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    Squamous Cell Carcinoma

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    Numan Qureshi
    Squamous cell carcinoma accounts for over 90% of oral cancers. It is most commonly caused by tobacco and alcohol use and occurs most often in the fourth decade of life. Clinically, it presents as an ulcerated or exophytic lesion that can invade surrounding bone and tissues. Diagnosis is made through biopsy and staging involves evaluating tumor size, lymph node involvement, and presence of metastases. Treatment options include surgery, radiation therapy, or a combination depending on the stage and patient factors, with the goal of improving longevity and quality of life.

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    Squamous Cell Carcinoma

    Uploaded by

    Numan Qureshi
    38 views5 pages
    Squamous cell carcinoma accounts for over 90% of oral cancers. It is most commonly caused by tobacco and alcohol use and occurs most often in the fourth decade of life. Clinically, it presents as an ulcerated or exophytic lesion that can invade surrounding bone and tissues. Diagnosis is made through biopsy and staging involves evaluating tumor size, lymph node involvement, and presence of metastases. Treatment options include surgery, radiation therapy, or a combination depending on the stage and patient factors, with the goal of improving longevity and quality of life.

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    Scc

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    Squamous cell carcinoma (1)

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    Squamous cell carcinoma accounts for over 90% of oral cancers. It is most commonly caused by tobacco and alcohol use and occurs most often in the fourth decade of life. Clinically, it presents as an ulcerated or exophytic lesion that can invade surrounding bone and tissues. Diagnosis is made through biopsy and staging involves evaluating tumor size, lymph node involvement, and presence of metastases. Treatment options include surgery, radiation therapy, or a combination depending on the stage and patient factors, with the goal of improving longevity and quality of life.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    38 views5 pages

    Squamous Cell Carcinoma

    Uploaded by

    Numan Qureshi
    Squamous cell carcinoma accounts for over 90% of oral cancers. It is most commonly caused by tobacco and alcohol use and occurs most often in the fourth decade of life. Clinically, it presents as an ulcerated or exophytic lesion that can invade surrounding bone and tissues. Diagnosis is made through biopsy and staging involves evaluating tumor size, lymph node involvement, and presence of metastases. Treatment options include surgery, radiation therapy, or a combination depending on the stage and patient factors, with the goal of improving longevity and quality of life.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 5

    Squamous cell carcinoma

    Incidence
     Squamous cell carcinoma accounts for 90 per cent or more of all oral malignant
    neoplasms.

    Etiology
     Tobacco smoking
    o pipes
    o cigars
    o cigarettes
    o bidis
    o reverse smoking
     Smokeless tobacco
    o snuff dipping
    o tobacco sachets
    o tobacco chewing
    o Betel chewing, betel quid, areca nut
     Alcohol
    o spirits
    o wines and beers
    o alcohol and tobacco synergism
     Diet and nutrition
    o iron deficiency
    o vitamins A, C and E
    o nutritional deficiencies and alcoholism
     Dental factors
     Ultraviolet light
     Viruses
    o herpes simplex viruses
    o human papillomaviruses
    o human immunodeficiency virus
    o Epstein-Barr virus
     Immunosuppression
     Chronic infections
    o candidosis
    o syphilis
     Occupation
    Clinical Features

     Commonly occurs in 4th decade.


     Male predilection.
     Early diagnosis is the most important factor influencing prognosis.

    1. Early lesion
     Usually asymptomatic, having variable appearances such as white patch, a small
    exophytic growth (with or without ulceration or erythema), a small indolent ulcer, or
    an area of erythroplakia.
     Pain can be a feature.
     Ulceration, induration and fixation of affected tissue to underlying structures.
     Underlying bone destruction in case of carcinoma arising from alveolar mucosa.
     Lymph node may not be involved. If the are palpable, they are due to inflammatory
    response.
    2. Advanced lesion
     Presented as broad-based exophytic mass with a rough, nodular, warty,
    hemorrhagic, or necrotic surface.
     Or as a deeply destructive and craterlike ulcer with raised, rolled evened edges.
     Infiltration of the oral musculature may result in functional disturbances.
     Difficulty in swallowing if tongue is involved.
     Pain may be feature.
     Bone invasion may be detected on radiographs.
     Mobility of teeth.
     Alteration of taste over the distribution of mental nerve.
     Pathological fracture.
    Sites
    SCC of alveolar ridge is most common, followed by retromolar region (Oropharynx)
    gingiva, floor of the oral cavity, lower lip, and base of the tongue.

    Investigations
     Photographs
     Incisional biopsy
     FNAC (Lymph node cytology)
     OPG
     CXR
     ECG
     CBC
     MRI and CT head and neck (for staging)
    Histology

    A. Epithelium

    1. Well-differentiated tumours
     Neoplastic squamous epithelium with masses of prickle cells and limiting basal
    cells around periphery.
     Intercellular bridges are recognizable.
     Keratin pearls (keratin surrounded by whorls of prickle cells) are found within
    masses of infiltrating cells.
     Nuclear and cellular pleomorphism is not prominent.
     A few mitotic figures.

    2. Moderately-differentiated tumours
     Epithelium is still recognized as squamous in type.
     Show less keratinization.
     More cellular and nuclear pleomorphism.
     More mitotic activity

    3. Poorly-differentiated tumour
     Epithelial cells are hardly recognizable as epithelial cells in some poorly-
    differentiated tumours.
     Keratinization is usually absent.
     Prominent cellular and nuclear pleomorphism.
     Abundant mitoses.

    4. Undifferentiated tumours
     Show complete anaplasia.
    B. Stroma
     Variable lymphocytic and plasma cell infiltration.
     2 patterns of infiltration:
    i. Cohesive invasive front consists of broad groups of sheets of malignant
    cells. It has better prognosis.
    ii. Non-cohesive consists of small islands and narrow strands as individual
    cell infiltration.

    Variants of SCC
     Verrucous carcinoma
     Nasopharyngeal carcinoma
     Adenoid SCC
     Basaloid SCC
     Basal cell carcinoma
     Adenosquamous carcinoma
     Spindle cell carcinoma
    Spread of carcinoma

    1. Local invasion
     lymphatic permeation
     vascular invasion
     sarcolemmal spread
     perineural spread
     invasion of bone (edentulous/dentate)

    2. Metastatic spread to regional lymph nodes in neck


     intracapsular spread (tumour confined within capsule of node)
     extracapsular spread (tumour infiltrates through the capsule into the adjacent
    tissue of the neck)

    3. Blood-borne metastases to distant sites occur relatively late during the disease.

    TNM staging

    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)

    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
    o N2a - single ipsilateral node, 3-6 cm
    o N2b - multiple ipsilateral nodes, < 6 cm
    o N2c bilateral nodal metastases OR contralateral nodal metastases < 6 cm
     N3 - any nodal metastasis > 6 cm

    Metastases (M)
     M0 - no metastases
     M1 - distant metastases present
    Clinical Staging
    Stage 1 Tl NO MO
    Stage 2 T2 NO MO
    Stage 3 T3 NO MO or
    Tl, T2, or T3 Nl MO
    Stage 4 T4 NO or Nl MO or
    any T N2 orN3 MO or
    anyT any N Ml

    Management
     Management regimens for cancer must focus on longevity and quality of life.
     Coordinated by a multidisciplinary team, including maxillofacial surgeons, oncologists,
    radiotherapists, speech therapists, dedicated oncology nurses, and other personnel
    involved in rehabilitation.
     The treatment of choice depends on several factors including patient preference,
    biological age, general health, and site and staging of the tumour.
     Majority of cases involves surgery (with reconstruction), radiotherapy, or a combination
    of both.
     Chemotherapy is not routinely used.

    Differential Diagnosis
     Actinic keratosis
     Basal cell carcinoma
     Pyoderma gangrenosum
     Viral wart
     Keratocanthoma

    References
    Tyldesly’s Oral Medicine 5th Edition
    Oral Pathology by J. V. Soames 4th Edition
    Written by:
    Izaz Ullah
    3rd Year BDS
    KMU-IDS, Kohat

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