Oral squamous

cell carcinoma
Group B

It is a malignant neoplasm of stratified squamous

epithelium in the oral cavity, capable of local destructive
growth and distant metastasis
It is the most common cancer of head and neck region
It is the tenth most common type of cancer worldwide

Definition

 Possible sites

lower lip 30-40%

tongue 25%
floor of the mouth 20%
soft palate
15%
gingival / alveolar ridge 6%
buccal mucosa 1%

Incidence

The etiology is unknown. But a number of etiological

factors have been implicated.
Predisposing Factors:

Tobacco use

Alcoholic beverages

Betel quid

Human papilloma virus infection

Etiology

Weak associations:
Chronic irritation from ill-fitting denture
Sub mucosal fibrosis
Poor orodental hygiene
Nutritional deficiencies
Exposure to sunlight(lip cancer)
Plummer Vinson syndrome

Major source of intraoral carcinogen.

All forms of tobacco consumption have been linked.
It could be held in the mouth
Carcinogens in tobacco: Nitrosamine (nicotine), the
polycyclic aromatic hydrocarbons (3,4-benzopyrene)

Tobacco

 Second major risk factor

Associated with cancer of the floor of the mouth and
tongue.
Mechanism(s)

Dehydrating effects of alcohol on the mucosa

Increasing mucosal permeability,
Irritation of mucosa
It also acts as a solvent for carcinogens(especially those in
tobacco)

Alcohol

 The first group, called proto-oncogenes, produces protein

products that normally enhance cell division or inhibit normal
cell death.
The mutated forms of these genes are called oncogenes.
The second group, called tumor suppressors, makes proteins
that normally prevent cell division or cause cell death.

Cytogenetics

Proto-oncogene is activated or tumor suppressor gene is

inactivated
normal growth oncogenesis

Activation of proto-oncogene:
point mutation
translocation
gene amplification

 Cytogenetic analysis of these carcinomas has

demonstrated:
Oncogenes associated with SCC are 1p22 and 11q13
The tumor-suppressor gene p53 is also thought to be
involved in the development of SCC in head and neck
tumors

Cytogenetic analysis of
SCC

 Carcinoma in situ (CIS), also known as

in situ neoplasm, is a group of abnormal cells.
Cancer that has stayed in the place where it began and
has not spread to neighboring tissues
Basement membrane is not involved
While they are a form of neoplasm there is disagreement
over whether CIS should be classified as cancer.

Carcinoma in situ

Carcinoma in situ

 A sore in the mouth that does not heal (most common

symptom)
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 bad breath

Increased mitotic activity

Well differentiated
Keratin pearls (abnormal keratinization)
Hyperchromatic nuclei
Pleomorphism
Epithelium islands
Connective tissue stroma with chronic inflammation
(histiocytes, lymphocytes, etc.)

Histopathology

Grossly, squamous cell carcinoma of oral cavity

may have the following types:
Ulcerative type
Papillary or verrucous type
Nodular type
Scirrhous type
All these types appear on a background of leukoplakia or
erythroplasia of the oral mucosa.
Enlarged cervical lymph nodes may be present.

Types

 Prognosis depend on the stage, site and size of the lesion

Later stages often have poor prognosis
SCC of the tongue or floor of the mouth are usually not
well differentiated and so have poorer prognosis than the
rest

Prognosis

TNM Clinical Staging

TNM Clinical Staging

 Primary:

Incisional biopsy
Fine needle aspiration biopsy
Orthopantogram
Mucosal staining
CXR
Chemiluminescent light

For staging

MRI
CT face + neck CT chest
USG of neck or primary USG guided FNAC of suspicious lymphadenopathy
PET
Endoscopy

Lab investigations

 Surgery
Removal of part or all of the jaw
Removal of the tumor on a larger area to remove the tumor and
surrounding healthy tissue
Maxillectomy
Removal of lymph nodes and other tissue in the neck
Plastic surgery, including skin grafts, tissue flaps or dental implants to
restore tissues removed from the mouth or neck
Tracheotomy, or placing a hole in the windpipe, to assist in breathing
for patients with large tumors or after surgical removal of the tumor
Dental surgery to remove teeth or assist with reconstruction

Treatment

Non-Surgical Treatment
Radiation Therapy
-used alone to treat small or early-stage tumors.
Proton Therapy
-delivers high radiation doses directly into the tumor, sparing
nearby healthy tissue and vital organs.
Chemotherapy
-used to shrink the cancer before surgery or radiation
Tumor Growth Factor Inhibitors
-target EGF receptors and may stop cancer cells from
growing.

 Mucositis: an inflammation of the mucous membranes in the

mouth.
Infection, pain, and bleeding
Dehydration and malnutrition due to dysphagia
Xerostomia due to injury to the glands that produce saliva.
Trismus due to damage to the muscles and joints of the jaw and
neck.
Hypovascularization
Affect other forms of dental disease (caries, or soft tissue
complications),
Osteonecrosis.

Complications

 A diffused, largely exophytic, superficial spreading,

warty form of well differentiated SCC
Does not metastasize
Highly keratinized
Occurs mostly in males
Individuals above the age of 60 years

Verrucous Carcinoma

Gingiva
Alveolar mucosa
Buccal mucosa
Hard palate and floor of the mouth (rarely)

Most common sites involved

 Surface is usually papillary and is covered by thick layer

of parakeratin
Epithelium is dysplastic but not severely
Basement membrane remains intact
Well-defined borders
Bulb-shaped rete pegs
Saucerization may occur sometimes

Histopathology

 Surgical excision
Laser therapy

Treatment

 Prevention involves interventions aimed at eliminating,

eradicating or minimizing the impact of the disease.
PRIMARY: Reduce the incidence of cancer and
precancer. It is aimed reducing the number of new cases.
Discourage smoking and alcohol consumption
Encourage good oral hygiene
Encourage balanced diet

Prevention of SCC

 SECONDARY: Aimed at detection of cancer atan early stage.

Public education on early signs and self-examination
Screening

TERTIARY: Treat late stage of disease and complications

THANK YOU
Group members: Beenish Shahid, Bushra Bibi, Fatima
Mushtaq, Misbah Arshad, Mishal Niazi and Yusra Shaukat