Evaluation of Serum Lipid Profile in Patients with Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma: A Case Control study

The present study titled “Evaluation of serum lipid profile in Patients with Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma” was conducted in the Department of Oral Medicine and Radiology, Ragas Dental College, Uthandi, Chennai and Dr. Rai Memorial Medical and Cancer Centre, Chennai, to estimate the serum levels of TC, LDL, HDL, VLDL and TGL in patients with Potentially Malignant disorders like Leukoplakia and Oral submucous fibrosis, Oral cancer and to compare the values with the control subjects. A total of 75 individuals were selected for the study. Among the study subjects 25 patients were suffering from Potentially Malignant Disorders, 25 patients were suffering from Oral Cancer, and 25 patients were normal controls. Informed consent was taken from all subjects before including them in the study. The experimental subjects were made to sit comfortably on a Dental Chair. Sterile hand gloves were used during examination of the patients. Patients were examined under halogen lamp in the dental chair under aseptic conditions and relevant demographic data were collected. Clinical diagnosis was made and patients who showed characteristic features of Leukoplakia, Oral submucous fibrosis and Oral Cancer were prepared for sample collection. 5ml of blood from the patient was taken for the evaluation of lipid profile. The study documents the following data: 1. Among the 75 subjects 56 (74.7%) were males and 19 (25.3%) were females. The minimum age of the study subjects was 22 years and the maximum age was 70 years. 2. Among the 75 subjects 15 (20%) had the habit of smoking, 32 (42.7%) had the habit of chewing, 7 (9.3%) had the habit of chewing and smoking, 3 (4%) had the habit of smoking and alcohol consumption and 4 (5.3%) had all three habits together with a p-value of 0.000 which is statistically significant. Thus a positive correlation between smoking, chewing, alcohol consumption and development of precancer and cancer has been established. 3. The most common sites for leukoplakia were in the retrocommissure area with 5 (45.5%) subjects followed by buccal mucosa 5 (45.5%) and one in floor of the mouth. 4. The present study showed all cases of OSMF in the buccal mucosa 6 (42.8%) in Grade III and 4 each in Grades I and IV and none in Grade II. 5. Among the total of 25 (100%) subjects, 3 (12%) had carcinoma in the tongue, 12 (48%) had in the buccal mucosa, 5 (20%) had in the alveolar mucosa, 1 (4%) had carcinoma in the floor of the mouth and 4 (16%) in the palate. Oral cancer was mostly seen in the buccal mucosa, followed by tongue, alveolar mucosa, floor of the mouth and palate. 6. There was a significant decrease in levels of serum TC, HDL which were observed in patients with Potentially Malignant Disorders like Leukoplakia and Oral submucous fibrosis. The mean TC in patients with PMD was 159.84±15.5 mg %, the mean HDL was 40.72±3.2 mg % . LDL, VLDL and TGL were also reduced but not significant. 7. There was a significant decrease in the serum TC, HDL, VLDL in patients with oral carcinoma. The mean TC in patients with OSCC was 157.44±12.3mg %, the mean HDL was 38.92±2.5 mg %, the mean VLDL was 26.00±26.9 mg%. LDL and TGL were also reduced but not significant. 8. There were no significant relation between lipid profile in relation to gender, duration of habits, clinical types of leukoplakia, grades of OSMF and stages of OSCC. Reduced lipid level may be attributed to the production of free radicals induced by tobacco carcinogens and excessive use of areca nut. It is believed that tobacco carcinogens and excessive use of areca nut induce generation of free radicals and reactive oxygen species, which are responsible for high rate of peroxidation of polyunsaturated fatty acids. Because of lipid peroxidation there is greater utilization of lipids including total cholesterol, lipoproteins and triglycerides for new membrane biogenesis. Cells fulfill these requirements either from circulation, by synthesis through metabolism or from degradation of major lipoprotein fractions like VLDL, LDL, and HDL. To conclude an inverse relationship exists between serum lipid profile in Oral cancer and Oral Potentially Malignant disorders. The lower serum lipid status may be a useful indicator for initial changes occurring in neoplastic cells. The present findings are drawn by a smaller sample size but the findings strongly warrant an indepth study on a large sample size of oral cancer. Further study with larger sample size and additionally a long term follow up of PMD subjects with periodic estimation of lipid profile would be needed to establish correlation between a transformation from precancerous state to malignancy. Thus lipid profile may be used as a marker for malignant transformation in PMD and hence early detection of malignancy would give way to early treatment thereby increasing the survival rate in these patients.