Pattern of presentation and some Risk factors of Oral Squamous Cell Carcinoma at Kenyatta National Hospital

Abstract

It is estimated that the annual incidence and mortality of OSCC are 450,000 and 194,000 respectively with a 5 year survival of about 51%. The main objective of the study was to describe the pattern of presentation of OSCC and to determine the association between some correlates and the disease at the Kenyatta National Hospital. The cases were persons who presented with OSCC while controls were age and gender matched persons from the same hospital. Data including sociodemographic characteristics, body weights and behavioral factors were obtained from cases and controls. In addition, clinical features of the disease were recorded from the cases. Swabs were obtained from the lesions on cases and equivalent mucosal sites on controls and analysed for the 28 HPV viral subtypes. Biopsy specimen from lesions of cases and swabs from equivalent mucosal sites of controls were obtained and analysed for P53 and Notch1 gene mutations. Blood was obtained from cases and controls and analysed for CRP levels by using a biochemistry machine. The data was analyzed using descriptive statistics, Mantel Haenszel and unconditional logistic regressions and presented using narratives, tables and figures. The mean age of the study subjects was 58 years (SD 13.2) with more males (61.8%) presenting at the hospital with the disease. The tongue was the most affected site (38%) and majority of the cases (93.4%) presented with pain and stage 4 disease. There were Significant associations between farming (OR=2.16), weight loss (OR=2.6), tobacco (OR=16.96), inflammation (OR=2.66), P53 (OR=75), Notch1 (OR=140) and OSCC. From this study, it is recommended that health care providers should be sensitized about the signs and symptoms of OSCC and the need for early referral to a tertiary facility. Furthermore, nutritional support and pain control should be instituted at an early stage to reduce the morbidity of the disease. Regarding clinical care, CRP assays should be done for all cases of OSCC in order to control inflammation in the course of the disease. Finally, more studies should be done on the gene mutations and their role in choice of treatment and prognosis of OSCC.