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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 9  |  Page : 1208-1212

A clinicopathological study of upper aerodigestive tract cancers


1 Department of ENT, Government Medical College and Hospital, Patiala, Punjab, India
2 Department of Pathology, Government Medical College and Hospital, Patiala, Punjab, India

Date of Acceptance25-Apr-2019
Date of Web Publication6-Sep-2019

Correspondence Address:
Dr. M Singh
Incharge Unit II, Department of ENT, Government Medical College and Hospital, Patiala, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_131_19

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   Abstract 


Background: The upper aerodigestive tract (UAT) includes the nose and paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands. Cancers of the UAT constitute approximately 4% of all malignancies. In this study, the varied nature of the UAT cancers was studied to find out their incidence, etiology, and clinicopathological correlations. Materials and Methods: This prospective, observational, and clinicopathological study was conducted on 100 patients who were presented at outdoor in the Department of ENT, Government Medical College/Rajindra Hospital, Patiala, Punjab, India, from October 2016 to October 2018. Proven cases of UAT cancers were taken up and reviewed to gather data on multiple clinicopathological variables, such as age, sex, predisposing factors, and site of pathology. Histopathological differentiation was noted after conducting a biopsy. Results: Most patients of UAT cancers were in the age group of 40–70 years. Maximum incidence was among males (82%) compared to females (28%). The most common predisposing factor was alcohol + smoking (28%), followed by alcohol + chewing tobacco (25%). The most common symptom in the oral cavity was ulcer and odynophagia (38%) each. In oropharyngeal cancers, dysphagia (92%) was the most common symptom. In laryngeal cancers, dyspnea (68%) and hoarseness of voice (32%) were the most common. The most common site involved in UAT cancers was the oral cavity (31%), followed by oropharynx (28%), larynx (22%), hypopharynx (7%), and salivary gland (5%). The most common histopathological type was squamous cell carcinoma (SCC) (90%). Most of the ulceroproliferative and exophytic growth was moderately differentiated SCC on histopathology. Conclusion: Studies are essential for education and awareness aimed at reducing exposure to habit-forming substances.

Keywords: Dysphagia, dyspnea, squamous cell carcinoma, tobacco, upper aerodigestive tract cancers


How to cite this article:
Kaur G, Singh M, Kaur M, Singh B, Gupta R K. A clinicopathological study of upper aerodigestive tract cancers. Niger J Clin Pract 2019;22:1208-12

How to cite this URL:
Kaur G, Singh M, Kaur M, Singh B, Gupta R K. A clinicopathological study of upper aerodigestive tract cancers. Niger J Clin Pract [serial online] 2019 [cited 2019 Sep 21];22:1208-12. Available from: http://www.njcponline.com/text.asp?2019/22/9/1208/266153




   Introduction Top


The upper aerodigestive tract (UAT) includes the nose and paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands.[1] Cancers of the UAT constitute approximately 4% of all malignancies. Most aerodigestive tract cancers originate in the epithelial layer of the mucous membrane, which lines the UAT from the lips and nasal cavity to the vocal cords and extends laterally to the accessory sinuses.[2]

Tobacco is the most important factor, and over 90% of patients have a history of smoking. Tobacco contains more than 30 known carcinogens, such as polycyclic aromatic hydrocarbons and nitrosamines.[3] Alcohol may act as a solvent, increasing the cellular permeability of tobacco carcinogens through the mucosa of the UAT.[4] Human papilloma virus has been extensively studied, and there seems to be a definite association between virus and tumor formation.[5],[6] In particular, between 30% and 100% of verrucous carcinomas have human papillomavirus (HPV).[7] High-risk types are associated with premalignant lesions and squamous cell carcinoma (SCC) and include HPV-16, -18, -31, -33, -35, and -39.[8],[9]

Aims and objectives

  1. To find out the incidence of different types of UAT cancers.
  2. To find out the etiology of different type of UAT cancers.
  3. To find out the clinicopathology of different types of UAT cancers.



   Materials and Methods Top


This prospective, observational, and clinicopathological study was conducted on 100 patients who were presented at outdoor in the Department of ENT, Government Medical College/Rajindra Hospital, Patiala, Punjab, India, from October 2016 to October 2018. Proven cases of UAT cancers were taken up and reviewed to gather data on multiple clinicopathological variables, such as age, sex, predisposing factors, and site of pathology. Histopathological differentiation was noted after conducting a biopsy.

Inclusion criteria

Inclusion criteria include all age groups, clinical suspicion of premalignant lesion and/or condition in the UAT, clinically and histopathologically diagnosed UAT cancer, being males and females, no history of previous treatment taken for UAT cancer, patients' informed consent to participate in the study.

Exclusion criteria

Exclusion criteria include history of head and neck irradiation, current or previous history of immunosuppression (disease or treatment related), history of head and neck cancer, benign masses of UAT, and patients' refusal to participate in the study.


   Results Top


This prospective study was conducted on 100 patients at the ENT Department, Government Medical College, Rajindra Hospital, Patiala, Punjab, India. These patients were studied for incidence, etiology, and clinicopathology of UAT cancers.

Most patients of UAT cancers were in the age group of 40–70 years [Figure 1]. Maximum incidence was among men (82%) as compared to women (28%).
Figure 1: Distribution according to age

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The most common predisposing factor was alcohol + smoking (28%) followed by alcohol + chewable tobacco (25%). Alcohol + smoking was more common in laryngeal and hypopharyngeal cancers, whereas alcohol + chewable tobacco was more common in the oral cavity and oropharyngeal cancers [Table 1].
Table 1: Distribution according to symptoms

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The most common symptom in the oral cavity was ulcer and odynophagia (38%) each. In oropharyngeal cancers, dysphagia (92%) was the most common symptom. In laryngeal cancers, dyspnea (68%) and hoarseness of voice (32%) were the most common symptoms.

The most common site involved in UAT cancers was the oral cavity (31%), and buccal mucosa was the most common subsite to be involved in oral cavity. The second most common site involved was oropharynx (28%), and the most common subsite involved was tonsillar fossa.

Larynx was the third most common site involved (22%), and the most common subsite involved in larynx was supraglottic. In hypopharynx, the most common subsite involved was pyriform fossa and the most common salivary gland involved was parotid gland.

In paranasal sinuses, the most common sinus involved was maxillary sinus. In nasopharynx, the most common site involved was fossa of Rosenmüller [Table 2].
Table 2: Distribution according to site

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The most common lesion in the oral cavity was ulcerative (61.29%) followed by exophytic lesions. In oropharynx, exophytic lesions (57.14%) were most common. In nasopharynx (100%), larynx (72.7%), and nose and paranasal sinuses (60%), ulceroproliferative lesions were most common. In the salivary gland, infiltrative lesions were most common [Table 3].
Table 3: Distribution according to the type of lesion at various sites

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The most common histopathological type was SCC (90%). Among SCC, moderately differentiated SCC (44%) was the most common followed by well differentiated (36%) and then poorly differentiated type (8%) and verrucous (2%).

In the salivary gland, mucoepidermoid histopathological type was the most common, and the sinonasal undifferentiated type was most common in nasal cavity. Lymphoma (non-Hodgkin) of histopathological type was found in oropharyngeal cancer [Table 4].
Table 4: Histopathology at different subsites

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Most of the ulceroproliferative and exophytic growth was moderately differentiated SCC on histopathology. Mucoepidermoid carcinomas were mainly infiltrative type [Table 5].
Table 5: Distribution according to the type of lesion and histopathology

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According to TNM staging, in oral cavity, T1 stage (87.10%) and N0 stage (87.10%) were the most common. In oropharynx, T2 stage (53.57%) and N0 stage (42.80%) were the most common.

In larynx, T2 stage (59.9%) and N0 stage (50%) were the most common. In hypopharynx, T1 stage (71.46%) and N1 stage (85.71%) were the most common. In salivary gland, all cases were in stages T1 and N0.

In nasal cavity, all cases were in T1 stage and 66% were in N0 stage. All the cancers of UAT were in M0 stage except for the one case of oropharyngeal cancer.


   Discussion Top


In our study, the mean age was 55.07 ± 12.93 years with the highest incidence in the 41- to 70-year age group [Figure 1]. This study is comparable to the study conducted by Foma et al.,[10] which reported the mean age to be 51.3 ± 16.5 years.

In our study, the male-to-female ratio was 4.5:1 with 82% males and 18% females. This is comparable to the study conducted by Kumar et al.,[11] which reported 83.4% males and 16.6% females.

In our study, UAT cancer was more common in alcohol + smoking group (26%) closely followed by the alcohol + chewable tobacco group (25%), only chewable tobacco (14%), only alcohol (13%), only smoking (11%), poor orodental hygiene (2%), and Plummer–Vinson syndrome (1%). This is comparable to the study conducted by Pooja et al.,[1] which reported that alcohol + smoking was associated with the cases of laryngeal and hypopharyngeal cancers, and chewable tobacco was associated with oral cavity cancer.

Ahluwalia et al.[12] also reported the synergistic effects of alcohol and smoking on laryngeal cancers.

Our study is comparable to the study conducted by Kamal et al.,[13] which reported soreness and ulceration as the most common symptoms in oral cavity cancers. For laryngeal cancers, Chauhan et al.[14] reported dysphagia (63%) as the most common symptom followed by hoarseness of voice (50%). A study conducted by Bhagat et al.[15] reported dysphagia as the most common symptom in hypopharyngeal cancers.

Our study is comparable to the study conducted by Foma et al.,[10] which reported that oral cavity (36.2%) cancer was the most common among UAT cancers, and the study conducted by Aggarwal et al.[16] reported oropharyngeal cancer as the second most common site involved in head and neck cancers.

Our study is comparable to Kamal et al.'s [13] study on oral cancers, which reported ulcerative lesions to be the most common (60%), followed by exophytic (36.66%) and infiltrative (3.33%) cases.

SCC was the most common histopathological type (90%) in UAT cancers. Among patients with SCC, moderately differentiated carcinoma (44%) was the most common followed by well differentiated (36%), poorly differentiated (8%), and verrucous type (2%) [Table 4]. This is comparable to the study conducted by Muir et al.,[2] which reported that SCC was the most common histopathological type in UAT cancers, and Sharma et al.[17] reported moderately differentiated carcinoma to be common among the different types of SCC.

Our study is comparable to the study conducted by Arora et al.,[18] which showed that T1 and T2 stage tumors were the most common in oral cavity cancers, and 67% of the cases were in N2 stage and 20% cases in N1 stage. A study conducted by Bhagat et al.[15] on hypopharyngeal cancers reported the maximum number of patients in T1 and T2 stages, whereas 40% cases were in N0 stage and 40% cases were in N1 stage. A study conducted by Chauhan et al.[14] on laryngeal cancer reported 43.08% of the cases in N0 stage and 33.85% of the cases in N1 stage.


   Conclusion Top


The major limitation of our study is its small sample size. A second limitation is that we did not include HPV status, which is associated with oral and oropharyngeal cancers, in our patient. Studies are essential for spreading education and awareness aimed at reducing exposure to habit-forming substances.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Pooja P, Andrews CJ, Arjun GM, Vinayakumar AR. Prevalence and major causative factors of upper aerodigestive tract malignancies. Int J Med Sci Public Health 2016;5:651-5.  Back to cited text no. 1
    
2.
Muir C, Weiland L. Upper aerodigestive tract cancers. Cancer Suppl 1995;75:147-53.  Back to cited text no. 2
    
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International Agency for Research on Cancer. Tobacco smoking. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. Washington, DC: IARC; 1986.  Back to cited text no. 3
    
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McCoy DG, Wynder EL. Etiological and preventive implications in alcohol carcinogenesis. Cancer Res 1979;39:2844-50.  Back to cited text no. 4
    
5.
Fakhry C, Gillison ML. Clinical implications of human papillomavirus in head and neck cancers. J Clin Oncol 2006;24:2606-11.  Back to cited text no. 5
    
6.
Brandsma JL, Abramson AL. Association of papillomavirus with cancers of the head and neck. Arch Otolaryngol Head Neck Surg 1989;115:621-5.  Back to cited text no. 6
    
7.
Steinberg BM. Viral etiology of head and neck cancer. In: Harrison LB, Sessions RB, Hong WK, editors. Head and Neck Cancer: A Multidisciplinary Approach. Philadelphia, PA: Lippincott-Raven; 1999. p. 35-47.  Back to cited text no. 7
    
8.
Snijders PIF, Scholes AGM, Hart CA. Prevalence of mucosatropic human papilloma viruses in squamous cell carcinomas of the head and neck. Int J Cancer 1996;66:464-9.  Back to cited text no. 8
    
9.
Androphy EJ. Molecular biology of human papilloma virus infection and oncogenesis. J Invest Dermatol 1994;103:248-56.  Back to cited text no. 9
    
10.
Foma W, Amana B, Pegbessou E, Bissa H, Adam S, Dolou W, et al. Upper aero digestive tract cancers: Epidemiological and histopathological aspects in Togo. Int J Otorhinolaryngol Head Neck Surg 2017;3:11-6.  Back to cited text no. 10
    
11.
Kumar A, Sharma A, Ahlawat B, Sharma S. Site specific effect of tobacco addiction in upper aerodigestive tract tumors: A retrospective clinicopathological study. Sci World J 2014.  Back to cited text no. 11
    
12.
Ahluwalia H, Gupta SC, Singh M, Gupta SC, Mishra V, Singh PA, et al. Spectrum of head–neck cancers at Allahabad. Indian J Otolaryngol Head Neck Surg 2001;53:16-21.  Back to cited text no. 12
    
13.
Kamal MA, Yousuf M, Haider MY, Tarafder KH. Clinicopathological study of oral carcinoma. Bangladesh J Otorhinolaryngol 2014;20:15-9.  Back to cited text no. 13
    
14.
Chauhan JPS, Bharti B, Bhaduriya SS, Kumar A, Narain P, Singh J, et al. Laryngeal cancer: A clinicopathological study of 65 cases. Int J Otorhinolaryngol Head Neck Surg 2018;4:163-8.  Back to cited text no. 14
    
15.
Bhagat S, Singh B, Verma SK, Singh D, Bal MS. Clinicopathological study of tumours of hypopharynx. Indian J Otolaryngol Head Neck Surg 2003;55:241-3.  Back to cited text no. 15
    
16.
Aggarwal VP, Rao DCL, Mathur A, Batra M, Makkar DK. Prevalence of head and neck and oral cancer in Rajasthan: An infirmary based retrospective study. Clin Cancer Investig J 2015;4:339-43.  Back to cited text no. 16
  [Full text]  
17.
Sharma M, Madan M, Manjari M, Bhasin TS, Jain S, Garg S. Prevalence of head and neck squamous cell carcinoma (HNSCC) in our population: The clinic-pathological and morphological description of 198 cases. Int J Adv 2015;3:827-33.  Back to cited text no. 17
    
18.
Arora N, Davessar JL, Singh J. Oral cancer profile in a tertiary care center. Int J Otorhinolaryngol Head Neck Surg 2017;3:343-6.  Back to cited text no. 18
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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