Buccal Mucosa Cancer PDF

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Buccal Mucosa Cancer PDF

Buccal Mucosa Cancer PDF

Carcinoma of the Buccal Mucosa is the commonest oral cavity cancer in India.

As per the data available from the National Cancer Registry Programme (Population Based Cancer Registries), of the Indian Council of Medical Research, the males of Ahmedabad urban showed highest Age Adjusted Rate (AAR) for mouth cancer (12.9) followed by Bhopal (9.9).

For females however, Bengaluru showed the highest AAR (6.5) followed by Kamrup urban district (5.8)1 .

In the Hospital Based Cancer Registry report, cancer of the mouth is also ranked as the leading site in Mumbai in males and was within the first five leading sites in all registries in males2 .

In the developed countries, carcinoma Buccal Mucosa is relatively uncommon as compared to the Indian subcontinent3 .

The high incidence of carcinoma of the Buccal Mucosa in our country is attributable to the extensive use of tobacco in various forms and the locally advanced cancers account for about 70% of the cases at the time of presentation.

The reported 5 year survival rates for Buccal Mucosa cancers in India ranges from 80% for stage I disease to 5-15% for locally advanced disease4-5.

There is lack of consensus over the use of surgery, radiotherapy and chemotherapy in the treatment of advanced Buccal Mucosa cancers.

This includes sequence/combination of the different modalities and the use of concurrent chemo-radiotherapy.

Recurrent disease after surgery and/or radiotherapy is difficult to salvage and therefore it is necessary to provide optimum, state of the art, evidence based care to patients to improve cure rates with minimum morbidity and good quality of life.

Providing treating doctors with uniform guidelines for the management of Buccal Mucosa cancer appears to be an appropriate step forward in achieving this goal.

Several international consensus guidelines are available for the management of oral cavity cancers, but none them addresses Buccal Mucosa cancers in particular.

Therefore, formulating reliable guidelines based on western data is questionable given the fact that Buccal Mucosa tumors are quite rare in the developed countries.

A recent publication from Australia is based on the report of only 32 cases of Buccal Mucosa cancer6 .

There is obviously an urgent need to formulate consensus statement for the management of carcinoma of Buccal Mucosa based on Indian data and experience which would not only incorporate the evidence available but would also be feasible to be practiced in the hospitals of India.

The following part of this chapter provides some of the existing National and International guidelines for oral cavity cancer and reviews the applicability of the given guidelines for patients with carcinoma of Buccal Mucosa, especially in Indian context.

A short review of the National and International data on Buccal Mucosa cancer is provided.

The proposed national consensus document for Buccal Mucosa cancer is presented. Some of the key areas of research relevant to our country have also been mentioned.

The sources of the current guidelines available for management of Buccal Mucosa cancer are:

National Comprehensive Cancer Network (NCCN)7 .

2) Indian Comprehensive Cancer Network (ICCN)8 .

3) National Health Services (NHS)9 .

4) European Society of Medical Oncology (ESMO)10.

5) TMH textbook on evidence based medicine

The NCCN guidelines are most widely followed and quoted.

While these provide the general principles for the management of oral cavity tumors, they do not address specific issues pertaining to cancer of the Buccal Mucosa which is more prevalent in our part of the world.

Interpretation and practice of the existing guidelines needs to be done with caution considering the following facts:

1. Many of published guidelines including that from TMH and ICCN are based on evidence in other Head & Neck disease sub sites from western experience.

2. There is a dearth of randomized, prospective studies from Indian subcontinent on chemoradiation (CT+RT), induction chemotherapy and palliative chemotherapy in Buccal Mucosa cancers.

3. Oral cancer in India is different compared to the western countries.

Here it involves the gingivo buccal sulcus (the site where the tobacco quid is kept by the patient).

These cancers are also more likely to present in higher stage (stage III and stage IV) with higher risk of failure at local site. The nature of spread, biological behavior and the treatment is also different.

In the absence of international and national data specifically on Buccal Mucosa cancer (large, randomized, prospective case series and trials), literatures of head and neck cancers in general has been reviewed.

Analysis of the available Indian literature revealed information on the following aspects.

a) Epidemiological studies on Carcinoma Buccal Mucosa.

b) Studies evaluating the role of clinical and molecular markers in the prognostication of oral cancers.

c) Treatment experiences.

The following highlights only the studies which report on treatment outcomes.

An early publication on cancer of the Buccal Mucosa from India was in the year 1966 (Singh et al)12. In 1989, Pradhan et al reported the treatment outcome of these cancers in detail4 .

Sixty six percent of patients in this series had T4 lesions.

At 18 months follow-up, it was reported that post operative radiotherapy (PORT) significantly improved disease free survival.

Author also reported that patients with poorly differentiated squamous cell tumors fared worse (no survivor at 18 months of follow up). Similar experience was reported by Mishra et al13.

PORT was found to improve survival of patients with T3 and T4 Buccal Mucosa cancer from 38% to 68%. Krishnamurthy et al from Cancer Institute, Adyar reported their experience on Buccal Mucosa cancers in 197114.

Ninety three percent of patients in this series had T3 and T4 lesions and 5 year survival with single modality treatment was 19-20%.

Post operative RT became standard treatment in locally advanced disease in India. Dinshaw et al reported a relapse rate of around 50% in oral cavity tumors after post operative radiotherapy in locally advanced disease15. In this report,

Dinshaw et al reviewed the role of radiotherapy in all head and neck tumors over 15 years, which suggested that adjuvant RT is a preferred method of treatment while at the same time, dose modification in RT or addition of CT with RT should be studied, because, in spite of surgery and post operative RT (60Gy), the patients with Buccal Mucosa cancers did not fare well.

Bahadur et al16 from the All India Institute of Medical Sciences, New Delhi reported their experience of treating locally advanced head and neck cancer with combination of surgery and RT.

They treated 252 cases of stage III and IV resectable cancers of the head and neck region by a combined regime of pre or post operative RT and radical surgery.

Only 193 patients completed the planned treatment protocol.

There were 58 cases (33.5%) who failed either at the primary or regional sites or both. Nine cases (5%) developed distant metastasis.

Absolute and determinate 4-year disease free survival was 55% and 61% respectively.

They concluded that a reduction in primary and regional failures correlates well with a combined modality therapy.

Language English
No. of Pages36
PDF Size2.4 MB

Buccal Mucosa Cancer PDF Free Download

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