Oral squamous cell carcinoma Under Supervision of: Dr. Issam Halboub Prepared By: Mahmoud Hamdan Mahmoud Zitawi

Outlines Introduction . Definition of squamous cell carcinoma . Incidence . Etiology . Clinical features . Differential diagnosis Investigations . Staging of oral cavity squamous cell carcinoma . Treatment . Prognosis .

Introduction Oral 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.

Overview 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 .

Oral epithelial structure

Definition 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

Incidence account 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

, chronic dental injuries Etiology The etiology is unknown. But a number of etiological factors have been implicated. Predisposing Factors Tobacco Use Alcohol Use Sunlight Exposure liver cir- rhosis` dietary deficiencie , chronic dental injuries viruses Race And Genetics

Clinical features Early 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 carcinoma Early squamous cell carcinoma of the lateral border of the tongue.

Clinical features In 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.

Clinical features Squamous-cell carcinoma presenting as exophytic ulcerated tumor of the lateral border of the tongue

Clinical features Late squamous-cell carcinoma on the dorsum of the tongue.  

Clinical features A sore in the mouth that does not heal (most common symptom) Pain in the mouth A persistent lump or thickening in the cheek A persistent white or red patch on the gums, tongue, tonsil, or lining of the mouth A sore throat or a feeling that something is caught in the throat Increased salivation

Clinical features Difficulty chewing or swallowing Difficulty moving the jaw or tongue Swelling of the jaw that causes dentures to fit poorly or become uncomfortable Loosening of the teeth or pain around the teeth or jaw Voice changes A lump or mass in the neck Weight loss Persistent of bad breath

Differential diagnosis Traumatic ulcer Tuberculosis Systemic mycoses Syphilis Eosinophilic ulcer Necrotizing sialadenometaplasia Wegener granulomatosis Malignant granuloma Minor salivary gland carcinomas.

investigations Photographs Incisional biopsy Histopathological examination. Fine needle aspiration biopsy Orthopantogram Mucosal staining (toluidine blue( Chest X-Ray Chemiluminescent light Routine blood investigations

investigations For staging MRI CT face + neck ± CT chest Positron emission tomography Endoscopy

Staging of oral cavity squamous cell carcinoma  TNM staging system Primary tumour staging (T) Tx - Tumour cannot be assessed T0 - No evidence of primary tumour Tis - Carcinoma in situ T1 - Tumour 2 cm or less in greatest dimension T2 - Tumour greater than 2 cm and less than 4 cm in greatest dimension T3 - Tumour greater than 4 cm in greatest dimension T4 - Tumour invades adjacent structures (mandible, maxilla, skin, extrinsic muscles of the tongue

Staging 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 assessed N0 - no regional nodal metastases N1 - single ipsilateral node, ≤ 3cm N2 N2a - single ipsilateral node, 3-6 cm N2b - multiple ipsilateral nodes, < 6 cm N2c bilateral nodal metastases OR contralateral nodal metastases < 6 cm N3 : any nodal metastasis > 6 cm

Staging of oral cavity squamous cell carcinoma Metastases (M) M0 - no metastases M1 - distant metastases present

Treatment The three main tools for treating cancers of the oral cavity are : Surgery Radiation therapy Chemotherapy In 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.

PROGNOSIS Overall 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.

References Color Atlas of Oral Diseases. George Laskaris Pocket atlas of oral diseases Burket's oral medicine Head and neck imaging. Ed. by Peter M. Current Diagnosis and Treatment Surgery Thirteenth Edition Head and Neck Cancer. Louis B Harrison Internet resources