Diagnostic Accuracy of Computed Tomography in Detecting Bone Invasion due to Squamous Cell Carcinoma of Buccal Mucosa

Abstract

Oral cancer is a violent, 1 and devastating disease, which ranks second commonest malignancy in Pakistan. (Incidence rate, according to age standardised rates in the world, is 5.3 in males and 2.6 in females). Oral cancer is the great risk to public health of not only in Pakistan but all over the world, although a wide geographical variation noted in the occurrence and outcomes. 2 According to recent cancer registry record of Shaukat Khanum Memorial Hospital, Lahore, it is the eighth most common worldwide malignancy; but in the Pakistan, it is the second commonest malgnancy. It accounts for 15% of all new cancer cases in this region in comparison to 3% detected worldwide. 2 The prevalence of oral cancer is variable throughout the world. It is higher in Pakistan reaching the 10% of all cancers, and around 45% in India. A study conducted in Pakistan during 1995-2004 showed much higher incidence rate, 22.5% in males and 20.4% in females. 3 Over 300,000 new cases of oral and oropharyngeal cancer were diagnosed in 2004-2009 worldwide, and over 7,000 affected individuals died of these cancers. 4 It is estimated that more than 90% of all oral neoplasms are oral squamous cell carcinoma (OSCC), so this term tends to be used interchangeably with oral cancer. 4 Squamous cell carcinoma (SCC) comprises 90% of head and neck cancers; whereas, oral cavity squamous cell carcinoma (OCSCC) is the commonest. Subsites of oral cavity are lip, alveolar ridge, buccal mucosa, retromolar trigone, floor of mouth and tongue; 5 but buccal mucosa being the aggressive subsite. 6 Risk factors associated with SCC include betel quid chewing, tobacco and alcohol consumption. 7 Although there are rapid advancements in the diagnostic and therapeutic procedures in the past decades, but the five-year survival rate has showed none or only slight improvement at 65% between 2002-2008. 5 If disease is properly diagnosed and staging done at early phase, then treatment option is surgical (transoral