Table of Contents  
Year : 2016  |  Volume : 8  |  Issue : 2  |  Page : 123-127

Orofacial cancers in the West of Iran: A 10-year study

1 International Research Collaborative - Oral Health and Equity, School of Anatomy, Physiology and Human BIology, University of Western Australia, Perth, Australia
2 Department of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Web Publication16-Dec-2016

Correspondence Address:
Prof. Jamileh Bigom Taheri
Shahid Beheshti University of Medical Sciences, Evin, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-8844.195918

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Background: Orofacial cancer remains a substantial life-threatening disease in developing countries. Late diagnosis and treatment still lead to many avoidable deaths. The differences in incidence and prevalence between different geographical and ethnic groups remain an important issue for service planning and international action against cancer. Methods: In this retrospective study, cancer of the orofacial region for the 10-year period (April 2002–March 2012) was evaluated. Age, sex, histopathological type, and the primary site of tumor were recorded according to the International Classification of disease for Oncology. Descriptive analyses were used to describe basic features, means (±standard deviation) were reported, and appropriate tests of significance were used. Results: Squamous cell carcinoma was the most common malignancy (55.8%) followed by mucoepidermoid carcinoma (9.4%). The male to female ratio was 5:4 and the average age was 63 years. The most common site was lower lip (22%), followed by tongue (15%) and parotid salivary gland (13%). Conclusion: This 10-year retrospective study analyzed frequency of orofacial malignancies. Considering the difference in incidence and mortality of head and neck cancer in less developed versus more developed regions, this kind of research in various population provides better understanding of cancer for global programming in terms of prevention, detection, and treatment.

Keywords: Epidemiology, head and neck, malignancy, prevalence, retrospective study

How to cite this article:
Azimi S, Tennant M, Kruger E, Taheri JB, Sehatpour M, Rezaei B. Orofacial cancers in the West of Iran: A 10-year study. J Orofac Sci 2016;8:123-7

How to cite this URL:
Azimi S, Tennant M, Kruger E, Taheri JB, Sehatpour M, Rezaei B. Orofacial cancers in the West of Iran: A 10-year study. J Orofac Sci [serial online] 2016 [cited 2023 Jun 9];8:123-7. Available from:

  Introduction Top

One of the most significant causes of mortality is cancer.[1] The World Health Organization (2011) estimates that cancers are now leading to more deaths than coronary heart disease or stroke. It is estimated that the burden of cancer will be increasing over the next decades, especially in low- and middle-income countries, and it is anticipated that there will be over 20 million new cancer cases annually in <10 years, by 2025. According to the GLOBACAN in 2012, estimates from 184 countries worldwide indicated 14.1 million new cases of cancer and 8.2 million deaths.[2] Furthermore, in Iran, according to Mousavi et al., cancer is the third main cause of death and annually more than 30,000 deaths are reported as a result of cancer.[3]

Cancers of the head and neck include lip, oral cavity, oropharynx, hypopharynx, larynx, sinonasal tract, and nasopharynx as well as the pharyngeal tonsils and salivary glands;[4] and represent a considerable burden worldwide. The prevalence of head and neck malignancies differs (by up to twenty times) in different places across the world, with higher tendency in less developed regions.[1],[4],[5],[6],[7],[8],[9] However, data of incidence and mortality are not of high quality, and evidence is limited in developing countries; hence, the exact nature and extent of the problem remain unknown.[4],[5],[6],[7],[8],[9] Considering the fact that regular observation of head and neck cancer incidence rates is required for global cancer control strategies, data of each specific region are important for understanding the burden of disease and evaluation of the extent of the problem. Moreover, these data are essential for the allocation of resources for prevention, diagnosis, treatment, and supporting services. The aim of this study was to determine the 10-year incidence of head and neck primary malignant tumors in Kermanshah, in the West of Iran.

  Materials and Methods Top

In this retrospective descriptive study, data were collected from pathology records registered in the laboratories of the three leading public hospitals in Kermanshah Metropolitan (West of Iran) from 2002 to 2012. This study was approved by the ethics committee of Shahid Beheshti University of Medical Sciences. This research has been conducted in full accordance with the World Medical Association Declaration of Helsinki. We confirm that patients' information remained confidential and data were anonymized and de-identified period to analysis.

A total of 3927 case records were evaluated and all cases with the definitive diagnosis of primary oropharyngeal cancer were extracted for the study. Recurrent, metastatic, and premalignant lesions were not included in the study. Age, gender, tumor location, and histopathological type were obtained from patients' records. Information regarding the lesions was registered in specific record sheets according to the International Classification of Disease for Oncology. Anatomical origin was classified as follows: larynx, oral cavity (lip, tongue, floor of mouth, maxilla, mandible, gingival, and buccal mucosa), oropharynx, sinonasal, and salivary glands. The data were analyzed with SPSS software version 18.0. Descriptive analysis was used to describe basic features and means (±SD) were reported and tests of significance were used as appropriate. Significance was set at a P value of 0.05.

  Results Top

Overall 181 cases (4.6%) from 3927 patients were diagnosed with primary malignant head and neck cancers by histopathological confirmation. The mean age of all patients was 63 years (range: 7–92 years). The mean age of males and females did not differ significantly and was 63.7 (±14.3) years and 62.3 (±16.2) years, respectively [Table 1], [Table 2] and [Figure 1]. The most common site of involvement was the lower lip (22%) followed by the tongue (15%) and parotid salivary glands (13%) [Figure 2].
Table 1: The frequency of orofacial cancers in different age groups

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Table 2: The number of lesions and mean age

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Figure 1: Frequency of lesions according to type of cancer

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Figure 2: The distribution of the lesions by location

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In the current study, 89% of cancers were of epithelial origin (with average age of 66 years), from which most of them were from mucosa (62.3% squamous cell carcinoma (SCC) and 3.7% verrucous carcinoma) and rests of them were from salivary gland epithelium, 6% of bone origin, and 4% of lymphoid origin. SCC was the most common histological type, comprising 62% of epithelial cancers. In the oral cavity, the most affected site of SCC was the tongue (37%). SCC was the most common lesion type in both males and females [Figure 3].
Figure 3: Gender distribution according to type of cancer

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For all malignancy cases (n = 181), 101 were male (56%) and 80 were female (44%); but for SCC cases (n = 101), 60 (59%) were male and 41 (41%) were female.

The most common malignancy of salivary glands was mucoepidermoid carcinoma (MEC) with 17 cases (38%) followed by adenoid cystic carcinoma with 9 cases (20%). The most commonly affected salivary gland was the parotid with 24 cases (54%) followed by minor and submandibular salivary glands. Osteosarcoma with 8 cases (66%) was the most common bone malignancy.

  Discussion Top

In this descriptive study, 181 patients from the archive (n = 3927) of the pathology department of the three main hospitals of Kermanshah, Iran, from 2002 to 2012 were reviewed. The mean age of cases was 63 years with 92% of patients more than 40 years old. These data compare to previous research from a close region (middle of Iran-Isfahan) where the mean age of cases was 52 years, and around one-third of cases (27%) occurred in patients younger than 40 years.[10] A separate previous study from Southeast of Iran, in 2014 showed the average age of 53 years, with 18% under 41 years old. These reports of high rate young cancer patients are more than reported by other studies worldwide.[11] Our findings are more consistent with international trends and may be a result of the larger number of cases in our sample.

The mean age of SCC patients in the present study was 65 years, which compares well with other studies: in Myers et al. and Schantz et al., the mean age at diagnosis for SCC was approximately 60 years,[10],[12],[13] and Funk et al. reported 64 years as average.[10],[14]

In this study, the mean age of males was slightly higher than females (63 vs. 62 years). Arotiba et al. in Nigeria reported that males with SCC were relatively younger than females (mean 48 years versus 58 years).[15]

In this study, the male to female ratio in SCC was 1.2–1, and in overall malignancies was the same. Razavi et al. (Iran) reported a male to female ratio of 1.4–1 in Iran [10] and Larizade et al. in 2014 reported that most patients (73%) were male and the overall male to female ratio was 2.74:1.[11] Moreover, time trend analysis of oral cancer in Iran highlighted disparities between oral cancer incidence trends in males and females over the 6 years from 2005 to 2010.[16] It seems that not only the higher rate of smoking and alcohol consumption is a vital issue but also sex hormone differences may be the reason for male predilection.[17] However, recently, the incidence of head and neck cancer has increased significantly in women, changes in environmental exposure probably could explain this finding.[11]

The greatest majority of malignancy types in this study were SCC (56%) followed by MEC (9%). This result was in line with Razavi et al.'s study in Iran, with the majority of SCC (60%) followed by MEC (8%).[10] Rabiei et al. (2016) in north of Iran reported that the most common type of cancer was SCC followed by basal cell carcinoma.[18] Furthermore, in a UAE study (2014), the most prevalent malignant lesion was OSCC followed by MEC.[19] However, in one study in Iran, lymphoma was the second most prevalent malignancy (9%) after SCC (77%). A systematic review on 25 articles in Iran showed that the range of SCC was different from 38% to 97% in different studies; however, none of them was in the West of Iran.[11]

In the present study, the most commonly involved site was the lip with more than one out of every four cancers. This finding is in agreement with other reports in Iran.[1] For instance, in 2016 in the north of Iran, Rabiei et al. reported that in the oral cavity (C00–C08), the most common cancers were lip cancer (C00) followed by tongue cancer (C01, C02).[18]

The tongue was the most frequently involved site of oral cavity (when lip was excluded), and that was consistent with previous reports.[20],[21],[22] However, some studies have also reported other sites (rather than lip and tongue) to be the most involved sites. For example, the gingiva and larynx were reported as most commonly affected sites in recent studies in Iran.[10],[11],[23] Considering various sites of distribution, it seems logical that preventive plans will be focus on all sites with potential of oral cancer. However, due to considerable lack of understanding of oral cancer incidence, especially in populated developing countries, such as Iran,[16] focus on screening for prevention and early detection of lip and tongue cancer is recommended due to its high rate of involvement.[1]

We report that about half of salivary gland neoplasms were in the parotid gland. The most common type was mucoepidermoid (38%) followed by adenoid cystic carcinoma (20%). These findings are confirmed by another study in Iran (2014), which reported mucoepidermoid (35%) followed by adenoid cystic carcinoma (17%) as the most common types.[11]

Around 90% of all malignancies were epithelial cancers, 6% bony lesions (with majority of osteosarcoma), and 4% lymphomas in accordance with Andisheh Tadbir in Southeast of Iran.[4] Furthermore, in the UAE, malignant neoplasms of epithelial origin occurred in 78% cases followed by malignant neoplasms of glandular origin (13%) and malignant neoplasms of mesenchymal origin (8%).[19]

  Conclusion Top

This kind of research in different populations and countries provides a better understanding of these lesions and these are required for national and global programming in terms of prevention, early detection, and treatment. Oral health professionals should be educated on comprehensive examination of head and neck for screening of malignancy. Furthermore, educational programs for awareness of people about risk factors and signs of head and neck cancer are highly recommended.


Dr. Azimi acknowledges the funding of postgraduate award from the University of Western Australia. This project was done with close cooperation of Oral Medicine department of Shahid Beheshti University of Medical Sciences.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Maleki D, Ghojazadeh M, Mahmoudi SS, Mahmoudi SM, Pournaghi-Azar F, Torab A, et al. Epidemiology of oral cancer in Iran: A systematic review. Asian Pac J Cancer Prev 2015;16:5427-32.  Back to cited text no. 1
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.  Back to cited text no. 2
Mousavi SM, Gouya MM, Ramazani R, Davanlou M, Hajsadeghi N, Seddighi Z. Cancer incidence and mortality in Iran. Ann Oncol 2009;20:556-63.  Back to cited text no. 3
Andisheh Tadbir A, Mehrabani D, Heydari ST. Primary malignant tumors of orofacial origin in Iran. J Craniofac Surg 2008;19:1538-41.  Back to cited text no. 4
Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2006;42:229-39.  Back to cited text no. 5
Drivas EI, Skoulakis CE, Symvoulakis EK, Bizaki AG, Lachanas VA, Bizakis JG. Pattern of parotid gland tumors on Crete, Greece: A retrospective study of 131 cases. Med Sci Monit Basic Res 2007;13:CR136-40.  Back to cited text no. 6
Glick M. Burket's Oral Medicine: Coco. India: Jaypee Brothers Medical Publishers; 2014.  Back to cited text no. 7
Al-Kaabi R, Gamboa AB, Williams D, Marcenes W. Social inequalities in oral cancer literacy in an adult population in a multicultural deprived area of the UK. J Public Health 2016;38:474-82.  Back to cited text no. 8
Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009;45:309-16.  Back to cited text no. 9
Razavi SM, Siadat S, Rahbar P, Hosseini SM, Shirani AM. Trends in oral cancer rates in Isfahan, Iran during 1991-2010. Dent Res J (Isfahan) 2012;9 Suppl 1:S88-93.  Back to cited text no. 10
Larizadeh MH, Damghani MA, Shabani M. Epidemiological characteristics of head and neck cancers in Southeast of iran. Iran J Cancer Prev 2014;7:80-6.  Back to cited text no. 11
Myers JN, Elkins T, Roberts D, Byers RM. Squamous cell carcinoma of the tongue in young adults: Increasing incidence and factors that predict treatment outcomes. Otolaryngol Head Neck Surg 2000;122:44-51.  Back to cited text no. 12
Schantz SP, Yu GP. Head and neck cancer incidence trends in young Americans, 1973-1997, with a special analysis for tongue cancer. Arch Otolaryngol Head Neck Surg 2002;128:268-74.  Back to cited text no. 13
Funk GF, Karnell LH, Robinson RA, Zhen WK, Trask DK, Hoffman HT. Presentation, treatment, and outcome of oral cavity cancer: A National Cancer Data Base report. Head Neck 2002;24:165-80.  Back to cited text no. 14
Arotiba GT, Ladeinde AL, Oyeneyin JO, Nwawolo CC, Banjo AA, Ajayi OF. Malignant orofacial neoplasms in Lagos, Nigeria. East Afr Med J 2006;83:62-8.  Back to cited text no. 15
Iranfar K, Mokhayeri Y, Mohammadi G. Time trend analysis of oral cancer in Iran from 2005 to 2010. Asian Pac J Cancer Prev 2016;17:1421-6.  Back to cited text no. 16
Suba Z. Gender-related hormonal risk factors for oral cancer. Pathol Oncol Res 2007;13:195-202.  Back to cited text no. 17
Rabiei M, Basirat M, Rezvani SM. Trends in the incidence of oral and pharyngeal cancer (ICD00-14) in Guilan, North of Iran. J Oral Pathol Med 2016;45:275-80.  Back to cited text no. 18
Anis R, Gaballah K. Oral cancer in the UAE: A multicenter, retrospective study. Libyan J Med 2013;8:21782.  Back to cited text no. 19
Aghbali AA, Halimi M, Pour AF, Mahmoudi SM, Janani M. A Ten-year Study of Oral Cancer In Patients Referred to Pathology Department of Emam Reza Hospital, Tabriz; 2011.  Back to cited text no. 20
Delavarian Z, Pakfetrat A, Mahmoudi S. Five years retrospective study of oral and maxillofacial malignancies in patients referred to Oral Medicine Department of Mashhad Dental School-Iran. J Mash Dent Sch 2009;33:129-38.  Back to cited text no. 21
Sargeran K, Murtomaa H, Safavi SM, Vehkalahti M, Teronen O. Malignant oral tumors in iran: Ten-year analysis on patient and tumor characteristics of 1042 patients in Tehran. J Craniofac Surg 2006;17:1230-3.  Back to cited text no. 22
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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2]


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