JOURNAL OF INTERNATIONAL ACADEMIC RESEARCH FOR MULTIDISCIPLINARY Impact Factor 1.393, ISSN: , Volume 2, Issue 2, March 2014

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1 INCIDENCE OF PRIMARY HEAD AND NECK CANCERS AT B K L W HOSPITAL & RURAL MEDICAL COLLEGE, A TERTIARY CARE CENTRE IN KONKAN, MAHARASHTRA RAJASHREE A KULKARNI* MAHESH S PATIL** *Assistant Professor, Dept. of Pathology, B K L Walawalkar Rural Medical College, Kasarwadi, Sawarde, Maharashtra, India **Assistant Professor, Dept. of Pathology, B K L Walawalkar Rural Medical College, Kasarwadi, Sawarde, Maharashtra, India ABSTRACT Head and neck cancers are among the top ten malignancies worldwide. Their true extent is lacking in konkan area of Maharashtra. There is no known published data covering the subject among konkan. To determine the incidence of primary head and neck cancers at B K L W Hospital, Diagnostic & Research centre, a tertiary care centre, Sawarde. The present study is a retrospective study carried out in the department of histopathology of B K L Walawalkar Hospital, diagnostic and Research centre, Sawarde, Maharashtra. A total of 1832 patients underwent histopathological examination between the period January 2012 to December Data regarding age, site, sex and histopathological diagnosis was analysed. A Total of 1832 cases were reported, out of which 696 were malignant lesions. Among 696, 362 cases were squamous cell carcinoma of head & neck and 188 includes squamous cell carcinomas of cervix, vault, GI tract etc. 146 cases are diagnosed as non Squamous carcinomas which includes breast carcinoma( 104 cases), soft tissue tumors (18 cases), lymphoma 6 cases, metastatic (07 cases),), liver (8 cases) and CNS includes 03 cases. Out of 362 head & neck malignancies, gender wise 240 patients were male and 122 were female patients. Male predominance was seen with male to female ratio 1.8 to 1. The age range varied from34 to 84 years. The commonest malignant tumor involving the head and neck region was Squamous cell carcinoma. Squamous cell carcinoma is the commonest, occurring more commonly in men than women. The gender ratio is similar to that seen in most countries. This study offers a benchmark for future studies, planning resources and monitoring the efficiency of efforts to manage the different pathologies in this region. Observed incidence patterns in the region are a reminder of widespread unawareness, low healthcare utilization. It also underlines the need to advocate for reliable cost-effective programs to create awareness, for early detection and plan appropriate management strategies. KEYWORDS: Squamous Cell Carcinoma (SCC), Head & Neck, Histomorphology, Sawarde. 51

2 INTRODUCTION Head and neck malignancies are among the most devastating disease processes we encounter, and treatment of these head and neck cancers is complex 1. These are the major cause of mortality and morbidity in several parts of the world. Squamous cell carcinomas accounts for approximately 20% of the cancer burden in India. The major risk factors are tobacco chewing, smoking and alcohol consumption, which are all preventable 2. Patients with head and neck cancer have specific requirements that are beyond the needs of most other patients diagnosed with other types of cancer 3. Several assorted histological types of tumor are found in the head and neck region. Between 70% to 90% of head and neck cancers are epithelial in origin, and squamous cell carcinoma constitutes 66.7% of carcinomas and 47.8% of all head and neck cancers 4,5 In developing strategies and planning resources to manage this group of pathologies in any population one needs to have a comprehensive and accurate data with respect to incidence, trends, common sites and histological type. To the best of our knowledge, there is no published study in the present literature on this subject among patients of konkan region. We studied head & neck cancers over two years in the B K L Walawalkar hospital, a tertiary health institution in Sawarde, to describe the histopathological aspects and determine the incidence of primary head and neck malignant tumors to contribute to the knowledge and understanding on this subject. Methodology Retrospectively head & neck cancers were studied at the Department of Pathology, B K L Walawalkar hospital, Diagnostic & Research centre, a tertiary care hospital over a period of two years (January 2012 t0 December 2013). The charts which met our selection criteria of primary malignant tumor were selected for further study after excluding, inflammatory swellings mimicking neoplasms, reactive cervical lymphadenitis and metastasis to the head and neck areas. The age, gender, site of pathology, and the histological diagnoses were noted and recorded. Statistical analysis Data were analyzed using Microsoft Excel spread sheet after they were scrutinised and cleaned. 52

3 Results There were total of 1832 histopathological cases, out of which 696 are diagnosed as malignant lesions from different sites. Among the total number of malignant cases 550 cases are of Squamous cell carcinoma. SCC of head & neck carries the highest rate with 362 cases. Remaining include 188 cases of SCC other than head & neck, squamous cell carcinomas of cervix, vault, GI tract etc. 146 cases are diagnosed as non Squamous carcinomas which includes breast carcinoma( 104 cases), soft tissue tumors (18 cases), lymphoma 6 cases, metastatic (07 cases),), liver (8 cases) and CNS includes 03 cases. Total of 240 male and 122 female head & neck squamous carcinoma were diagnosed. There is a male preponderance with male to female ratio of 1.8:1. The average age was 49.2 for male, for female and The oldest was 82 years and youngest was 34 years. The incidence increased with increasing age. Table 1: Age and sex distribution of the study sample AGE MALE FEMALE M:F RATIO 0-10 Nil Nil Nil Nil Nil Nil Nil Nil Nil Nil Nil Nil TOTAL Table 2: Site related study 13 SITE NUMBER OF CASES % Lower lip Anterior tongue Upper alveolus Lower alveolus Floor of the Mouth Buccal mucosa Retromolar trigone Hard palate Base of tongue Tonsil Oropharynx Nasopharynx Post cricoids Pyrifirm Sinus Supraglottis TOTAL

4 The incidence of head and neck tumors when averaged over last two years was observed to have systematically rising. The cause could be unawareness in this area and habits like tobacco chewing, smoking and poor oral hygiene. The commonest histopathological type was squamous cell carcinoma (n=362) which constituted 52.01% of all the primary head and neck tumors with a male to female ratio of 1.8:1. DISCUSSION Head and neck cancers are amongst the top ten malignancies globally and continue to pose challenges for all health workers in this area of care 6,7,8. Research into cancers in this area is not as rampant as in other areas of, and the incidence continues to rise in some societies especially in the third World 7,9. The search for their aetiology continues, however there are well known risk factors which contribute to the persistence and cause of these pathologies 10,11. Geographic variations exist especially with respect to sub-sites and this tends to be associated with the various risk factors found in different areas. Most world regions show an increasing incidence of head and neck cancers, with a few exceptions 9. In this study however, rather than trend, a rising incidence of head and neck cancer has been observed 8. The commonest lesion was squamous cell carcinoma (n=362). It represented 56.5% of all the primary head and neck malignancies.122 female and 240 male were affected with a male to female ratio of 1.8. The oldest was a 82 year old female and youngest was 34 year male. The commonest sub-site was the buccal mucosa][n=159], however, when considered together, the lip, the oral cavity, the tongue, gingivae, upper and lower alveolus and oropharynx constituted a higher incidence of squamous cell carcinoma. According to the National Cancer Institute s Surveillance, Epidemiology, and Ends Results (SEER) program, 30 percent of oral cancers originate in the tongue, 17% in the lip, and 14% in the floor of the mouth NCI, 2001) 12. Bhugri et al. suggested that the difference in the sub site of involvement in the two geographical areas is probably indicative of the difference in risk factors 11. This may demonstrate that some patients never avail themselves to the institutions or clinics from where our data is recorded. Public education may be helpful if the latter is the case to help capture a complete picture. 54

5 CONCLUSION This study provides data on the incidence of head and neck tumours in the konkan society. It conforms as in most other studies that head and neck neoplasms are mostly squamous cell carcinoma (SCC), and also lays credence to a rising incidence trend. Observed incidence patterns in the region are a reminder of widespread lack of awareness, low healthcare utilization and regional habits like chewing betel nut or gutka and poor hygiene. It also underlines the need to advocate for reliable cost-effective programs to create awareness, for early detection and plan appropriate management strategies. The peak age incidence is however lower compared to most other studies.. This study offers a contribution for future studies, planning resources and monitoring the efficiency of efforts to manage the different pathologies. Whilst it offers some baseline level on the incidence of these pathologies, to arrive at a true national picture, there is the need for more extensive study involving collecting data from many more areas of the country. References 1. Ekhar VR, Mahore DM, Kapre GM, Bokare BD, Gawarle SH /jp-journals Sankaranarayanan R, Masuyer E,Swaminathan R, Ferlay J, Whelan S. Head and neck cancer: a global perspective on epidemiology and prognosis. Anticancer Res 1998;18: Ringström E, Peters E, Hasegawa M, et al.: Molecular oncology, markers, clinical correlates. Human papillomavirus type 16 and squamous cell carcinoma of the head and neck. Clin Cancer Res 2002, 8: Semple CJ: The role of the CNS in head and neck oncology. Nurs Stand 2001, 15(31): Adeyemi BF, Adekunle LV, Kolude BM, Akang EEU, Lawoyin JO: Head and neck cancer - a clinicopathological study in a tertiary care centre. 7. Sankaranarayanan R, Masuyer E,Swaminathan R, Ferlay J, Whelan S. Head and neck cancer: a global perspective on epidemiology and prognosis. Anticancer Res 1998;18: Dobrossy L. Epidemiology of head and neck cancer: magnitude of the problem. Cancer Metastasis Rev 2005;24: Sankaranarayanan R, Masuyer E, Swaminathan R, Ferlay J, Whelan S. Head and neck cancer: a global perspective on epidemiology and prognosis. Anticancer Res 1998;18: Matta A, Ralhan R. Overview of current and future biologically based targeted therapies in head and neck squamous cell carcinoma. Head and Neck Oncology 2009;1: Tumino R, Vicario G. Head and neck cancers: oral cavity, pharynx, and larynx. Epidemiol Prev 2004;28: Bhurgri Y, Bhurgri A, Usman A, Pervez S, Kayani N, Bashir I, Ahmed R, Sheema H. Epidemiological review of head and neck cancers in Karachi. Asian Pacific J Cancer Prev 2006;7: Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Cancer incidence and mortality worldwide: GLOBOCAN IARC Cancer Base No v Dinshaw KA, Rao DN, Shroff PD. End result report on head & neck cancers, T M H Mumbai