Malignant Tumors of Tongue in Iranian Population

AUTHORS

Mohammad Esmaeil Akbari 1 , Saede Atarbashi Moghadam ORCID 2 , * , Fazele Atarbashi Moghadam 3 , Zahra Bastani 4

1 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

2 Department of Oral and Maxillofacial Pathology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

3 Department of Periodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

4 Dental School, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

How to Cite: Akbari M E, Atarbashi Moghadam S, Atarbashi Moghadam F, Bastani Z. Malignant Tumors of Tongue in Iranian Population, Int J Cancer Manag. 2016 ; 9(4):e4467. doi: 10.17795/ijcp-4467.

ARTICLE INFORMATION

Iranian Journal of Cancer Prevention: 9 (4); e4467
Published Online: August 15, 2016
Article Type: Research Article
Received: October 20, 2015
Revised: January 4, 2016
Accepted: August 10, 2016
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Abstract

Background: The incidence of oral cancers varies from one country to another, which can be clarified by the difference in the distribution of the risk factors and the possible etiologies. Tongue is a main segment of oral cavity and malignant lesions of this region accounts for nearly 30% of all oral cancers.

Objectives: In the present study, we evaluated the pattern of tongue cancer in Iranian population and compared these findings with those previously reported in the other countries.

Methods: In this multicenter, retrospective cross-sectional study recorded cases of the malignant tongue tumors in the cancer research center (CRC) of Shahid Beheshti University of Medical Sciences were extracted. The patient records and their microscopic reports were retrieved from the archives and age, sex and microscopic types were evaluated. It is to be noted that the CRC has been serving as a cancer registry center for major hospitals all over the country since the year of 2003. Thus, the obtained statistics are highly reliable.

Results: During the years 2003 to 2008, a total number of 952 new cases of the tongue cancer were recorded in the CRC. Most cases are diagnosed in the sixth and seventh decades of life. 450 cases (47.2%) occurred in men and 489 cases (51.36%) in women. Four different types of malignant lesions (epithelial, salivary gland, hematopoietic and mesenchymal) were diagnosed. Epithelial tumors were the most prevalent malignancies (93%) of which squamous cell carcinoma (SCC) made up 87.39% of all lesions. Salivary gland tumors had the second place with 3.15% of the total lesions.

Conclusions: In Iranian population, squamous cell carcinoma is the most prevalent malignancy of tongue and it is notable that the ratio of female to male population was equal. These lesions were prevalent in the sixth and seventh decades of life. Thus screening examination of tongue by dentist especially in elderly patients is necessary for early detection of cancerous lesions.

Keywords

Malignant Tongue Tumor Cancer in Iran Prevalence Carcinoma, Squamous Cell

Copyright © 2016, Iranian Journal of Cancer Prevention. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

According to traditional Chinese medicine, tongue is the main window into the body (1, 2). A number of authors explain that tongue lesions represent an important part of oral mucosal lesions, with incidence varying among epidemiologic research from different parts of the world (1). Several studies have been working on the prevalence of tongue lesions (1-4) but cancers are of particular importance and prevalence of oral malignancies reveals vast geographic difference (5). Oral clinicians are the pioneer for the early discovery of oral cancers. Curriculums of cancer control are structured on the principles that the early detection of the lesion lead to better treatment, increased survival rate, and mortality reduction (6).

2. Objectives

Therefore, the purpose of this study was to illustrate the prevalence of malignant tumors of the tongue in Iranian population and compare these findings with those previously reported in the other countries.

3. Methods

This multicenter, retrospective, cross-sectional study was carried out to assess the recorded cases of tongue malignancies in the cancer research center (CRC) of Shahid Beheshti University of Medical Sciences. Patients’ records and the associated pathology reports were retrieved from the archives. Then age and sex of the patients and its microscopic type were assessed and classified in tables. CRC has been collecting the needed information about patients with cancer from all major hospitals in Iran since 2003. One of the primary objectives of this center is to record the changes in pattern of malignancies in Iran. Such information is classified and recorded according to the guidelines of the cancer office of center for disease control (CDC). These standards include monitoring of information coverage and complete details, controlling the accuracy of information, and elimination of repeated cases. Also, collected data dating back to 2008 and onward were in the process of electronic storage and the CRC did not provide us with such information. Data were statistically analyzed using descriptive statistics.

4. Results

During the years 2003 to 2008, a total number of 952 new cases of the tongue cancer were recorded in the CRC. In the current study, tongue cancers accounted for 21.33% of oral malignancies and 2.22% of head and neck cancers. The tongue cancers were the most common in the fourth to eighth decades of life and most cases are diagnosed in the sixth and seventh decades (Table 1). 450 cases (47.2%) were men and 489 cases (51.36%) were women. Four different types of malignant lesions (epithelial, salivary gland, hematopoietic and mesenchymal) were diagnosed. Epithelial tumors were the most prevalent malignancies (93%) of which squamous cell carcinoma (SCC) made up 87.39% of all lesions (Table 2). Salivary gland tumors had the second place with 3.15% of the total lesions. Among salivary gland malignancies, adenoid cystic carcinoma (AdCC) and mucoepidermoid carcinoma (MEC) were the most common. Hematopoietic group constituted 2% of the lesions. Non-Hodgkin lymphoma especially “Diffuse large B cell lymphoma” (DLBL) was most prevalent in hematopoietic group. Mesenchymal malignancies made up 0.4% of the cancers and rhabdomyosarcoma was the most common form. 13.02% of all cancers and 13.3% of SCCs occurred below 40 years and 32.11% was detected in women.

Table 1. Age Distribution of Patients With Tongue Cancer
Age, Y
0 - 910 - 1920 - 2930 - 3940 - 4950 - 5960 - 6970 - 7980Unknown
Epithelial tumors0634699317519420910122
Salivary gland tumors0044527720
Hematopoitic tumors0013329222
Mesanchymal tumors1101010000
Table 2. Histopathologic Type and Gender Distribution Among Patiens With Tongue Cancer
Total NumberFemaleMale
Squamous cell carcinoma836435401
Verrucous carcinoma251114
Undifferentiated carcinoma19136
Total epithelial tumors893459421
Adenoid cystic carcinoma1898
Mucoepidermoid carcinoma890
Polymorphous low grade adenocarcinoma110
Lympho epithelial carcinoma110
Mucin-producing Adeno carcinoma101
Epithelial-myo epithelial carcinoma110
Total salivary gland tumors30219
Neurofibrosarcoma110
Giant cell sarcoma101
Embryonal rhabdosarcoma211
Total mesenchymal tumors422
Lymphoma25718
Total hematopoitic tumors25718

5. Discussion

In the current study, tongue cancers accounted for 21.33% of oral malignancies. Several studies established that tongue was the most common site of occurrence in oral cavity cancers with incidence rate of 50% (7), 43% (8), 23% (5), and 20% (6, 9). In contrast some studies introduced other sites such as gingival as the most common location in this regard (10, 11). This represents that geographic regions can potentially influence the area of involvement within oral cavity. For example in South and South-East of Asia the most common site in oral cavity for cancer development is buccal mucosa followed by tongue carcinoma but in Western Countries the tongue is a more common location (12).

The susceptibility of tongue for malignancies was described in previous reports (5, 13, 14). Saliva would combine with carcinogen agents and collected at the bottom of the mouth and persistently wash these regions. In addition, lateral border and ventral part of the tongue have thin and nonkeratinized mucosa with less protection (5). Tongue has rich lymphatic network and highly muscularized structure which makes it poorly supplied to save itself from invasion and metastasis (13, 14). In our research SCC was the most common malignant tumor of tongue. This is in agreement with most of the previously published reports (1, 5, 7-10, 15). In our study the most cases are diagnosed in the sixth and seventh decades of life similar to other studies (1, 16). Many studies showed oral cancers have tendency to affect elderly patients (5-10). In accordance with previous reports (5, 7, 17), in our series 13.02% of all cancers and 13.3% of SCCs occurred below 40 years. Razmpa et al. (16) found that only 6.9% of the patients were younger than 40 years. Other studies reported 29.2% (9), 27.1% (18), 25.8% (19), 34.3% (20) and 45% (21) of the cases were under 40 years of age. Tongue seems to be the most common location in young patients with head and neck SCC without a history of tobacco use, or association with HPV (22). Further studies in this age group were required to assess the risk factors and characteristics of tongue cancer (16). Biopsy of suspicious oral lesions was necessary to exclude malignancy in young patients (7). The prevalence of tongue cancers including SCC was almost equal between men and women in our study with a mild tendency to women. This is in compliance with other studies on SCC of tongue (16, 23-25). In contrast, a male to female ratio 1.75 (21), 2 (26) and 2.5 (27) was reported.

Moreover, it was described that the prevalence of oral carcinoma considerably elevated among females rather than males; especially in developing countries (11, 28). But previous reports demonstrated that malignancies of the oral cavity predominantly occurred in men (6, 7, 10). There are many risk factors for oral SCC such as alcohol and tobacco, geographic variation, genetic predisposition, diets, immune status, oncogenic viruses, radiation, Poor oral hygiene, and environmental factors (5, 29-31). Diets rich in fresh fruits and vegetables, micronutrients and vitamins A, C, E may have protective role against oral cancer (32). Risk of oral malignancies is greater for non-vegetarians probably due to increased exposure to polycyclic aromatic hydrocarbons that are present in high concentrations in meat products (31). Obesity and a diet rich in fat were associated with oral malignancies (32). Also, Bosetti et al. (33) indicate that diabetes may increase the risk of cancers of the oral cavity. Moreover, in iron deficiency, epithelial cells of the oral mucosa turn over more rapidly and produce an atrophic or immature mucosa and consequently may cause malignancy (34). The majority of the Iranian population are Muslims and their religion prohibits them from alcohol consumption. But unfortunately traditional water pipe (hookah) is smoked in many cafes and restaurants due to this wrong insight that hookah smoking is less harmful than cigarette smoking especially among young women. Another problem in Iran, (Afghanistan and Pakistan) is smokeless tobacco use named nass (snus) whose consumers are unaware of the harm and it is cheap and easily available. Nass is used by placing it under the lip for extended periods of time. Smokeless tobacco is very strongly correlated with cancers of the cheek and gums (35). This may decrease the frequency of tongue cancer ratio in Iran.

In our study epithelial cancers constituted 93% of all malignant tumors and most of them were SCC (87.39% of all tumors). This is in agreement with most of the previously published reports (1, 5, 7-10). Razmpa et al. (16) found that 63.2% of tongue cancers were SCC and 36.8% were other types but they did not describe other types of malignancies. In our series salivary gland carcinomas comprised 3.15% of the total lesions followed by non-Hodgkin lymphoma and sarcomas. Anis et al. (7) found 13.6% of malignancies had salivary gland origin that MEC (5.4%) was the most common followed by AdCC (2.7%). Similar to our findings Chidzonga et al. (9) found that salivary gland malignancies comprised 4.9% of the all lesions that AdCC with 3.3% and MEC with 0.9%. The low percentage of cancers of glandular origin in our series is related to evaluation of tongue malignancies and the common site for salivary gland tumor in oral cavity was palate. Dias et al. (8) found that only 3% of tumors were non-epithelial that 1.3% of them were non-hodgkin lymphoma. Moreover in another study, the prevalence of lymphoma was 2.7% of the oral cancers (7) that was similar to our findings. In our series DLBL was the most common form; whereas, in other studies, burkit lymphoma was common (9, 10). In addition, Arotiba et al. (36) mentioned that the proportion of orofacial SCC in Nigerians is quite low (42.8%) because of a high ratio of salivary gland carcinoma and Burkitt’s lymphoma.

As seen in most of the studies, sarcomas were less common than carcinomas (5, 7, 37). In our research sarcomas were diagnosed in young age groups. This is in agreement with other studies (5, 36).

In conclusion, In Iranian population SCC is the most prevalent malignancy of tongue and female to male ratio was equal. These lesions were prevalent in the sixth and seventh of life but it may be seen below 40 years old. The dentists have a special role in detection and initial management of oral cavity lesions. Screening examination of tongue by dental practitioner, especially in elderly patients is necessary for early detection of cancerous lesions.

Acknowledgements

Footnotes

References

  • 1.

    Costa FW, Osterne RL, Mota MR, Alves AP, Soares EC, Sousa FB. Tongue lesions. J Craniofac Surg. 2012; 23(6) : 548 -51 [DOI][PubMed]

  • 2.

    Avcu N, Kanli A. The prevalence of tongue lesions in 5150 Turkish dental outpatients. Oral Dis. 2003; 9(4) : 188 -95 [PubMed]

  • 3.

    Voros-Balog T, Vincze N, Banoczy J. Prevalence of tongue lesions in Hungarian children. Oral Dis. 2003; 9(2) : 84 -7 [PubMed]

  • 4.

    Motallebnejad M, Babaee N, Sakhdari S, Tavasoli M. An epidemiologic study of tongue lesions in 1901 Iranian dental outpatients. J Contemp Dent Pract. 2008; 9(7) : 73 -80 [PubMed]

  • 5.

    Subhashraj K, Orafi M, Nair KV, El-Gehani R, Elarbi M. Primary malignant tumors of orofacial region at Benghazi, Libya: a 17 years review. Cancer Epidemiol. 2009; 33(5) : 332 -6 [DOI][PubMed]

  • 6.

    Al-Rawi NH, Talabani NG. Squamous cell carcinoma of the oral cavity: a case series analysis of clinical presentation and histological grading of 1,425 cases from Iraq. Clin Oral Investig. 2008; 12(1) : 15 -8 [DOI][PubMed]

  • 7.

    Anis R, Gaballah K. Oral cancer in the UAE: a multicenter, retrospective study. Libyan J Med. 2013; 8 : 21782 [DOI][PubMed]

  • 8.

    Dias GS, Almeida AP. A histological and clinical study on oral cancer: descriptive analyses of 365 cases. Med Oral Patol Oral Cir Bucal. 2007; 12(7) : 474 -8 [PubMed]

  • 9.

    Chidzonga MM. Oral malignant neoplasia: a survey of 428 cases in two Zimbabwean hospitals. Oral Oncol. 2006; 42(2) : 177 -83 [DOI][PubMed]

  • 10.

    Ajayi OF, Adeyemo WL, Ladeinde AL, Ogunlewe MO, Effiom OA, Omitola OG, et al. Primary malignant neoplasms of orofacial origin: a retrospective review of 256 cases in a Nigerian tertiary hospital. Int J Oral Maxillofac Surg. 2007; 36(5) : 403 -8 [DOI][PubMed]

  • 11.

    Marocchio LS, Lima J, Sperandio FF, Correa L, de Sousa SO. Oral squamous cell carcinoma: an analysis of 1,564 cases showing advances in early detection. J Oral Sci. 2010; 52(2) : 267 -73 [PubMed]

  • 12.

    Trivedi TI, Tankshali RA, Goswami JV, Shukla SN, Shah PM, Shah NG. Identification of site-specific prognostic biomarkers in patients with oral squamous cell carcinoma. Neoplasma. 2011; 58(3) : 217 -26 [PubMed]

  • 13.

    Sano D, Myers JN. Metastasis of squamous cell carcinoma of the oral tongue. Cancer Metastasis Rev. 2007; 26(3-4) : 645 -62 [DOI][PubMed]

  • 14.

    Lim MS. Re: Correlational of oral tongue cancer inversion with matrix metalloproteinases (MMPs) and vascular endothelial growth factor (VEGF) expression, by Kim S-H, Cho NH, Kim K, et al. J Surg Oncol. 2006; 93(4) : 253 -4 [DOI][PubMed]

  • 15.

    Sargeran K, Murtomaa H, Safavi SM, Vehkalahti M, Teronen O. Malignant oral tumors in iran: ten-year analysis on patient and tumor characteristics of 1042 patients in Tehran. J Craniofac Surg. 2006; 17(6) : 1230 -3 [DOI][PubMed]

  • 16.

    Razmpa E, Memari F, Naghibzadeh B. Epidemiologic and clinicopathologic characteristics of tongue cancer in Iranian patients. Acta Med Iran. 2011; 49(1) : 44 -8 [PubMed]

  • 17.

    Falaki F, Dalirsani Z, Pakfetrat A, Falaki A, Saghravanian N, Nosratzehi T, et al. Clinical and histopathological analysis of oral squamous cell carcinoma of young patients in Mashhad, Iran: a retrospective study and review of literature. Med Oral Patol Oral Cir Bucal. 2011; 16(4) : 473 -7 [PubMed]

  • 18.

    Park JO, Sun DI, Cho KJ, Joo YH, Yoo HJ, Kim MS. Clinical outcome of squamous cell carcinoma of the tongue in young patients: a stage-matched comparative analysis. Clin Exp Otorhinolaryngol. 2010; 3(3) : 161 -5 [DOI][PubMed]

  • 19.

    Liao CT, Wang HM, Hsieh LL, Chang JT, Ng SH, Hsueh C, et al. Higher distant failure in young age tongue cancer patients. Oral Oncol. 2006; 42(7) : 718 -25 [DOI][PubMed]

  • 20.

    Morris RE, Mahmeed BE, Gjorgov AN, Jazzaf HG, Rashid BA. The epidemiology of lip, oral cavity and pharyngeal cancers in Kuwait 1979-1988. Br J Oral Maxillofac Surg. 2000; 38(4) : 316 -9 [DOI][PubMed]

  • 21.

    Sutandyo N, Ramli R, Sari L, Soeis DS. Profile and survival of tongue cancer patients in "Dharmais" Cancer Hospital, Jakarta. Asian Pac J Cancer Prev. 2014; 15(5) : 1971 -5 [PubMed]

  • 22.

    Harris SL, Kimple RJ, Hayes DN, Couch ME, Rosenman JG. Never-smokers, never-drinkers: unique clinical subgroup of young patients with head and neck squamous cell cancers. Head Neck. 2010; 32(4) : 499 -503 [DOI][PubMed]

  • 23.

    Li R, Faden DL, Fakhry C, Langelier C, Jiao Y, Wang Y, et al. Clinical, genomic, and metagenomic characterization of oral tongue squamous cell carcinoma in patients who do not smoke. Head Neck. 2015; 37(11) : 1642 -9 [DOI][PubMed]

  • 24.

    Patel SC, Carpenter WR, Tyree S, Couch ME, Weissler M, Hackman T, et al. Increasing incidence of oral tongue squamous cell carcinoma in young white women, age 18 to 44 years. J Clin Oncol. 2011; 29(11) : 1488 -94 [DOI][PubMed]

  • 25.

    Goepfert RP, Kezirian EJ, Wang SJ. Oral tongue squamous cell carcinoma in young women: a matched comparison-do outcomes justify treatment intensity? ISRN Otolaryngol. 2014; 2014 : 529395 [DOI][PubMed]

  • 26.

    Krishnamurthy A, Ramshankar V. Early stage oral tongue cancer among non-tobacco users--an increasing trend observed in a South Indian patient population presenting at a single centre. Asian Pac J Cancer Prev. 2013; 14(9) : 5061 -5 [PubMed]

  • 27.

    Krishnatreya M, Nandy P, Rahman T, Sharma JD, Das A, Kataki AC, et al. Characteristics of oral tongue and base of the tongue cancer: a hospital cancer registry based analysis. Asian Pac J Cancer Prev. 2015; 16(4) : 1371 -4 [PubMed]

  • 28.

    Ahmed MM. Expression profile of apoptotic mediators and proliferative markers in oral squamous cell carcinoma. J Egypt Natl Canc Inst. 2009; 21(2) : 85 -92 [PubMed]

  • 29.

    Franceschi S, Bidoli E, Herrero R, Munoz N. Comparison of cancers of the oral cavity and pharynx worldwide: etiological clues. Oral Oncol. 2000; 36(1) : 106 -15 [PubMed]

  • 30.

    Moore SR, Johnson NW, Pierce AM, Wilson DF. The epidemiology of tongue cancer: a review of global incidence. Oral Dis. 2000; 6(2) : 75 -84 [PubMed]

  • 31.

    Krishna Rao SV, Mejia G, Roberts-Thomson K, Logan R. Epidemiology of oral cancer in Asia in the past decade--an update (2000-2012). Asian Pac J Cancer Prev. 2013; 14(10) : 5567 -77 [PubMed]

  • 32.

    Zain RB. Cultural and dietary risk factors of oral cancer and precancer--a brief overview. Oral Oncol. 2001; 37(3) : 205 -10 [PubMed]

  • 33.

    Bosetti C, Rosato V, Polesel J, Levi F, Talamini R, Montella M, et al. Diabetes mellitus and cancer risk in a network of case-control studies. Nutr Cancer. 2012; 64(5) : 643 -51 [DOI][PubMed]

  • 34.

    La Vecchia C, Tavani A, Franceschi S, Levi F, Corrao G, Negri E. Epidemiology and prevention of oral cancer. Oral Oncol. 1997; 33(5) : 302 -12 [PubMed]

  • 35.

    Hashemipour MA, Gholampour F, Fatah F, Bazregari S. Snus (nass) and oral cancer: A case series report. Dent Res J (Isfahan). 2013; 10(1) : 116 -21 [DOI][PubMed]

  • 36.

    Arotiba GT, Ladeinde AL, Oyeneyin JO, Nwawolo CC, Banjo AA, Ajayi OF. Malignant orofacial neoplasms in Lagos, Nigeria. East Afr Med J. 2006; 83(3) : 62 -8 [PubMed]

  • 37.

    Rawashdeh MA, Matalka I. Malignant oral tumors in Jordanians, 1991-2001. A descriptive epidemiological study. Int J Oral Maxillofac Surg. 2004; 33(2) : 183 -8 [DOI][PubMed]

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