Oral epithelial changes in thirty indians with oral cancer and submucous fibrosis

Abstract

Among one hundred patients with oral cancer in Trivandrum, South India, 40 suffered from oral submucous fibrosis, a chronic condition characterized by blanching and stiffness of the oral mucosa. Histologically, submucous fibrosis is associated with a marked atrophy of the oral epithelium. Oral biopsies were taken from 30 patients, either in areas remote from the cancer or in the vicinity of the cancer. Epithelial atypia was observed in 11.5% in areas remote from the cancer and in 71.4% in the vicinity of the cancer. Though the biopsies were taken from areas normally unkeratinized, the majority revealed keratinization in varying degrees. Clinically, leukoplakias were found in 46.7%. Since all patients chewed tobacco, it is most likely that the epithelial changes and the cancers are the results of this habit, primarily because the atrophic oral epithelium in submucous fibrosis is more vulnerable to action of carcinogens. The authors postulate that submucous fibrosis is due to a hypersensitivity to chilli, a theory supported by the occurrence of submucous fibrosis among chillieating populations in South East Asia.