Oral and Esophageal Cancer: Incidence, Prevalence and Correlation in General Indian Population: A retrospective Study.

BACKGROUND: Squamous cell carcinoma is the most frequent head-and-neck malignancy and chiefly encompasses malignancies of the upper aerodigestive tract, including the oral cavity, nasal cavity, paranasal sinuses, nasopharynx, oropharynx, hypopharynx, pharynx, and larynx.
OBJECTIVES: The current study was conducted to evaluate the incidence, prevalence, and correlation of oral and esophageal cancer in the Indian population.
MATERIALS AND METHODS: The present study was conducted on the basis of data collected from various government cancer hospitals in India. A total of 1000 patients of either sex admitted to the oncology ward with head-and-neck cancer from June 2018 to June 2020 were included in the study. Information regarding family history, deleterious habits, and immunity status was also collected from their medical records. The readings were recorded in a master chart, and data analysis was carried out statistically.
RESULTS: A total of 1000 patients (617 males and 383 females) between the age range of 38 and 86 years were selected for the study. A total of 425 out of 1000 patients had esophageal cancer, whereas, 575 patients had oral cancer. A total of 347 males and 228 females had oral cancer, whereas 270 males and 155 females had esophageal cancer. Among the patients with oral cancer, 44 presented with a history of cigarette smoking, 49 with bidi smoking, 140 with tobacco chewing, 142 with gutkha chewing, and 159 with betel quid chewing. Majority of the patients had a habit of consuming tobacco in smokeless form. Among the patients with esophageal cancer, 175 presented with a history of cigarette smoking, 136 with bidi smoking, 12 with tobacco chewing, 13 with gutkha chewing, and nine with betel quid chewing.
CONCLUSION: The incidence of both types of cancer was high in older age group, particularly in those aged above 50 years. Males had a higher predilection rate than females for both cancer types. The incidence of oral cancer was higher than that of esophageal cancer. Majority of the patients with oral cancer had a history of tobacco consumption in smokeless form, whereas the ones with esophageal cancer reported with a history of tobacco consumption in smoked form. Copyright:

INTRODUCTION

Head-and-neck cancer is the sixth-most common malignancy in the world and one of the leading causes of death, accounting for 1%–2% of mortalities. The major etiological factors involved are tobacco chewing and alcohol consumption. Betel nut, betel leaf, and diet may also be involved in the development of head-and-neck cancer. The term cancer has been derived from a Latin word “karkinos” meaning crab or crayfish. Over the past decade, there has been an exponential rise in the incidence of head-and-neck cancers globally. Squamous cell carcinoma is the most frequent head-and-neck malignancy.[1] It chiefly encompasses malignancies of the upper aerodigestive tract, including the oral cavity, nasal cavity, paranasal sinuses, nasopharynx, oropharynx, hypopharynx, pharynx, and larynx.[2] These cancers are associated with high morbidity because there is meddling with vital functions such as breathing, swallowing, speech, hearing, vision, taste, and smell.[3]

It most frequently affects people over the age of 40 years and males carry a 2–3-fold high risk to develop head-and-neck cancer than females.[4] The major etiological factors involved are tobacco chewing and alcohol consumption. Betel nut, betel leaf, and diet may also be involved in the development of head-and-neck cancers. Research illustrates that infection with human papillomavirus is a risk factor for head-and-neck cancer.[5]

Tobacco may have a carcinogenic impact in the oral cavity and may be available in a variety of forms including cigarette smoking, bidi smoking, cigars, pipe, hookah (chillum), tobacco chewing, gutkha chewing, betel nut, betel leaf, and betel quid.[6] Nitrosamines and polycyclic aromatic hydrocarbons are regarded as the main carcinogenic agents in tobacco smoke, regardless of the tobacco-smoking patterns. It has been reported that longer duration of low-intensity smoking has been found to be shoddier than shorter duration with more intensive tobacco smoking.[7]

The role of alcohol in the development of head-and-neck cancer remains unclear. It may not act as a carcinogen but may increase the “permeability” of oral mucosa to other carcinogens. The first metabolite of alcohol, acetaldehyde, has been considered the contributing factor. The carcinogenic effect of alcohol occurs when daily ethanol intake is higher than 45 mL.[8] Recent evidence reports that HPV is involved in the occurrence of 25% of head-and-neck cancers, particularly oropharyngeal carcinoma.[9]

The incidence of head-and-neck cancer is more common in the Indian subcontinent along with China, Taiwan, as the consumption of betel quid, tobacco, or areca nut chewing is high. The incidence is also high in South America, Eastern Europe, and France due to high smoking and alcohol consumption habits.[10]

The current study was conducted to evaluate the incidence of oral and esophageal cancer in the said population.

MATERIALS AND METHODS

The present study was conducted on the basis of data collected from various government cancer hospitals in India. A total of 1000 patients admitted to the oncology ward with head-and-neck cancer from June 2018 to June 2020 were included in the study.

The data of all histologically confirmed cases of head-and-neck cancer were retrieved from the head-and-neck oncology department and were reviewed in a retrospective manner. The overall period of sampling of data was 24 months. In addition to the type of cancer or the site involved, information regarding family history, deleterious habits, and immunity status was also collected from their medical records. Patients with a history of secondary involvement were excluded from the study. The readings were recorded in a master chart, and data analysis was carried out statistically.

RESULTS

A total of 1000 patients were included in the study. All the patients were between the age range of 38 and 86 years. A total of 617 out of the 1000 patients were male, whereas 383 were female, and 425 out of the 1000 patients had esophageal cancer. The mean, median, and standard deviation were 62.50, 62, and 9.60, respectively. A total of 575 out of the 1000 patients had oral cancer. The mean, median, and standard deviation were 62, 61, and 9.61, respectively [Table 1].

Table 1

Distribution of esophageal cancer and oral cancer

Group	n	Minimum	Maximum	Mean	SD	Median	T	P
Esophageal cancer	425	38	85	62.50	9.60	62	0.3561	0.3911
Oral cancer	575	38	86	62	9.61	61	0.1735	0.4453

SD: Standard deviation

Gender-wise distribution of oral cancer cases included 347 males and 228 females. Gender-wise distribution of esophageal cancer cases included 270 males and 155 females [Tables 2 and 3].

Table 2

Gender-wise and habit-wise distribution of oral cancer

Age	Gender			Cigarette smoking	Bidi smoking	Tobacco chewing	Gutkha chewing	Betel leaf quid chewing	N/A
	Male	Female	Total
30-40	3	2	5	-	-	-	2	3	-
41-50	35	27	62	5	7	16	20	8	6
51-60	126	87	213	18	12	54	50	59	20
61-70	117	62	179	11	19	44	45	51	8
71-80	54	39	93	9	9	20	23	26	6
81-90	12	11	23	1	2	6	2	12	-

N/A: Not available

Table 3

Gender-wise and habit-wise distribution of esophageal cancer

Age	Gender			Cigarette smoking	Bidi smoking	Tobacco chewing	Gutka chewing	Betel leaf quid chewing	N/A
	Male	Female	Total
30-40	5	-	5	3	1	-	-	-	-
41-50	22	13	35	12	12	2	4	-	7
51-60	97	62	159	66	48	5	4	5	31
61-70	90	54	144	64	45	3	2	3	27
71-80	46	21	67	25	24	1	3	1	13
81-90	10	5	15	5	6	1	-	-	3

N/A: Not available

DISCUSSION

Head-and-neck cancer represents the sixth-most common cancer worldwide. India has one of the biggest incidences of oral cancer in the world. Majority of these cancers are squamous cell carcinomas and arise from the mucosal surface of the oral cavity, oropharynx, and pharynx.[11] Even in the current study, majority of the cases exhibited oral cancer.

The major etiological factors involved in the occurrence are tobacco and alcohol. Tobacco is available in a variety of smoked and smokeless forms. The site of involvement is critically dependent on the form of tobacco used. Cigar and pipe smoking has a high predilection for cancer of the lower lip; reverse smoking is associated with the involvement of hard palate; betel quid, tobacco, and gutkha chewing is associated with the involvement of gingiva, buccal mucosa, and vestibule; and cigarette and bidi smoking may cause cancer of any site in the oral cavity and might be associated with involvement of the lungs, esophagus, or larynx. Although alcohol is not considered to be a carcinogen, its excessive use increases the risk of head-and-neck cancer as it has a synergistic effect when used in combination with tobacco.[12]

Esophageal cancer is an aggressive malignancy and a leading cause of mortality worldwide. The two common subtypes are squamous cell carcinoma and adenocarcinoma, with squamous cell carcinoma being the most common histological type. The major risk factors involved in the occurrence of esophageal cancer are Helicobacter pylori infection, human papillomavirus infection, gastroesophageal reflux disease, Barrett's esophagus, and PlummerVinson syndrome. Cigarette and bidi smoking plays a role in involvement of esophagus as well.[11] The clinical symptoms associated with esophageal cancer include dysphagia seen in almost 74% of cases, weight loss, and odynophagia. These symptoms may be accompanied by pain radiating to the chest or back, and aspiration pneumonia. Rarely, patients may also present with coughing, hoarseness, dyspnea, and retrosternal pain.[13] The incidence of esophageal cancer varies greatly globally, with more than tenfold difference between some countries. Areas with the peak incidence include Southern Europe and Eastern and Southern African belt covering regions from Northeastern Iran through Central Asia to North-Central China. It is sometimes referred to as the “esophageal cancer belt.”[14]

A total of 1000 patients were included in the study. All the patients were between the age range of 38 and 86 years. A total of 617 out of the 1000 patients were male, whereas 383 were females. A total of 425 out of the 1000 patients had esophageal cancer, whereas, 575 patients had oral cancer. Among the total cases, 347 males and 228 females had oral cancer and 270 males and 155 females had esophageal cancer.

Among the patients with oral cancer, 44 presented with a history of cigarette smoking, 49 with bidi smoking, 140 with tobacco chewing, 142 with gutkha chewing, and 159 with betel quid chewing. Majority of the patients had the habit of chewing tobacco in smokeless form. Forty patients with oral cancer did not have any history of deleterious habits. The development of malignancy could be attributed to the presence of a sharp broken down tooth, immunocompromised status, etc., Majority of the patients with oral cancer were between the age group of 51 and 60 years (n = 213).

Among the patients with esophageal cancer, 175 presented with a history of cigarette smoking, 136 with bidi smoking, 12 with tobacco chewing, 13 with gutkha chewing, and 9 with betel quid chewing. Majority of the patients had the habit of consuming tobacco in smoked form. Eighty-one patients with esophageal cancer did not have any history of deleterious habits. The development of malignancy in these cases could be attributed to conditions such as H. pylori infection, human papillomavirus infection, gastroesophageal reflux disease, Barrett's esophagus, and PlummerVinson syndrome. Majority of the patients with esophageal cancer were also between the age group of 51 and 60 years (n = 159).

CONCLUSION

In the present study, the incidence of oral cancer was higher than that of esophageal cancer. The incidence of both types of cancer was high in older age group, particularly in those aged above 50 years. Males had a higher predilection rate than females for both the types. Majority of the patients with oral cancer had a history of tobacco consumption in smokeless form, whereas the ones with esophageal cancer reported with a history of tobacco consumption in smoked form.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.