2Outlines Introduction . Definition of squamous cell carcinoma . Incidence .Etiology .Clinical features .Differential diagnosisInvestigations .Staging of oral cavity squamous cell carcinoma .Treatment .Prognosis .
3IntroductionOral cancer is a subtype of head and neck cancer, the cancerous tissue growth located in the oral cavity. It may arise in any of the tissues of the mouth. It may arise as a primary lesion or as metastasis from a distant site of origin such as the nasal cavity.Worldwide, oral cancer is a prevalent malignancy, mainly associated with a variety of tobacco- related habits and forms , as well as poor diets with low intake of vegetables and fruits. It is the cause for significant morbidity, suffering, and death.
4Overview OF Oral Mucosa It is the mucous membrane lining the inside of the mouth and consists of stratified squamous epithelium termed oral epithelium and an underlying connective tissue termed lamina propria. The oral cavity has sometimes been described as a mirror that reflects the health of the individual. Changes indicative of disease are seen as alterations in the oral mucosa lining the mouth, which can reveal systemic conditions, such as diabetes or vitamin deficiency, or the local effects of chronic tobacco or alcohol use .
6Definition of Squamous Cell Carcinoma It is a Malignant neoplasm of stratified squamous epithelium in the oral cavity capable of local destructive growth and distant metastasis
7Incidenceaccount for 3 to 5% of all malignancies. Squamous cell carcinoma is the most frequent, accounting for about 90% of all malignant neoplasms of the oral cavity
8, chronic dental injuries EtiologyThe etiology is unknown. But a number of etiological factors have been implicated.PredisposingFactorsTobacco UseAlcohol UseSunlight Exposureliver cir- rhosis`dietary deficiencie, chronic dental injuriesvirusesRace And Genetics
9Clinical featuresEarly carcinoma may appear as an asymptomatic erythematous or white lesion, or both: it may mimic an erosion, small ulcer, or exophytic mass, periodontal lesion, or even crust formation, as in lip carcinomaEarly squamous cell carcinoma of the lateral border of the tongue.
10Clinical featuresIn advanced stages oral carcinoma may present as a deep ulcer with irregular vegetating surface, elevated borders, and hard base; a large exophytic mass with or without ulceration; and an infiltrating hardness of the oral tissues.
11Clinical featuresSquamous-cell carcinoma presenting as exophytic ulcerated tumor of the lateral border of the tongue
12Clinical featuresLate squamous-cell carcinoma on the dorsum of the tongue.
13Clinical featuresA sore in the mouth that does not heal (most common symptom)Pain in the mouthA persistent lump or thickening in the cheekA persistent white or red patch on the gums, tongue, tonsil, or lining of the mouthA sore throat or a feeling that something is caught in the throatIncreased salivation
14Clinical features Difficulty chewing or swallowing Difficulty moving the jaw or tongueSwelling of the jaw that causes dentures to fit poorly or become uncomfortableLoosening of the teeth or pain around the teeth or jawVoice changesA lump or mass in the neckWeight lossPersistent of bad breath
17investigations For staging MRI CT face + neck ± CT chest Positron emission tomographyEndoscopy
18Staging of oral cavity squamous cell carcinoma TNM staging systemPrimary tumour staging (T)Tx - Tumour cannot be assessedT0 - No evidence of primary tumourTis - Carcinoma in situT1 - Tumour 2 cm or less in greatest dimensionT2 - Tumour greater than 2 cm and less than 4 cm in greatest dimensionT3 - Tumour greater than 4 cm in greatest dimensionT4 - Tumour invades adjacent structures (mandible, maxilla, skin, extrinsic muscles of the tongue
19Staging of oral cavity squamous cell carcinoma Nodal status (N)Nodal staging is the same for SCCs of the oral cavity, oropharynx, hypopharynx and larynx.Nx - nodes cannot be assessedN0 - no regional nodal metastasesN1 - single ipsilateral node, ≤ 3cmN2N2a - single ipsilateral node, 3-6 cmN2b - multiple ipsilateral nodes, < 6 cmN2cbilateral nodal metastases ORcontralateral nodal metastases < 6 cmN3 : any nodal metastasis > 6 cm
20Staging of oral cavity squamous cell carcinoma Metastases (M)M0 - no metastasesM1 - distant metastases present
21TreatmentThe three main tools for treating cancers of the oral cavity are :SurgeryRadiation therapyChemotherapyIn general, Stage I and Stage II cancers require one type of treatment, either surgery or radiation therapy, to successfully control the cancer. Advanced Stage III and Stage IV cancers will often require combinations of surgery, radiation therapy and chemotherapy or even the use of all three.
22PROGNOSISOverall survival rates for any cancer of the oral cavity are about 70 percent five-year survival for stage I or II disease. Five-year survival drops to about 50 percent for stage III cancers and further drops to roughly 35 percent for stage IV cancers.
23References Color Atlas of Oral Diseases. George Laskaris Pocket atlas of oral diseasesBurket's oral medicineHead and neck imaging. Ed. by Peter M.Current Diagnosis and Treatment Surgery Thirteenth EditionHead and Neck Cancer. Louis B HarrisonInternet resources