1. Case Report: Squamous Cell Carcinoma of the Tongue
NYU- Woodhull Medical Center
Case Report: Squamous Cell Carcinoma of the Tongue
David R. Telles, DDS
Jason Swantek, DDS
Joshua M. Abrahams, DMD

2. Sqaumous Cell Carcinoma
Statistics
94% of all oral malignancies
21,000 new cases diagnosed annually
6,000 Americans die each year from SCC
Tobacco and alcohol is shown in the elevation of cancer risk more than 35-fold for men who smoke two or more packs of cigarettes and consume more than four alcoholic drinks per day1
Carcinoma of the Tongue
Accounts for more than 50% of intraoral cancers in the US
20% occur on anterior lateral and ventral surfaces
4% occur on dorsum of tongue
66% of lingual carcinomas appear as painless, indurated masses or ulcers of the posterior lateral border of the tongue
Etiology
No single causative agent (Extrinsic and Intrinsic Factors)
Risk Factors:
Tobacco Smoking , Alcohol
Phenols, Radiation, Iron Deficiency, Vit A deficiency, Candidal Infection
Oncogenic viruses, Immunosuppression

3. 78 y/o Hispanic Female CC: “My lower right side of my tongue hurts”
HPI: Pt first noticed lesion approx 6 months prior which she notes has grown and become painful. Pt on presentation denied voice changes or dysphagia
PMHx: HTN, Dislypidemia, Osteoarthritis
Meds: Altace
NKDA
Social Hx: Denies Tobacco/ drug use, Hx of past chronic alcoholism when her husband was alive – 5x/wk for ~ 30 yrs – currently pt does not drink
ROS:
HEENT: burning tongue on R side for last with mild bleeding on palpation,
PE:
Erythroleukoplakic lesion on right lateral border of tongue approx. 1.5 cm x 2.0 cm
No palpable Lymph nodes on H&N exam

4. Surgical Pathology Examination Incisional Biopsy
6/15/10: Pt taken to operating room for incisional biopsy of right lateral border of tongue lesion
Results: Mild, moderate, severe dysplasia, carcinoma in situ, and superficially invasive squamous cell carcinoma
Ulcer Carcinoma

5. Surgical Pathology Examination Excisional Biopsy
7/08/10: Pt taken to operating room for excisional biopsy of right lateral tongue lesion
On same day of excisional biospy Panendoscopy was performed by ENT and noted to be negative
Results: Specimen measured 2.5x2.0x1.0cm. All margins of excision including deep margin are free of neoplasm

6. Tumor-Node-Metastasis (TNM) Staging
Primary Tumor Size (T) TX
No available info on primary tumor T0
No evidence of primary tumor
T1S
Only Carcinoma in situ at primary site T1
Tumor is less than 2cm in greatest diameter T2
Tumor is 2-4cm in greatest diameter T3
Tumor >4cm in diameter T4
Massive tumor >4cm w/ involvement of antrum, pterygoid muscles, base of tongue, or skin
Regional Lymph Node Involvement (N) NX
Nodes couldn’t be or were not assessed N0
No clinically positive nodes N1
Single clinically + homolateral node less than 3cm in diameter N2
Single clinically + homolateral node 3-6cm in diameter or multiple clinically + homolateral nodes, none more than 6cm in diameter
N2a – Single clinically + node 3-6cm in diameter
N2b – Multiple clinically + homolateral nodes, none more than 6cm in diamter N3
Massive homolateral node or nodes, bilateral nodes, or contralateral node or nodes
N3a – Clinically positive homolateral or nodes, one more than 6cm in dia
N3b – Bilateral clinically + nodes
N3c – Contralateral clinically + node or nodes
Involvement By Distant Metastases (M) MX
Distant metastasis was not assessed M0
No evidence of distant metastasis M1
Distant Metastasis is present
Stage
TNM Classification
5-Year Survival Rate
Stage I
T1 N0 M0
85%
Stage II
T2 N0 M0
66%
Stage III
T3 N0 M0 or T1, T2, T3, N1 M0
41%
Stage IV
Any T4 lesion, or Any N2 or N3 lesion, or any M1 lesion 9%

7. Histopathologic Grading
Histopathologic Evaluation
Tumors that closely resemble the original squamous epithelium seem to grow at a slower pace and are slower to metastasize (Low-grade, Grade 1, or well-differentiated)
Less differentiated tumors receive higher grades and often enlarge rapidly, metastasize earlier (high-grade, grade III/IV, poorly differentiated
Diagnosis of SCC
Almost always made with routine light microscopy
Hyperchromatic Nuclei
Carcinoma Foci found within skeletal muscle

8. Treatment and Prognosis
Guided by clinical stage of the disease
Consists of wide (radical) surgical excision, radiation therapy, or combination
Suspected local lymph node metastasis
Radical Neck Dissection
Removal of all ipsilateral cervical lymph node groups from levels I-V, together with spinal accessory nerve (SAN), SCM, Internal jugular vein (IJV)
Modified Radical Neck Dissection
Removal of all lymph node groups but with preservation of one or more nonlymphatic structures (SAN, SCM, IJV)
According to Bellinger et. al.
no demonstrable differences in rates of locoregional control or survival between surgery and irradiation for T1 and T2 lesions. Surgical resection is typically employed for stage I and II lesions
combined therapy using surgery and postoperative radiotherapy is indicated for stage III and IV disease.

9. References
Bellingers Otorhinolaryngology: Head and Neck Surgery 16th Ed. 1996
Neville, Oral and Maxillofacial Pathology, 2nd Edition, WB Saunders Company, 2002