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Original Article

Incidence of bone metastasis in squamous cell carcinoma of the
buccal mucosa

Virendra Bhandari
Roentgen-SAIMS Radiation Oncology Centre, Sri Aurobindo Institute of Medical Sciences, Indore 452001, Madhya Pradesh, India.
Correspondence to: Dr. Virendra Bhandari, Roentgen-SAIMS Radiation Oncology Center, Sri Aurobindo Institute of Medical Sciences,
401, Samyak Towers, 16/3, Old Palasia, Indore 452001, Madhya Pradesh, India. E-mail: virencancer@yahoo.co.in

ABSTRACT
Aim: This retrospective study was performed to show the incidence of bone metastasis from carcinoma of the buccal mucosa.
Head and neck cancer is a leading health problem in India due to an increased incidence of tobacco use and poor oral hygiene.
Squamous cell carcinoma of the buccal mucosa is common and roughly 2.5% of all malignancies that present to our center.
Moreover, most patients present at late stages (III/IV) and consequently, survival rates are low. Bone metastasis in advanced cases
of such carcinomas is rarely reported worldwide but is more prominent in parts of India. Methods: Here, we present a series
of patients diagnosed with buccal mucosa carcinomas within the past 5 years that also demonstrated bone metastases. Results:
These patients were young, with a history of tobacco chewing with locally advanced disease and bone metastases that developed
within one year of diagnosis. Flat bones and vertebrae were mainly involved and the survival was short after diagnosis of
metastasis despite treatment with local radiotherapy and chemotherapy. The cause of such frequent metastases cannot be proved
but subclinical seeding of malignant cells before the eradication of the primary tumor is probable contributory with advanced local
and nodal disease with high grade tumor. Conclusion: A pretreatment bone scan should be performed in locoregionally advanced
buccal mucosa carcinomas at the time of diagnosis to defi ne the treatment plan.
Key words: Bone metastases, buccal mucosa, squamous cell carcinoma

Introduction present in an advanced local and nodal stage, leading
to poor results, with chances of distant metastasis also
Carcinoma of the buccal mucosa is the most common increasing. Importantly, up to 70% of patients diagnosed
oral cavity cancer diagnosed in India. The National with advanced solid tumors develop bone metastases
Cancer Registry Programme of the Indian Council of primarily from breast and prostate carcinoma. Bone
Medical Research estimates that head and neck cancer metastasis is rarely seen in head and neck cancers and
forms 20% of all new cancers in India. Males of the primary buccal mucosa malignancies rarely metastasize
Ahmedabad urban area showed the highest age adjusted
rate (AAR) for mouth cancer (12.9), followed by to distant sites. They usually metastasize to lymph nodes
Bhopal (9.9). For females, however, Bengaluru showed or spread locally. The development of newer radiotherapy
[1]
the highest AAR (6.5) followed by the Kamrup urban techniques and availability of better chemotherapy drugs
district (5.8). In hospital, based cancer registry reports, used concurrently have led to better control of such
cancer of the mouth is also ranked as the leading site cancers. In fact, better control of local disease may lead
[2]
in Mumbai in males and within the fi rst fi ve leading to an increased incidence of distant metastasis, affecting
sites in all registries in males. In developed countries, survival. Bone metastases depend on the primary site of
carcinoma of the buccal mucosa is relatively uncommon involvement, T and N stage and control of the nodal
compared to the Indian subcontinent. The high incidence disease. It has been shown that patients presenting with
of carcinoma of the buccal mucosa in our country is advanced nodal disease show a higher incidence of
attributable to the oral consumption of tobacco, betel distant metastasis, especially when there is extensive soft
[3]
leaves, and nuts with lime. Alcohol, smoking habits, and tissue or jugular vein involvement in the neck. In this
poor socio-economic conditions also are contributing study, we found a surprisingly high incidence of bone
factors. Here, two-thirds of head and neck cancers metastasis in carcinoma of the buccal mucosa patients,
mostly in those who underwent surgery. Thus, we
present the incidence and discuss possible causes of such
Access this article online metastasis and provide treatment recommendations. This
Quick Response Code: study was approved by review board of SAIMS.
Website: Methods
www.jcmtjournal.com
From January 2008 to October 2014, a total of 5791 cases
of cancer were registered at the Sri Aurobindo Hospital
DOI:
10.4103/2394-4722.153444 in Central India. Head and neck cancer represented
25.8% of all malignancies and carcinoma of the buccal

Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 1 ¦ April 15, 2015 ¦ 27