Incidence and various modalities of treatment of oral cavity malignancy in Government Rajaji Hospital, Madurai

Ramachandran, K (2013) Incidence and various modalities of treatment of oral cavity malignancy in Government Rajaji Hospital, Madurai. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: The oral cavity is made of complex structures that include the lips, tongue, gingivae, alveolus, and palate, floor of the mouth, mucous lining membrane and minor salivary glands. Like elsewhere in the body, these structures are made of fundamental tissues like blood vessels, nerves, bones, muscles, mucous membrane and skin. Malignancy may arise from any of these structures. The tissues of the oral cavity are exposed to a wide variety of infectious, chemical irritants and carcinogens and thus are liable to develop a wide variety of malignancies. Cancers of the oral cavity are notorious for their poor prognosis and outcome inspite of advances in treatment. Majority of the patients are seen in an advanced stage of presentation and treatment of these patients is very demanding which is predominantly by a multimodal approach. 95% of oral cavity cancers are squamous cell cancers4 and it is one of the most important health burdens in India. This study aims to analyze the incidence of oral cavity cancers in different age groups, sexes, occupation, sites, the association of risk factors with oral cancers, determine the average presenting stage and to discuss the various clinical presentations, modalities of treatment and their outcomes. AIM OF THE STUDY: 1. To analyses the incidence (Age, Sex, Occupation, Site and Histology). 2. To discuss the association of risk factors with oral cancers, 3. To find presenting stage at the time of hospital visit, 4. To discuss the various clinical presentation, 5. Various modalities of treatment and their outcomes. MATERIALS AND METHODS: This study includes all patients who reported to the departments of surgery, medical oncology, radiation oncology and surgical oncology at Govt. Rajaji Hospital who were diagnosed with oral cancer. The study was for a period of Twenty four months from Jan 2011 to Dec 2012. There was no specific selection criteria used to select cases; patients came to the departments either directly or were referred from other departments and other hospitals after malignancy was proven by histopathological examination. Diagnosis was confirmed by histopathological examination of specimen which was obtained by wedge biopsy of the ulcer/growth. Detailed history regarding number, duration of symptoms, habits like smoking, tobacco / pan chewing were obtained, baseline investigations like a complete hemogram, blood biochemistry, X-ray chest and X-ray mandible were done as required. It was followed by a through physical examination to accurately assess the size, extent and infiltration of tumour and neck nodes. All patients were given TNM staging. Patients with advanced disease were given chemoradiotherapy exceptin rare instances where surgery was done following chemoradiotherapy for residual disease. Those patients with inoperable disease were treated with palliative radiotherapy. Radiotherapy was given as external beam radio therapy using radioactive cobalt- 60, as the definitive treatment for advanced stages (stage 3 and 4) at a dose of 66 Gy (2.0 Gy/day for 5 days/week for a total of 6 weeks in 28-35 sittings) for primary and 50 Gy (2.0 Gy/day for 5 days/week for a total of 6 weeks) for neck combined with cisplatin at a dose of 100 mg/ m2, 5-FU at 1000 mg/m2 as infusion on 1,22nd and 43rd days as a chemoradiotherapy. Patients with early & operable disease was treated with surgery depends on site. Primary reconstructions of the post excisional defect was done for all patients which included Primary suturing, Split skin graft, Pectoralis major myocutaneous flap, Pectoralis major osseomyocutoneus flap and Fore head flap. Pectoralis major myocutaneous flap was used in majority of cases for both inner lining and cover. CONCLUSIONS: 1. The most common cancer of the oral cavity that we encountered was squamous cell carcinoma which accounted for 93.83% of the cases. 2. In our study the buccal mucosa was most commonly involved (36.42%) followed by the tongue (35.18%) though the difference was negligible. 3. Incidence of oral cancer was found to be highest in the 6th & 7th decades 31.48% & 30.25% respectively. 4. There was a definite male preponderance with a male to female sex ratio of1.61:1. 5. The most common etiological factor (in 47.53% of cases) was the habit of chewing betel leaf and tobacco with slaked lime (quid).It was also apparent that this habit was much more common in females 32.10% against 15.43% for males. 6. The commonest mode of presentation in our study was an ulcer 93.0%. 7. Majority of patients had an ulcerative type of growth 58.03% against 5.55% with a proliferative growth and 36.42% with an ulceroproliferative pattern of growth. 8. Almost all of the cases were from a low socioeconomic stratum 99.38%. 9. Lack of awareness among the general public about oral cancers and non availability of mechanisms for early diagnosis and referral are probably the reasons for majority of patients presenting in Stage III 32.10% and IV 48.76% in our study. 10. There were no cases of distant metastasis Stage IVC. 11. Management of early oral cancers (Stage I & Stage II) with surgery yielded a good result; complete response was seen in 85.71% of cases. Likewise advanced stages were managed with a multimodal approach either surgery with chemoradiotherapy in which 78.26% cure rate was achieved or surgery with radiotherapy alone in which 80.0% cure rate was seen. 12. A post operative mortality was encountered. 13. 41.97% of patients were given primary chemoradiotherapy and 38.23% responded completely while 17.64% of patients had residual disease and underwent salvage surgery. 14. Around 25.30% of patients who presented late and who had inoperable tumours were managed with palliative radiotherapy. 15. Our study was confounded by 36.41% defaulters. The recurrence rate was 9.38% following surgery. 16. So we conclude that early lesions can be successfully managed with single modality treatment, either surgery or radiotherapy while advanced cases definitely requires a multimodal approach.

Item Type: Thesis (Masters)
Uncontrolled Keywords: oral cavity malignancy ; Incidence ; various modalities of treatment ; Government Rajaji Hospital ; Madurai.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 05 Jun 2018 03:03
Last Modified: 05 Jun 2018 03:03

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