Title: Squamous Cell Carcinoma of the Buccal Mucosa: Staging and Surgical Management

Abstract:

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 (early and advanced) and histopathological characteristics. The purpose of this study was to evaluate the staging (AJCC 8th edition) and surgical management of squamous cell carcinoma of the buccal mucosa.

Methodology: A total of 54 histopathologically proven cases of oral squamous cell carcinoma of 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: All 54 (46 male and 8 female) cases were staged as per TNM criteria (AJCC 8th edition). The percentage of T1, T2, T3 and T4 lesions were 5.56, 27.78, 12.96 and 53.7% respectively. Twenty four cases (44.44%) presented in N0 stage, 10 (18.52%) in N1 stage, 9 (16.67%) in N2 stage and 11 cases (20.37%) presented in N3 stage. The lymph node positivity was highest in T4 followed by T3 and T2. Final histopathologic stage grouping revealed stage I in 3 (5.56%) patients, stage II in 8 (14.81%) patients, stage III in 8 (14.81%) patients, and stage IV in 35 (64.82%) patients. 9, 34 and 11 patients were treated by surgery alone, surgery with postoperative radiotherapy and surgery with postoperative CTRT respectively.

Conclusion: Majority (79.63%) of the patients had diagnosed in advanced stage (stage III and stage IV) of carcinoma. One-fifth (20.37%) of the patients were pathologically node-positive with extranodal extension (pN+/ENE+). Histopathology reports revealed the most of the cases had well-differentiated squamous cell carcinoma of the buccal mucosa. Early stage (stage I and II) patients were treated primarily by surgery alone and advanced stage (stage III and IV) patients were treated with combination therapy.

Biography:

Gaurav Vishal is an Oral and Maxillofacial Surgeon (M.D.S), Fellow in Oral Oncology and Reconstructive Surgery. He completed M.D.S- Oral and Maxillofacial Surgery from Institute of Dental Sciences, Bareilly International University, Bareilly, India in 2020 and Fellowship in Oral Oncology and Reconstructive Surgery from Rohilkhand Medical College and hospital, Bareilly, India in 2021 under the guidance of Dr. Arjun Agarwal (Surgical Oncologist) and Dr. Anurag Yadav (Oral, Onco & Reconstructive Surgeon).