document: the study was conducted in the department of oral medicine and radiology and a cancer centre . 
   the total sample consisting of 90 individuals was divided into a study group of 60 individuals and a control group of 30 individuals . 
   the study group had 60 oscc patients ( both male and female ) between the ages of 25 and 75 years with histologically proven oral cancer but before onset of any form of treatment . 
   individuals with other malignancies , liver disease , tuberculosis , diabetes mellitus , cardiovascular diseases , or any other chronic systemic diseases were excluded from the study . 
   a group of 30 healthy volunteers aged 2575 years without any history of debilitating systemic illness and no history of tobacco or alcohol consumption formed the control . 
   details of the study are explained to the volunteers and written informed consent is obtained . 
   serum l - fucose level was estimated using clinical chemistry autoanalyzer based on winzler method . 
   chicago : spss inc .. to compare the mean values between two groups ( between genders ) , independent samples t - test was used . to compare the mean values between three or more groups ( stages of cancer ) , one - way anova was used . 
   chicago : spss inc .. to compare the mean values between two groups ( between genders ) , independent samples t - test was used . to compare the mean values between three or more groups ( stages of cancer ) , one - way anova was used . 
   a comparison of the overall serum l - fucose levels between the oscc patients and healthy controls showed the mean value of serum l - fucose levels of oscc patients to be 10.85 mg / dl and the healthy controls had 3.47 mg / dl , thereby showing a difference of 7.38 mg / dl . 
   statistical analysis revealed a significant p value ( p < 0.001 ) [ graph 1 ] . 
   serum level of levo - fucose between oral cancer and healthy individuals among the 60 oscc , 2 belong to stage i with a mean serum l - fucose level of 8.13 mg / dl . 
   the serum l - fucose level progressively increased with its level being 9.18 mg / dl in stage ii , 10.53 mg / dl in stage iii , and 11.59 mg / dl in stage iv . 
   stage iv showed the highest level with a maximum value of 12.54 mg / dl and minimum of 10.55 mg / dl . 
   statistical analysis shows a significant p value ( p < 0.001 ) [ table 1 ] . 
   serum level of l - fucose in various stages of oral cancer an attempt to correlate the serum l - fucose levels with histopathological grading between genders and ages yielded no significant results thereby inferring that serum l - fucose levels are directly indicative of the degree of tissue destruction . 
   group of neoplasms affecting any region of the oral cavity is termed as oral cancer , among which oscc represents > 90% of all the neoplasm . 
   recently , the knowledge about cancer biomarkers has increased , and numerous studies have been carried out regarding these . 
   this has paved the way for improving the management of cancer patients by enhancing the accuracy of detection and efficacy of treatment . 
   understanding the relevance of biomarkers before using them is very important for diagnosis , treatment , and proper follow - up . 
   tumor markers are produced either by the tumor itself , as a tumor by product , by the body in response to the presence of cancer or certain benign ( noncancerous ) conditions . 
   these can aid in the diagnosis of cancer and in the assessment of tumor burden . 
   l - fucose is a monosaccharide , which is a common component of many n- and o - linked glycans and glycolipids produced by mammalian cells . 
   lack of a hydroxyl group on the carbon at the 6-position ( c-6 ) and the l - configuration is the two structural features which help to distinguish fucose from other six - carbon sugars present in mammals . 
   it is the most essential sugars that the body demands for normal cell - to - cell communication . 
   physiologically , the concentrations in serum are less but are increased in cancer and other diseases . 
   it is important in many of the signaling pathways which turns a healthy cell into a dysplastic cell . 
   the protein diversity is achieved by varying sequence and structure of sugar moieties or glycan attachment . 
   mammalian cells either express or mediate many of their properties through the cell surface . change in glycosylation of cell surface proteins 
   is essential in tumor progression , especially the terminal epitopes of glycoproteins , which have been proposed to play an essential role in cell  cell interactions , cell adhesion , malignant transformation , and metastasis . 
   fucosylation of glycoproteins ( the addition of l - fucose at the terminal end of the oligosaccharide chain ) is one of the most important features that mediate several specific biologic functions . 
   tumor cells alter their surface by increasing fucosylation levels to escape recognition ; this contributes to numerous abnormal characteristics of tumor cells such as decreased adhesion and uncontrolled tumor growth . 
   several studies have suggested that estimating the serum / tissue fucose levels could be a promising approach for the early detection , diagnosis , and prognosis of various cancer types . 
   group of enzymes catalyze incorporation of fucose from activated nucleotide donor guanosine diphosphate - fucose to the reducing end of complex glycans in a linkage - specific manner . 
   these enzymes are expressed in many tissues and are elevated in serum and tumors of cancer patients . 
   it has been mentioned in the article that increased fucosylation is associated with elevated fuct activity . 
   cancer cells which are shed or released into circulation from the primary tumor often overexpress fucosylated glycans on their surface . 
   the expression of fucosylated glycoproteins ( i.e. , fucoproteins ) has been detected by means of specific lectins . 
   profound fucosylation of the serum microenvironment may be a reason that interrupts adhesion and induces the formation of metastases ( for example ) , several fucose - containing  natural ligands 
   increased expression of fucosylated cell surface antigens , such as lewis x / y ( lex / y ) or sialyl lex/ , and the upregulation of 1 , 3/4-fuct have been associated with malignant transformation and increased metastatic potential of tumors , which leads to poor prognosis of patients with cancer . 
   -l - fucosidase is a lysosomal enzyme that catalyzes the hydrolytic cleavage of terminal fucose residue that is involved in maintaining the homeostasis of fucose metabolism . 
   extensive studies on the nature of metastasis have shown that only a small subpopulation of cells in tumors possess the characteristics necessary for their release from the primary tumor and transport to and establishment of tumor foci in distant organs . 
   carbohydrate moieties on cell surface glycoconjugates play an important role in this metastatic spread since it could be demonstrated that they are involved in adhesion processes . 
   several studies have mentioned that estimation of serum l - fucose levels could be a reassuring approach for the early detection , diagnosis , and prognosis of various types of cancer including oral carcinoma . 
   thus , the present study was undertaken to estimate the serum level of l - fucose ( tumor marker ) among various tnm stages in oral cancer patients and compare them with healthy individuals . 
   present study suggested that serum level of l - fucose can not be correlated with age and gender . 
   this was similar to other studies which were published in the literatures . in our study , out of 60 cancer patients , 
   31 were well differentiated , 27 - moderately differentiated , and 2 poorly differentiated and anaplastic - nil . 
   however , there was a negative correlation between serum fucose levels and histopathological tumor differentiation in our study as well as in the literatures . in our study 
   , the mean serum value of l - fucose in cancer group ( 10.85 mg / dl ) and control group ( 3.47 mg / dl ) shows a wide margin of difference ( 7.38 mg / dl ) . 
   moreover , all the 60 patients in the cancer group were categorized according to tnm staging . 
   comparison of all the four tnm stages in cancer group showed increase in fucose levels as the stages progressed . 
   they assessed the levels of glycoprotein - associated carbohydrates such as hexose ; hexosamine , fucose , and sialic acid . 
   they found a significant rise in the level in cases when compared to control subjects . 
   furthermore , there was a progressive rise in these markers as the stages of oral cancer advances . in cancer patients , elevated levels 
   have been observed more so in advanced stages and in cases with metastasis than in subjects without metastasis . 
   some studies have concluded that it is the most effective of the essential sugars when it comes to slowing the growth of cancer cells . 
   fall in serum fucose levels after treatment has been reported in many studies although it is emphasized that the follow - up period has to be long enough for significant serological alteration . 
   unfortunately , rise in serum fucose level is not specific for cancers , as elevated serum fucose levels have also been reported in other pathological states such as cirrhosis liver , meningitis , rickets , osteomalacia , tuberculosis , cardiovascular disorders as well as in depressive disorders . 
   furthermore , it has been observed that the serum fucose level is raised in different groups of malignancies such as breast cancer , ovarian cancer , colorectal adenocarcinomas , and leukemia as well as brain tumors . 
   thus , it becomes important to exclude other degenerative and proliferative diseases , while estimating the serum fucose levels in oral cancer . 
   literature is replete with studies on fucose levels in various malignancies including a few on oral cancer . 
   based on the analysis of the results of our study , we can conclude that there was a positive correlation between the serum l - fucose levels and tnm stages of oscc . 
   serum l - fucose levels remained constant among healthy individuals and was raised proportionately in oral cancer patients , commensurate with the stage of cancer . in conjunction with clinic - diagnostic procedures , 
   serum l - fucose levels can be used as an easy , noninvasive , cost - effective , biochemical indicator of cancer detection , staging , therapeutic success , prognosis , and as a posttreatment evaluation tool . 
   further investigation on a large scale would in all probability prove serum l - fucose as an effective tumor marker in the diagnosis and management of oral cancer . 
    
   
summary: background : oral cancer is a result of disordered cellular behavior initiated by various stimuli which is characterized by the alteration of serum glycoproteins consisting of different monosaccharides . 
   one of these is levo - fucose ( l - fucose ) , a methyl pentose . 
   elevated levels of protein - bound fucose have been reported in various malignancies.aim:the present study attempted to correlate levels of serum l - fucose as a biomarker with the various tumor node metastasis ( tnm ) stages of oral cancer.methodology:the study was carried out on 90 subjects consisting of 30 healthy controls and 60 histopathologically proven oral squamous cell carcinoma ( oscc ) cases . 
   the serum fucose level estimation was done based on the method adopted by winzler . 
   statistical analysis included independent sample 's t - test , one - way anova test , karl  pearson correlation test , and tukey 's hsd post hoc test to evaluate the significance and variability of values between groups.results:significant elevation in serum fucose levels was noticed among oscc patients when compared with the controls and a progressive ascent of l - fucose levels were noted as the stage of severity increased . 
   serum fucose levels were independent of histopathological grading , age , and sex.conclusion:serum l - fucose levels were increased in oscc patients , and a positive correlation was observed between serum l - fucose levels and tnm staging of oscc . 
   thus , serum l - fucose can be used as an effective diagnostic and prognostic biomarker in oscc patients .