Oral cancer is one of the leading causes of mortality and morbidity. It is a well-known fact that early detection of cancer is essential for best chances of cure. Use of biomarker measurements for early detection is a promising research innovation being applied to various human cancers ^[1]. It had been established that cancer cells synthesize certain glycoproteins, that may be detected in body fluids ^[2]. Glycoproteins contain galactose, mannose, glucosamine, galactosamine, sialic acid or fucose as the carbohydrate residue ^[3]. It has been reported that tumor cells modulate their surface by increasing fucosylation levels (addition of L-fucose at the terminal end of the oligosaccharide chain) to escape recognition, which contribute to several abnormal characteristics of tumor cells, such as decreased adhesion and uncontrolled tumor growth ^[4]. Hence, monitoring serum/tissue fucose levels could be a promising approach for the early detection, diagnosis, and prognosis of various cancer types ^[5].

Oral cancer may be preceded by precancerous lesions or conditions such as leukoplakia, oral submucous fibrosis etc. Oral precancer represents an increased risk of malignant transformation ^[6]. Altered glycosylation of glycoconjugates, such as sialic acid, fucose, etc. are few important molecular changes that accompany malignant transformation. Alterations in serum fucose levels had been associated with certain precancerous lesions ^[4-6]. Early detection of malignant transformation improves the clinical outcome of patients. The search for a biomarker that could predict the changes in the premalignant lesions would immensely help in the recognition of high-risk lesions. Therefore, if patients with clinically suspicious lesions can be analyzed with biomarkers along with routine histopathological tests for the prediction of its malignant potential, the chance of minimizing the morbidity and mortality will be high ^[5].

Hs CRP, a typical systemic inflammation marker, were first discovered in the plasma of patients during the acute phase of pneumococcal pneumonia. Hs CRP is produced in hepatocytes in response to inflammatory cytokines such as interleukin (IL)-1, tumor necrosis factor (TNF)-α, and IL-6 ^[7].

One of the important components responsible for the maintenance of cell integrity is lipids, which are also required for various biological functions like cell division and growth of normal and malignant tissues. Free radicals and reactive oxygen species are formed due to tobacco carcinogens which cause oxidation/ peroxidation of polyunsaturated fatty acids. This peroxidation further releases peroxide radicals. This affects the essential constituents of the cell membrane and might be involved in carcinogenesis/tumorigenesis.⁸ The lipid peroxidation causes an increased utilization of lipids such as total cholesterol, lipoproteins and triglycerides. The increased requirement of accomplished either from circulation, by synthesis through the metabolism or from degradation of major lipoprotein fractions like very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), or high-density lipoprotein.

To compare serum fucose, Hs CRP levels and lipid profile in clinically and histo pathologically diagnosed Oral Cancer, Oral Leukoplakia and Oral Submucous fibrosis cases.

The present study was done in the Department of pathology, Government Medical College, Ayodhya Uttar Pradesh. In this study 200 samples collected from our OPD which was divided into four groups. Group 1, II and III were include 50 in each group clinically and histo-pathologically diagnosed cases of oral leukoplakia, oral submucous fibrosis, oral cancer patients and groups taken as control healthy individuals respectively with the age group of 15 to 60 years both genders. Patients with known systemic conditions like diabetes, hypertension, pregnancy, allergies, infections, liver disease were excluded from the study. Those patients also not considered in this study whom taken any treatment, radiotherapy and chemotherapy for cancerous lesions. The detailed history and clinical examination of all the patients were recorded in a specially designed proforma. Incisional biopsy was taken from a representative site of the lesion under local anesthesia for histo-pathological confirmation of the lesion. 

Blood (5.0ml) were collected by venipuncture is preferred method of blood sampling that causes less pain than heel prick, Winged steel needle preferably 23 gouge, from all the participants. The samples were processed in research laboratory after collection of blood sample; it centrifuges for 10 min at 3000 rpm at room temperature. The obtained supernatant transferred in the fresh tube with proper labeling for the analysis of serum fucose, serum CRP.

Serum Hs C Reactive Protein (Hs CRP): Serum CRP were estimated by Immunoturbidimetry, CRP Test is based on the latex agglutination method introduced by Singer, et. al. in 1957. This is a slide agglutination test for the qualitative and semi-quantitative detection of Hs C - reactive protein (CRP) in human serum. Latex particles coated with goat IgG anti-human CRP are agglutinated when mixed with samples containing CRP. When latex particles coated with human anti-CRP are mixed with a patient’s serum containing C – reactive proteins, this results in visible agglutination within 2 minutes.

Estimation of lipid: enzymatic method: Serum lipid levels were determined by CHOD/PAP method (Cholesterol oxidase/peroxidise aminophenazone test): Cholesterol ester is converted to cholesterol and fatty acids in the presence of cholesterol esterase. Cholesterol is oxidized in the presence of cholesterol oxidase to produce hydrogen peroxide. Hydrogen peroxide reacts with phenol and 4-aminoantipyrin in the presence of peroxidase to give quinine and water molecule to give red colour. The optical density is read at 500nm against blank.

TGL was determined by GPO/PAP method in which TGL is hydrolyzed by lipase to glycerol and fatty acids. The glycerol formed is phosphorylated by Adenosine tri-phosphate (ATP) in the presence of glycerol kinase to glycerol-3-phosphate which is oxidized by the enzyme glycerol-3-phosphate oxidase producing hydrogen peroxide. Hydrogen peroxide so formed reacts with 4- amino-antipyrine and 4-chlorophenol in the presence of enzyme per-oxidases to produce red quinoeimine dye. The intensity of colour is proportional to TGL concentration. LDL cholesterol was assessed according to the formula by Friedwald et al, LDL = TC – (HDL + TG/5)

In our study 200 total samples collected from relevant department and go through bio-chemical analysis. Our sample divided into four group, group 1 consist health individual or normal and has 50 sample, group 2 consist clinical diagnosed oral-submucous fibrosis patients and has 50 samples, group 3 consist clinical and histopathological diagnosed oral leukoplakia has 50 sample and last group 4 consist confirmed cases of oral cancer by histopathologically has 50 sample.

The present study deals with estimation of serum fucose, Hs CRP and lipd profile levels in oral cancer, leukoplakia and oral submucous fibrosis.  A total of 200 subjects, 50 oral cancer patients, 50 oral leukoplakia patients, 50 oral submucous fibrosis patients and 50 normal healthy controls were recruited and evaluated. The all-recruited subjects were in both genders.

The age of four groups (normal, oral leukoplakia, oral submusous fibrosis and oral cancer) are summarized in Table 1 and also depicted in Fig. 1. 

Oral cancer is the most common type of cancer in the head and neck region with annual incidence Visible changes are detectable in the oral mucosa in the form of white or red patches before the occurrence of oral squamous cell carcinomas (OSCCs), therefore the current study design to evaluate the biomarkers for their determination and correlation in understanding the disease. Apart from this it sets a cut off value for each marker in the case which gives a clear picture to the clinician to aid the better treatment protocol and assessing the condition so prevention and early detection of such potentially malignant disorders (PMDs) have the potential of not only decreasing the incidence but also improving the survival of those who develop oral cancer.

This study is aimed at evaluation of serum fucose in oral submucosa fibrosis, leukoplakia, and oral cancer and the results obtained showed the significance for serum fucose, Hs CRP and lipid profile levels in oral submucosa fibrosis, leukoplakia, OC group as compared with healthy individuals. Analysis of the markers can be an additional tool for diagnosis, prognosis, and treatment monitoring of pre-cancer and cancer patients. Therefore, the evaluation of above biomarkers would be of good help in assessing early malignant change in increasing the accuracy of clinical diagnosis and also in assessing the spread and invasiveness.

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