Abstract

This study was conducted to evaluate the survival and prognosis of malignancies of the oral cavity at different sites. We also wanted to study the methylation difference in oral cancer cases and compare it with normal. Methods: The study was conducted in the Department of Otolaryngology – Head and Neck Surgery, Travancore Medical College, Kollam, over a period of 5 years from January 2017 to December 2021. 325 patients who presented with malignancies of the oral cavity were evaluated. The tumours of the salivary glands were excluded. A study on DNA methylation was conducted among 30 cases of different stages of carcinogenesis and compared with five normal cases. Results: The males were most commonly affected at all sites, and the male-to-female ratio was 2.3:1. Subjects in the 41-60 years age group were most commonly affected, with a mean age of 55 years. A significant proportion of the patients consumed tobacco or alcohol. 76.6% of patients presented at an advanced stage (stage III or stage IV). The majority of the patients presented with complaints of ulcers, pain, or local swelling. 39% of the patients had anemia on presentation. The tongue was the most common site involved, followed by the buccal mucosa. Squamous cell carcinoma was the most common type of malignancy in the oral cavity with well-differentiated SCC present in 48.62% of the cases. Level I was the most common level of lymph nodes involved. A biopsy of the lesion and FNAC from the lymph nodes were sufficient in most of the cases to reach a proper diagnosis. Surgery with or without postoperative radiotherapy was the preferred modality of treatment in early cases, while primary radiotherapy alone was employed in the majority of cases with late-stage disease. Surgical margins were positive in 17.5% of the cases. Recurrence rates were higher when radiotherapy alone was employed. Treatment failures occurred more commonly at the primary site than at the nodal sites. Immunostaining of tissue sections with anti-5-mc antibodies showed increased staining with the progression of the stage of carcinogenesis. Conclusion: A well-coordinated approach is necessary for the prevention, early detection and treatment to tackle the growing incidence of malignancies of the oral cavity and their associated mortality and morbidity. Early diagnosis is the key to effective treatment of oral malignancies. To optimize survival, the therapeutic approach requires careful planning on the part of an integrated team of head and neck specialists, including the surgeon and the radiotherapist.

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