Epidemiol Biomarkers Prev. 2006;15(10):1765–1777.
34. Hirayama T. Descriptive and analytic epidemiology of nasopharyngeal carcinoma [M] In: De The G, Ito Y, editors. Nasopharyngeal carcinoma: etiology and control. Lyon: IARC Scientific Publications; 1978. pp. 167–189.
35. Muir C, Waterhouse J, Mack T, editors. Lyon: IARC Scientific Publications; 1987. Cancer incidence in five continents [M] pp. 787–789.
36. Torre LA, Bray F, Siegel RL, et al. Globalcancer statistics, 2012. CA Cancer J Clin.2015. DOI: 10.3322/caac.21262.
37. Goldsmith DB, West TM, Mortan R. HLA associations with nasopharyngeal carcinoma in southern Chinese ; a metaanalysis. Clinical otolaryngology and allied sciences 2002; 27: 61 – 7.
38. Review of Nasopharyngeal cancer – AnitaJeyakumar M.D; Todd M.Brickman M.D; Alwin Jeyakumar M.D, Timothy Doerr M.D,2006,volume 85, number 3 168 – 173.
39. Scott Brown’s laryngology and head and neck surgery 1997, 6th edition, ch.13, 9.
40. Stell and Marans head and neck surgery, 4th edition, John C. WatkinsonMSc, MS,FRCS,DLO and Mark N. Gaze MD, FRCP,FRCR.
41. Sobin LH, Wittekind Ch. TNm classification of malignant tumours, UICC, 6th edition, Newyork, Wiley – Liss,2002. A summary and cornerstone for accurate staging.
42. Chimenos-Küstner E, Marques-Soares MS, Schemel-Suárez M. [Aetiopathology and prevention of oropharyngeal cancer]. Semergen. 2019;45(7):497-503.
43. Gillison ML, Koch WM, Capone RB, Spafford M, Westra WH, Wu L, Zahurak ML, Daniel RW, Viglione M, Symer DE, Shah KV, Sidransky D. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000;92(9):709-20.
44. Yete S, D'Souza W, Saranath D. High-Risk Human Papillomavirus in Oral Cancer: Clinical Implications. Oncology. 2018;94(3):133-141.
45. Taberna M, Mena M, Pavón MA, Alemany L, Gillison ML, Mesía R. Human papillomavirus-related oropharyngeal cancer. Ann Oncol. 2017 Oct 01;28(10):2386-2398.
46. Shah J.P (1996) oral cavity and oropharynx in head and neck surgery, 2nd edition, Mosby – Wolfe, London , chapter 6, PP 167 – 234.
47. Stell and Marans head and neck surgery, 4th edition, John C. Watkinson MSc, MS,FRCS,DLO and Mark N. Gaze MD, FRCP,FRCR.
48. Scott Brown’s otorhinolaryngology, head and neck surgery, 7th edition (2008), volume 2, 2359 – 2371.
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Dr vikram singh shekhawat
Senior resident ENT, Department of Otorhinolaryngology-Head and Neck Surgery
Dr SN Medical College Jodhpur
Dr Jaideep Singh Chouhan
Assistant Professor, Department Of Otorhinolaryngology-Head and Neck Surgery
Dr SN Medical College Jodhpur
Dr. Ankit Kumar Avasthi
Senior Resident, Department of Otorhinolaryngology-Head and neck Surgery
JLN Medical College, Ajmer
Dr Megh Ram Meena
Senior medical officer, Department Of Otorhinolaryngology-Head and Neck Surgery
Dr SN Medical College Jodhpur
