According to GLOBOCAN 2018 data, oral cancer is the most common cancer in India amongst men (16.1 % of all cancers) and second most common cancer in India amongst women (10.4 % of all cancers). Tobacco use causes around 80-90% of oral cancers.[1] Mean age for oral cancer is 50 years [2].The most common risk factors for oral cancer are smokeless tobacco, severe alcoholism, use of tobacco like cigarettes, betel nut chewing and human papilloma virus(HPV) [3,4]. Other causes for oral cancer are poor dental care and poor diet [5].The highest incidence of oral cancer is seen in India, south and South-East Asian countries.

Almost 90 to 95% of the oral cancers in India are squamous cell carcinoma [6]. A research on cancer by an international agency has predicted that the incidence of cancer in India will increase from 1 million in 2012 to more than 1.7 million in 2035, indicating that the death rate because of cancer will also increase from 680000 to 1- 2 million in the same period [7].

Males are affected more frequently than females, although the ratio is equalizing nowadays, and cases are increasing in elderly females as well as in young females.[8,9, 10] Oral cancer affects predominantly in middle-aged and older persons. [8] The increasing incidence of Oral Squamous Cell Carcinoma is also seen in persons under the age of 45.[11,12]

The retrospective study was done on seventy one cases reported during June 2018 to December 2019. For analysis, the data of these seventy one oral biopsies including age, gender, history of tobacco and alcohol consumption, site of lesion, clinical presentation and all cases were subjected to histopathology on paraffin sections. The diagnosis was reviewed, and confirmed. All the data was recorded.

RESULTS

All 71 cases included in study were histopathologically diagnosed. Among the cases, 49(69.0%) were males & 22(31.0%) were females patients.

Table 1:- Prevalence of oral lesions according to gender

GENDER                                                                                          Number of cases (%)

Male                                                                                                   49 (69.0%)

Female                                                                                               22 (31.0%)

Out of 71 cases, the highest population diagnosed with oral lesion was in between 40-60 years of age.

Table 2: Incidence of oral lesions in different age groups.

Table 3:- Common site of oral lesions

The most common site patients presented with was buccal mucosa followed by tongue and hard palate, 53.5%, 30.9% and 5.6%.

Table 4:- Histopathological Diagnosis of cases

Table 5:- Histopathological diagnosis according to age

The Global Adult Tobacco Survey (GATS) conducted in India in 2009–2010 reported the highest prevalence of use of areca nut-based tobacco products among males in Madhya Pradesh followed by Gujarat, Maharashtra and Delhi.[13] According to GATS, tobacco use in India has been higher among males than females. Though, among middle-aged and elderly males and females, the pattern of use of chewing tobacco was the same. Tobacco use was found to be more common among the uneducated masses in India.[14]

In Indian subcontinent, there are more number of people who are tobacco chewers as compared to smokers. Chewing tobacco more often results in buccal mucosa and lower alveolus cancer whereas smoking and alcohol consumption has been associated with higher incidence of tongue cancer.

Tobacco consumption is a major risk factor for oral and oropharyngeal SCC.[15] There is a strong association between the use of smokeless tobacco and the risk of development of OSCC.[16] Distinct cultural practices such as betel-quid chewing as well as varying patterns of the use of tobacco and alcohol are prevalent in Asian countries, which are important risk factors that cause oral cancer.[17] In India, the efforts of the Government for deterrence of tobacco products' use prove to be inadequate when looked at the easy availability of the products and their rampant use.

In the this observational study, all the patients were found to have complaints of oral lesions with history of tobacco eating and alcohol drinking. A study conducted by Tandon et al, in Western Uttar Pradesh revealed that smokeless tobacco habit (60%) was more prevalent than bidi or cigarette smoking habits (36.26%) in both males and females.[18] Another study conducted by Shenoi R, Devrukhkar V in a western city of India concluded that tobacco chewing is the major cause for the development of OSCC.[19]

The most common site for oral lesions was buccal mucosa and tongue followed by hard palate, whereas, the most common sites of OSCC were buccal mucosa and GBS followed by alveolus .The tongue is considered as the most common site of occurrence of primary OSCCs in the developed countries, but in the developing countries, betel quid and/or tobacco chewing more commonly results in cancer of the buccal mucosa.[15],[20]

In our study, the increase incidence of oral lesions was seen in males than in females with a ratio of 2.2:1. The result was consistent with other findings.Males are more commonly affected compared to females by OSCC in both developed (male: female ratio 2.5:1) and developing (male: female ratio 3:1) countries, which may be due to easy acceptance of habits by males.[21] In recent time, this difference in gender distribution is reducing in the developed countries due to more females taking up tobacco-related habits including smoking.[21]

Global Adult Tobacco Survey in India it was found that 34.6% of adults including 47.9% of males and 20.3% of females consume tobacco. Among these, 14% of adults smoke tobacco whereas 25.9% consume smokeless tobacco.[22] India has the world's highest number (nearly 20%) of oral cancers with an estimated 1% of the population having oral premalignant lesions.[23]

Majority of the patients presented between the age of 40-60 years, the finding are consistent with other studies.73.2% of the patients were between the age of 40-60 and the second most common population was > 60 years patients(14.1%).

OSCC accounts for ~90% of malignant oral lesions and is widely recognized as the most frequently occurring malignant tumor of oral structures, and the mortality rate of OSCC is relatively high, with a 5-year survival rate of 50%.[24] India has the world's highest number (nearly 20%) of oral cancers with an estimated 1% of the population having oral premalignant lesions.[25] According to Global Adult Tobacco Survey (GATS) 2016 states that around 19 per cent males smoke tobacco in MP whiles the numbers of women habitual of smoking is just 0.8 per cent. Over 38 per cent males in the State use tobacco in smokeless form (gutka, kahini and others) while only 16.8 percent female use tobacco in smokeless form.

In the present study, most of the cases were well differentiated (52.1 %) OSCC followed by moderately differentiated (21.1%) OSCC with few cases recorded for poorly differentiated (11.3%) OSCC. However, other studies from India and across reported that most of OSCC cases are diagnosed as moderately differentiated OSCC, and probably, this

reflects the contribution of etiological factors such as betel-quid and/or tobacco chewing toward the development of well or moderately differentiated tumors.[21,26,27,28]

The study has shown that the number of cases of Oral Squamous CC and pre malignant conditions has increased considerably. Tobacco intake and smoking are the predominant risk factors for the same. In present study, the increase incidence of oral lesions (premalignant as well as malignant) was seen in males predominantly

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