Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :1270
Small font sizeDefault font sizeIncrease font size
Navigate here
Resource links
 »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
 »  Article in PDF (404 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)  

  In this article
 »  Abstract
 » Introduction
 »  Materials and Me...
 » Result
 » Discussion
 » Conclusion
 » Acknowledgment
 »  References
 »  Article Tables

 Article Access Statistics
    PDF Downloaded338    
    Comments [Add]    
    Cited by others 6    

Recommend this journal


  Table of Contents  
Year : 2015  |  Volume : 52  |  Issue : 4  |  Page : 625-627

Oral squamous cell carcinoma in patients with and without predisposing habits in glossal and extra-glossal site: An institutional experience in South India

Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, Uthandi, Chennai, Tamil Nadu, India

Date of Web Publication10-Mar-2016

Correspondence Address:
K Ranganathan
Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, Uthandi, Chennai, Tamil Nadu
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.178444

Rights and Permissions

 » Abstract 

INTRODUCTION: We report our cohort of oral squamous cell carcinoma (OSCC) patients with or without predisposing habits in glossal and extraglossal sites. MATERIALS AND METHODS: A retrospective analysis of OSCC cases over a period of 13.75 years from the archives of Ragas Dental College and Hospital, Chennai, India. Demographic details, site, details of habits, and grade of OSCC were retrieved. Social Package for Social Service version 17.0 was used to analyze the data. Descriptive statistics, Chi-square test, and comparison of mean were employed appropriately. RESULTS: There were 151 OSCC cases, of which 60.9% (92/151) were males, 21.2% (32/151) were aged ≤40 years and 27.82% (42/151) occurred in the tongue. The glossal to extraglossal site ratio was 1:2.6. Predisposing habits were present in 52.4% of glossal OSCC and 82.6% with extra-glossal sites (P = 0.000). Besides tobacco, exclusive areca nut chewing was observed in 15.23% (23/151) patients. Thirty-nine (25.8%) belonged to non-tobacco, non-areca nut, non-alcohol (NTND) group with male to female ratio was1:3. DISCUSSION: In our cohort, 112 of 151 OSCC (74.8%) had at least one predisposing habit. Chewing of areca nut alone was a predisposing habit by itself. In addition, there was a small, subset of cases that were not associated with history of any habits. This study brings to focus the subsets of OSCC predisposed by areca nut and NTND, that needs to be studied further.

Keywords: Alcohol, India, nonhabit associated, oral cancer, tobacco

How to cite this article:
Ranganathan K, Rooban T, Rao U M. Oral squamous cell carcinoma in patients with and without predisposing habits in glossal and extra-glossal site: An institutional experience in South India. Indian J Cancer 2015;52:625-7

How to cite this URL:
Ranganathan K, Rooban T, Rao U M. Oral squamous cell carcinoma in patients with and without predisposing habits in glossal and extra-glossal site: An institutional experience in South India. Indian J Cancer [serial online] 2015 [cited 2022 Jan 28];52:625-7. Available from:

 » Introduction Top

Oral squamous cell carcinoma (OSCC) is one of the most common types of cancer. In South-East Asia, tobacco, areca nut with/without alcohol has been associated with OSCC.[1] Recent reports have described non tobacco, nonareca nut using and nonalcohol drinking patients (NTND) with OSCC.[2],[3] With regards to sites of occurrence, literature suggests that the prevalence of OSCC is on the decrease in non glossal sites.[4] Though histopathological features of cancers of the lips, oropharyngeal, alveolar, palatal, buccal, glossal, base of tongue significantly overlap, they significantly differ in terms of etiology, molecular pathogenesis and prognosis.[4] There is increasing evidence that OSCC of the oral cavity (excluding lips, base of tongue and oropharyngeal junction) differ from glossal OSCC.[4] This study reports the extra-glossal and glossal OSCC from a clinical and habit standpoint, in our cohort.

 » Materials and Methods Top

This retrospective study was performed on all cases referred to the institution during January 2000 to August 2013 (164 months). The demographics of patients attending the institution have been previously described.[5] The institution is situated in the suburb region of Chennai, in Southern part of India. The patients attending the institution are from adjoining rural, suburban, and urban regions.

From the department archives, biopsy details of all cases diagnosed with OSCC (excluding lips, base of tongue and oropharyngeal junction) were retrieved. The details of age, gender, and site and habit profile were tabulated. Broadly, habits were classified as with habits and those without habits (NTND). Habits were further classified as those using only tobacco in any form – smoking or chewing, those using only areca nut in any form and those who had multiple habits (tobacco and areca nut with or without alcohol). Age group was categorized as ≤40 years and those above 41 years. Site of lesions was dichotomized as glossal (including dorsal, lateral, ventral surface, and excluding base of tongue) and extra-glossal (alveolar, palatal, buccal, and retromolar trigone). All data were entered and analyzed using Social Package for Social Service (SPSS) version 17.0 (SPSS Inc., IBM, IL, USA). Descriptive statistics was done Chi-square test was employed for finding association of cross tabulations. A P ≤ 0.05 was considered significant.

 » Result Top

There were 4284 biopsies referred to the institution during the study period of January 2000 to August 2013 (164 months). Of the 206 (4.8%) cases of OSCC recorded in the department, 55 (26.7%) had no reliable data regarding the habits. Hence, these patients were removed from further analysis and 151 cases formed the study group.

Among those with habits (n = 112), 22 cases (19.6%) had glossal OSCC while 90 cases (80.4%) had nonglossal OSCC. In contrast, among those without habits (n = 39), 20 cases (51.3%) had glossal OSCC while 19 (48.7%) had nonglossal OSCC. The difference was statistically significant (P = 0.0003). Among glossal site 20 (47.6%) had no habits, 2 (4.8%) used tobacco, 1 (2.4%) used areca nut and 19 (45.23%) had multiple habits. Among the non glossal sites, 19 (17.4%) had no habits, 22 (20.2%) has areca nut habit, 49 (45%) had multiple habits and 19 (17.4%) had tobacco habits. This difference was statistically different (P = 0.001) [Table 1].
Table 1: Comparison of risk factors squamous cell carcinoma sites by gender and glossal site

Click here to view

Of the 151 OSCC cases, 112 (74.2%) cases had habits (21 [13.9%] cases used exclusively tobacco in some form, 23 [15.2%] used exclusively areca nut in some form while 68 [45%] had multiple habits). In the cohort, 32 (21.2%) were aged ≤40 years, 92 (60.9%) were males and 42 (27.8%) had OSCC in glossal sites. Buccal mucosa and retromolar trigone were the other common sites of OSCC.

There was no difference in terms of age or gender between the OSCC sites. Habits were associated with 52.4% of glossal and 82.6% of extra-glossal OSCC (P = 0.000). Of the glossal OSCC, 28% of males and 76.5% of females were NTND (m: f ratio was 1:2.73). While in extra-glossal OSCC, 11.9% of males and 26.2% of females (m: f 1:1.38) were NTND [Table 2].
Table 2: Comparison of gender, age, habits and risk factors in glossal and extraglossal squamous cell carcinoma

Click here to view

 » Discussion Top

The changing trends of habits and the rate of occurrence of OSCC have been reported in the literature.[6],[7] The shift of common etiology of OSCC from tobacco to areca nut has been projected, particularly from South East Asian countries where the chewing practice is common and is being increasingly reported.[6],[7],[8],[9],[10] This manuscript reconfirms and further contributes to establish the role of arecanut, without any other habits, as the causation of OSCC. The findings underlines the need to educate the general public and practitioners that areca nut by itself is a potential carcinogen. NTND OSCC is emerging as a distinct subgroup in both glossal and non glossal sites and the role of other factors such as human papilloma virus (HPV) needs to be addressed.

Areca nut related OSCC was seen with respect to habits and site in extra-glossal sites (22 cases against 1 glossal site) while the multiple habits (tobacco and areca nut with/without alcohol) were equally associated with OSCC in glossal (19 cases [45.23%]) and extra-glossal sites (49 [44.95%]).

In the present cohort, the gender predilection is similar to reports of other dental and medical institutions [11],[12] and the Indian cancer registry data.[4] Female NTND OSCC population is emerging as a unique subset.[2],[13] In our cohort, the m: f of OSCC was 1.6:1. Among glossal OSCC, m: f was 1.5:1 and in extraglossal it was 1.6:1. Of the 39 cases belonging to all NTND subgroup, the m: f ratio was 1:1.6. In NTND glossal OSCC, m: f was 1:1.9 while the same in extra-glossal site was 1:1.4. In males, 72% of glossal OSCC tumors were related to habits while in females only 23.5% were related to habits with 76.5% belonging to NTND subset. Reports suggest that nonrisk group NTND females, by virtue of their gender are more prone for glossal OSCC and this area needs further investigations.[2] The factors that could contribute to this phenomenon could include hormonal or viral infection such as HPV.[1],[2]

Increasing incidence of tongue cancer (excluding base of the tongue) has been documented in studies from several countries.[1],[2],[3],[14],[15],[16],[17] Such studies have suggested HPV to be one of the probable reasons, for the shift of pattern, particularly among the oropharyngeal OSCC.[2] Very few studies have focused on the elderly NTND cohorts.[2]

Increasing public awareness of tobacco associated health hazards has led to: (1) More number of patients discontinuing habits. (2) Increase in early treatment seeking behavior among the general public especially among high risk tobacco users.[2] Similar awareness of areca nut induced OSCC has to be created to sensitize the general public, practitioners and policy makers about the carcinogenic effects of areca nut.

 » Conclusion Top

The results of the present study indicate that in our cohort, glossal OSCC are seen in elderly (age) females, reflecting the global trend. There was a relative increase of glossal - NTND associated OSCC, particularly in females. This trend needs to be studied in detail as it is vital for an early diagnosis and this could facilitate a better prognosis.

Further epidemiological studies are needed to ascertain this trend of areca nut induced OSCC and NTND related OSCC. Further studies are neccessary to identify, if molecular carcinogenic pathway differ in these entities.

 » Acknowledgment Top

The authors would like to thank Dr. S. Ramachandran, Principal, Ragas Dental College and Hospital, Prof. A Kanagaraj and Mrs. K. Vijayakumari of Jaya Educational Trust for their continued support and encouragement.

 » References Top

Vatanasapt P, Suwanrungruang K, Kamsa-Ard S, Promthet S, Parkin MD. Epidemiology of oral and pharyngeal cancers in Khon Kaen, Thailand: A high incidence in females. Asian Pac J Cancer Prev 2011;12:2505-8.  Back to cited text no. 1
Koo K, Barrowman R, McCullough M, Iseli T, Wiesenfeld D. Non-smoking non-drinking elderly females: A clinically distinct subgroup of oral squamous cell carcinoma patients. Int J Oral Maxillofac Surg 2013;42:929-33.  Back to cited text no. 2
Dar-Odeh N, Abu-Hammad O. Tongue cancer subgroup. Br Dent J 2013;215:154.  Back to cited text no. 3
Elango JK, Gangadharan P, Sumithra S, Kuriakose MA. Trends of head and neck cancers in urban and rural India. Asian Pac J Cancer Prev 2006;7:108-12.  Back to cited text no. 4
Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Cross-sectional study in South India. Indian J Dent Res 2006;17:121-5.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
Chandra PS, Mulla U. Areca nut: The hidden Indian 'gateway' to future tobacco use and oral cancers among youth. Indian J Med Sci 2007;61:319-21.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
Sherin N, Simi T, Shameena P, Sudha S. Changing trends in oral cancer. Indian J Cancer 2008;45:93-6.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
Singh HP, Bains SK, Bansal T, Kumar P. Shifting trends in oral cancer with the winds of changing time. Int J Health Allied Sci 2012;1:209-10.  Back to cited text no. 8
  Medknow Journal  
Rooban T, Elizabeth J, Umadevi KR, Ranganathan K. Sociodemographic correlates of male chewable smokeless tobacco users in India: A preliminary report of analysis of National Family Health Survey, 2005-2006. Indian J Cancer 2010;47 Suppl 1:91-100.  Back to cited text no. 9
Rooban T, Joshua E, Rao UK, Ranganathan K. Prevalence of chewable smokeless tobacco in Indian women: Secondary data analysis from national family health survey 2005-06. J NTR Univ Health Sci 2013;2:29-35.  Back to cited text no. 10
  Medknow Journal  
Sharma P, Saxena S, Aggarwal P. Trends in the epidemiology of oral squamous cell carcinoma in Western UP: An institutional study. Indian J Dent Res 2010;21:316-9.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
Sharma RG, Bang B, Verma H, Mehta JM. Profile of oral squamous cell cancer in a tertiary level medical college hospital: A 10 yr study. Indian J Surg Oncol 2012;3:250-4.  Back to cited text no. 12
Toner M, O'Regan EM. Head and neck squamous cell carcinoma in the young: A spectrum or a distinct group? Part 1. Head Neck Pathol 2009;3:246-8.  Back to cited text no. 13
Schantz SP, Yu GP. Head and neck cancer incidence trends in young Americans, 1973-1997, with a special analysis for tongue cancer. Arch Otolaryngol Head Neck Surg 2002;128:268-74.  Back to cited text no. 14
Müller S, Pan Y, Li R, Chi AC. Changing trends in oral squamous cell carcinoma with particular reference to young patients: 1971-2006. The Emory University experience. Head Neck Pathol 2008;2:60-6.  Back to cited text no. 15
Albuquerque R, López-López J, Marí-Roig A, Jané-Salas E, Roselló-Llabrés X, Santos JR. Oral tongue squamous cell carcinoma (OTSCC): Alcohol and tobacco consumption versus non-consumption. A study in a Portuguese population. Braz Dent J 2011;22:517-21.  Back to cited text no. 16
Mishra A, Meherotra R. Head and Neck Cancer: Global Burden and Regional Trends in India. Asian Pac J Cancer Prev 2014;15:537-50.  Back to cited text no. 17


  [Table 1], [Table 2]

This article has been cited by
1 Two novel cell culture models of buccal mucosal oral cancer from patients with no risk-habits of tobacco smoking or chewing
Kavya Vipparthi, Ankit Kumar Patel, Subhashis Ghosh, Subrata Das, Chitrarpita Das, Koyeli Das, Anwesha Sarkar, Venu Thatikonda, Biswajoy Pal, Arun Sasi kumaran Nair Remani, Neeraj Arora, Mayur Parihar, Maleppillil Vavachan Vijayakumar, Manoj Kumar Bhat, Ramanamurthy Boppana, Samsiddhi Bhattacharjee, Nidhan Kumar Biswas, Pattatheyil Arun, Rajeev Sharan, Sandeep Singh
Oral Oncology. 2021; 113: 105131
[Pubmed] | [DOI]
2 Feasibility of investigating the association between bacterial pathogens and oral leukoplakia in low and middle income countries: A population-based pilot study in India
Krithiga Shridhar, Aastha Aggarwal, Ishita Rawal, Ruby Gupta, Shet Masih, Ravi Mehrotra, Theresa W. Gillespie, Preet K. Dhillon, Dominique S. Michaud, Dorairaj Prabhakaran, Michael Goodman, David M. Ojcius
PLOS ONE. 2021; 16(4): e0251017
[Pubmed] | [DOI]
3 mRNA expression of ferroptosis-related proteins in squamous cell carcinoma of tongue
Rooban Thavarajah
International Journal of Molecular & Immuno Oncology. 2020; 5: 73
[Pubmed] | [DOI]
4 Is suicide a significant contributor to mortality in head and neck cancer - A surveillance, epidemiology, and end results database study
Rooban Thavarajah,Anusa Arunachalam Mohandoss,Elizabeth Joshua,Umadevi Krishnamohan Rao,Kannan Ranganathan
Journal of Global Oral Health. 2019; 1: 37
[Pubmed] | [DOI]
5 Is suicide a significant contributor to mortality in head and neck cancer - A surveillance, epidemiology, and end results database study
Rooban Thavarajah,Anusa Arunachalam Mohandoss,Elizabeth Joshua,Umadevi Krishnamohan Rao,Kannan Ranganathan
Journal of Global Oral Health. 2018; 1(1): 37
[Pubmed] | [DOI]
6 Global incidence of oral and oropharynx cancer in patients younger than 45 years versus older patients: A systematic review
Aisha A. Hussein,Marco N. Helder,Jan G. de Visscher,C. René Leemans,Boudewijn J. Braakhuis,Henrica C.W. de Vet,Tymour Forouzanfar
European Journal of Cancer. 2017; 82: 115
[Pubmed] | [DOI]


Print this article  Email this article


  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  © 2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow