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

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

3. 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.

4. 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 .

5. Oral epithelial structure

6. 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

7. 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

8. , 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

9. 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.

10. 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.

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

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

13. 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

14. 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

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

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

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

18. 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

19. 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

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

21. 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.

22. 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.

23. 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