The term "oral cavity" in majority of studies take into account the tongue's anterior portion (Picture A1), the upper and lower gingiva (Picture A2,A3), the retromolar trigone (Picture A4), the hard palate (Picture A5), the lips (Picture A6), the vestibule of the mouth, and the cheek mucosa (Picture A7) The oral cavity is the origin of a variety of malignant tumors with different cellular lineages. Squamous cell carcinoma accounts for a major portion of them, making upto 95% of head and neck cancers [1]. The histology, vascular supply, and lymphatic network of the anatomic areas in the mouth cavity vary. Accessibility to a visual examination of the site may also affect the early diagnosis of oral squamous cell carcinoma (OSCC) in addition to these variables [2]. After surgical treatment, the 5-year survival rate for individuals with nodal metastases was reported to be 20-36% compared to 63-86% for patients without lymph node involvement. To ascertain the likelihood of lymph node metastasis, several researchers have examined the clinical and histopathologic characteristics of the initial tumor, such as the size of the tumor, the level of differentiation, the host immunological response, and the pattern of invasion (pi). Although surface size, histologic grade of malignancy, and growth pattern have been linked to metastasis, studies vary in how well they predict the likelihood of metastatic spread [3]. The habit of chewing tobacco, betel nuts, and pan (a mixture of tobacco, lime, and other substances wrapped in a vegetable leaf) is largely to blame for the high incidence of oral cancer [4]. The single most significant prognostic indicator for predicting local and distant failure as well as survival is metastasis to the local regional lymph node (LN). The nodal metastasis reduces the chance of survival by 50%. Surgery is the mainstay of treatment for oral cavity cancer, with adjuvant chemotherapy and radiation therapy only used in more severe cases, those that are unresectable, or those whose considerable comorbidities would make surgery impossible [5].

Study period: Nov 2022-Mar 2024 This was a prospective observational study, done at Department of surgical oncology Krishna institute of medical sciences Secunderabad Telangana. The protocol for the study was approved by the Ethics Committee. Aim of study To study the distribution of oral cavity cancer presenting to our hospital. To study stage of presentation of the disease. Significance of the study Oral cancer is one of the most common cancers in India, largely due to high tobacco and areca nut use. It contributes significantly to the country’s cancer burden, with many cases diagnosed late. This study highlights patterns relevant to the Indian population and can help improve early detection and public health strategies. Inclusion criteria -Patients with biopsy proven squamous cell carcinoma of oral cavity which were operable. -Primary tumor confined to oral cavity, -Histological squamous cell type, -Patients who underwent surgery in our institute only Exclusion criteria Non squamous cell carcinomas recurrent tumors Post radiotherapy cases Either of primary or neck surgery done outside Patients who received preoperative chemotherapy or radiotherapy Patients with multiple primary tumors All patients underwent thorough history taking, clinical examination which included oral cavity examination, indirect laryngoscopic examination, bilateral cervical examination and general physical examination. In all patients biopsy confirmation was done preoperatively. Patients with early lesions were evaluated by orthopantomogram to assess mandibular involvement. Computer tomography scan or magnetic resonance imaging were used as a investigation tool to confirm the local operability in indicated patients like in patients with large lesions having trismus, lesion reaching up to retro molar trigone (RMT) and lesions abutting the mandible where marginal mandibulectomy is being planned. Clinical N stage is confirmed by ultrasonography. All patients were staged clinically using AJCC/TNM classification. During surgery, level v lymph nodes were dissected, labelled, and processed separately from neck dissection specimens (PICTURE A10, A11 and A12). Analysis of clinical stage, pathological stage and other variables like differentiation, lymphovascular invasion (LVI), total number of lymph nodes, positive lymph nodes, level of involvement and extra capsular spread (ECS) were done. Chart review of the data was done to evaluate potential risk factors for level v ln metastasis. Sample size- 142 patients Study type – prospective observational study.

Demography This is a prospective observational study of 142 patients with carcinoma oral cavity treated with surgery (wide excision, hemiglossectomy or hemi mandibulectomy) for primary and Modified Radical Neck Dissection MRND for neck management. Mean age in this study was 43.5 years and the median age is 46 years. The study included 107 males and 35 females. Out of 142 oral cavity cancers, The most common primary site is Buccal mucosa / Retromolar trigone (62 43%), 31 cases had cancer involving gingival buccal complex (21%), 26 cases had cancer of the tongue/floor of mouth (15%), 14 cases had cancer of the alveolar process (8%) and 9 cases had cancer of lip (4.1 %). Table 1 and Figure;1 shows the distribution of primary cancer according to the site of origin. Histopathological Grades While analysing various histopathological grades we found that out of 142 cases, 68 cases are well-differentiated tumours, 55 are moderately differentiated and 19cases are poorly differentiated and more than 90% were squamous cell cancer. Prevalence of level V LN in various clinical stages Analyzing the data of 142 patients we found prevalence of 4.9% level v lymph node metastasis Table 1: Distribution Of Primary Cancer According to Site Site Number of Cases(N) Percentage (%) Buccal mucosa/Retro molar trigone 62 43 Tongue/Floor of mouth 26 15 Alveolar process 14 8 Gingivo buccal complex 31 21 Lip 9 4. TOTAL 142 100 Table 2: Distribution Of patients based on Histopathological grading Histopathological Grade Total Well Differentiated 68 Moderately differentiated 55 Poorly differentiated 19 Total 142 Table 3- showing Prevalence of level V LN in various clinical stages Clinical stage Number of patients Level V lymph node-positive Prevalence cN0 38 0 0 cN1 (level I) 54 1 1.8% cN1 (level II/III) 22 1 4,5 % cN2 28 5 17% total 142 7 4.9%

This was a prospective observational study carried out at Krishna Institute of Medical Sciences Secunderabad where we studied 142 patients with oral malignancy with the intent to study various characteristics of the oral cancer presenting to our institution. There are two types of neck dissections for managing the neck: radical and selective. By selective neck dissection, only nodal groups-which are more likely to harbour metastases-are removed depending on where the initial tumour is located. The idea behind selective neck dissection derives from the clinical finding that the upper aerodigestive tract SCC metastasizes to the cervical LN in a predictable, sequential and progressive pattern [6]. Extensive lymphadenectomy and selective neck dissection are equally effective in treating cN0 neck lesions, according to a review of previous research. Anil K. D’Cruz [7]. In their study concluded that elective neck dissection at the time of resection of the primary tumour confers an overall survival benefit in patients with early-stage, clinically node-negative oral squamous cell carcinoma. In our study we found mean age in this study was 43.5 years and the median age is 46 years. The study included 107 males and 35 females. Out of 142 oral cavity cancers, The most common primary site is Buccal mucosa / Retromolar trigone (62 43%), 31 cases had cancer involving gingival buccal complex (21%), 26 cases had cancer of the tongue/floor of mouth (15%), 14 cases had cancer of the alveolar process (8%) and 9 cases had cancer of lip (4.1 %), similar results were seen by Parul Tandon, et al., [8] were they found that Among the different sites of oral cavity, the highest incidence (31.47%) of oral squamous cell carcinoma was seen for buccal mucosa in our study. The most affected age group (39.50%) were patients above 50 years old, predominantly involving males. While analysing our data that out of 142 cases, 68 cases are well-differentiated tumours, 55 are moderately differentiated and 19cases are poorly differentiated Similar findings were stated by Sabiha Mokashi Khan et al., [9] were they found Out of 30 cases of OSCC, 13 were Well-differentiated, 12 moderately differentiated, and 5 poorly differentiated. In our data we found level V lymph node metastasis was 4.9% similar observations were made by Gouri H Pantvaidya et al., [10] were they found Five hundred eighty-three neck dissections were prospectively evaluated. A total of 95.7% metastases occurred at levels I to IV. Overall incidence of metastases to levels IIB and V was 3.8% and 3.3%, respectively. Multivariate analysis revealed IIA positivity as an independent predictive factor for metastases to both IIB and V.

Oral cancer remains a significant public health concern, particularly in rural regions of India, where it severely impacts essential human functions. Recent studies have provided deeper insights into its risk factors, evolving epidemiology, and potential prevention strategies. To combat this, regular free screening camps should be conducted to identify precancerous lesions early. Additionally, healthcare facilities and diagnostic centers should be established within accessible distances to offer routine check-ups, provide counseling for underprivileged populations, and refer diagnosed patients to multidisciplinary hospitals for comprehensive treatment.

1. Esam Ahmad Omar. The Outline of Prognosis and New Advances in Diagnosis of Oral Squamous Cell Carcinoma (OSCC): Review of the Literature. J Oral Oncology. 2013; 519312. 2. Massano J, Regateiro FS, Januario G, Ferreira A. Oral squamous cell carcinoma: review of prognostic and predictive factors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: 67-76. PubMed: https://pubmed.ncbi.nlm.nih.gov/16831675/ 3. Yamamoto E, Miyakawa A, Kohama G. Mode of invasion and lymph node metastasis in squamous cell carcinoma of the oral cavity. Head Neck Surg. 1984; 6: 938-947. PubMed: https://pubmed.ncbi.nlm.nih.gov/6724960/ 4. Sankaranarayanan R, Masuyer E, Swaminathan R, Ferlay J, Whelan S. Head and neck cancer: a global perspective on epidemiology and prognosis. Anticancer Res. 1998; 18: 4779-4786. PubMed: https://pubmed.ncbi.nlm.nih.gov/9891557/ 5. Johnson JT. Cervical LN metastases. Arch Otolaryngol. 1995; 111: 534-537. 6. Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer. 1990; 66: 109-113. PubMed: https://pubmed.ncbi.nlm.nih.gov/2354399/ 7. D'Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, et al. Elective versus Therapeutic Neck Dissection in Node Negative Oral Cancer. N Engl J Med. 2015; 373: 521-529. PubMed: https://pubmed.ncbi.nlm.nih.gov/26027881/ 8. Tandon P, Dadhich A, Saluja H, Bawane S, Sachdeva S. The prevalence of squamous cell carcinoma in different sites of oral cavity at our Rural Health Care Centre in Loni, Maharashtra - a retrospective 10-year study. Contemp Oncol (Pozn). 2017; 21: 178-183. PubMed: https://pubmed.ncbi.nlm.nih.gov/28947890/ 9. Sabiha MK, Nilima P, Rizwan RM, Sajda KG, Vaishali S, et al. Histopathological Grades of Oral Squamous Cell Carcinoma a Prognostic Indicator: Hospital-Based Study, Research. Int J Med Res Health Sci. 2022; 11. 10. Pantvaidya GH, Pal P, Vaidya AD, Pai PS, D'Cruz AK. Prospective study of 583 neck dissections in oral cancers: implications for clinical practice. Head Neck. 2014; 36: 1503-1507. PubMed: https://pubmed.ncbi.nlm.nih.gov/23996343/