Analysis of 64 cases of oral squamous cell carcinoma of the buccal mucosa

Introduction: Squamous cell carcinoma of the buccal mucosa is the most common oral cavity cancer in Southeast Asia. In India, 60 to 80% of oral squamous cell carcinoma cases present with advanced stage as compared to 40% in developed countries. Carcinoma of the buccal mucosa is treated mainly by surgery followed by adjuvant therapy, depending upon the stage and histopathological characteristics. The purpose of this study was to evaluate the neck node status, patterns of neck metastasis, distribution of patients according to T stage and management of squamous cell carcinoma of the buccal mucosa.

Methodology: A total of 64 histopathologically proven cases of oral squamous cell carcinoma of the buccal mucosa who had no previous malignancies were included in our study. Recurrent cases and prior treatment of oral cancer by chemotherapy and radiotherapy were excluded. All the patients involved in the study underwent tumor resection with neck dissection.

Results: A total of 64 patients were staged as per TNM criteria (AJCC 8th edition). More than 90% metastases occurred at levels I to III lymph nodes. The percentage of T1, T2, T3 and T4 lesions were 06.25, 28.12, 14.06 and 51.56% respectively. 45.31% patients were pathologically node- negative (pN0). In pathologically node-positive (pN+) patients N3 Category was the highest followed by N1 Category and N2 Category. The lymph node positivity was highest in T4 followed by T3 and T2. Final histopathological stage grouping revealed early stage disease in 14 patients and advanced stage disease in 50 patients. 12, 38 and 14 patients were treated by surgery alone, surgery with postoperative radiotherapy and surgery with postoperative CTRT respectively.

Conclusion: This study concluded that more than 90% metastases occurred at levels I to III lymph nodes. Nearly 45.00% of the patients were pathologically node-negative (pN0). 21.87% of the patients were pathologically node-positive with extranodal extension (pN+/ENE+). Majority of the patients had diagnosed in advanced stage of carcinoma. Histopathology reports demonstrated the most of the patients had well-differentiated squamous cell carcinoma. Stage I and II (Early stage) patients were treated mainly by surgery alone and stage III and IV patients were treated with combination therapy.

Audience Take Away Notes: -

• The aim of this presentation is to spread awareness about patterns of neck metastasis in buccal mucosa.
• In general, the T stage usually reflects tumor burden and therefore the risk of nodal metastasis increases with increasing T stage of the primary tumor at any site. Certain histomorphological features of the primary tumor also increase the risk of nodal metastasis.
• This study will help with the awareness levels and knowledge about risk factors, early sign and symptoms along with treatment options for buccal mucosa cancer.