Neoplasms

NEOPLASMS  Squamous Cell Carcinonma  Carcinoma of the Maxillary Sinus SQUAMOUS CELL CARCINOMA  Oral and Oropharyngeal SCC

represents 4% in men & 2% in women in all cancers  Death due to oral & oropharyngeal cancer represent approximately 2% of total in men & 1% in women  Survival rate is low  Improvement of survival rate lies in dearly detection ( oral cavity is readily accessible of clinical examination & biopsy) SQUAMOUS CELL CARCINOMA ETIOLOGY  Tobacco  Alcohol  Some microorganisms  Iron deficiency associated with Plummer-Vinson syndrome  Ultraviolet ray  Chronic Irritation SQUAMOUS CELL CARCINOMA CLINICAL FEATURES Carcinoma of the lips  Lower lip cancers are more common than upper lip lesions  Ultraviolet ray & pipe smoking are common cause  Growth rate is slower for lower lip cancers  Prognosis for lower lip cancer is generally very good SQUAMOUS CELL CARCINOMA CLINICAL FEATURES  Lip cancers 20-30% of all oral cancers  Appear 50-70 years of age  Affect men more often than women  Lesions are on the vermillion  Appear as chronic non-healing ulcers or exophytic lesions ( verrucous in nature)  Metastasis is uncommon  Larger & poorly differentiated cells SQUAMOUS CELL CARCINOMA CLINICAL FEATURES Carcinoma of the tongue  Most common intra-oral malignancy (25-40%) th th th  Predilection for male in their 6 , 7 , & 8 decades  Lingual carcinoma is typically asymptomatic  Later stages, deep invasion occurs, pain & dysphagia may be a prominent complaint  Indurated, non-healing ulcer with elevated margins  Small percentage of leukoplakias represent invasive SCC or eventually become SCC  Most erythroplakia patches that appear on the tongue are either in situ or invasive SCC  Most common location- posterior lateral border (45%) 

 



uncommon- dorsum or tip of the tongue 25% occur in the posterior 1/3 or base of the tongue  These lesions are more troublesome because of their silent progression in an area that is difficult to visualize  Poorer prognosis, discover during the advanced stage Metastases from the tongue are relatively common at the time of primary treatment Found in the lymph nodes of the neck  Submandibular or jugulodigastric nodes

SQUAMOUS CELL CARCINOMA DIFFERENTIAL DIAGNOSIS  Other ulcerative conditions should be considered  Biopsy should be done to an undiagnosed chronic ulcer  Careful history taking is important  Biopsy will confirm the diagnosis SQUAMOUS CELL CARCINOMA TREATMENT Surgery &/or Radiation  Smaller lesions are treated with surgery alone, with radiation as a backup in the event of recurrences  Larger lesions may be treated with surgery followed by radiation  Elective or prophylactic neck dissection or radiation is advocated  Oral SCC are generally resistant to chemotherapeutic measures( serve as adjunct only) SQUAMOUS CELL CARCINOMA PROGNOSIS  Depend on both the histologic subtype (grade) and clinical extent (stage) of the tumor  Other factor influencing clinical course: age, gender, general health, immune system status & mental attitude  Grading of a tumor  Well-differentiated lesions are less aggressive than poorly differentiated lesions  Clinical stage of the disease is the most important indicator of prognosis TNM system  T- primary tumor  N- regional node metastasis  M- distant metastasis T- tumor  T1 tumor less than 2 cm in diameter  T2 tumor 2-4 cm in diameter  T3 tumor greater than 4 cm in diameter  T4 tumor invades adjacent structures N- regional tumor size  N1 no palpable nodes  N2 ipsilateral palpable nodes  N3 bilateral nodes  N4 fixed palpable nodes M Metastasis to distant organs  M0 no distant metastasis  M1 clinical or radiographic evidence of metastasis TNM Staging  Stage I T1N0M0  Stage II T2N0M0  Stage III T3N0M0, T1N1M0,T2N1M0, T3N1M0  Stage IV T1N2M0, T2N2M0, T3N2M0, T1N3M0, T2N3M0, T3N3M0, T4N0M0  Any patients with M1

SQUAMOUS CELL CARCINOMA CLINICAL FEATURES Carcinoma of the Floor of the Mouth  Second most common location of SCC -15%  Seen predominantly in older men  Especially those who are chronic alcoholics and smokers  Lesions are painless, non-healing, indurated ulcers  May appear white or red patch  May infiltrate the soft tissue causing decreased moblity of the tongue SQUAMOUS CELL CARCINOMA CLINICAL FEATURES Carcinoma of the Buccal Mucosa & Gingiva  Account for 10% of oral SCC th  Men in their 7 decade are affected  Smokeless tobacco is an important etiologic factor in malignant change  Appearance varies from white patch to a non-healing ulcer to an exophytic lesion SQUAMOUS CELL CARCINOMA CLINICAL FEATURES Verrucous carcinoma  Presents as a broad-base wart-like mass  Slow growing & very well-differentiated  Rarely metastasizes w/ good prognosis SQUAMOUS CELL CARCINOMA CLINICAL FEATURES Carcinoma of the Palate  Soft palate & faucial tissues- 10-20%  Hard palate- SCC relatively uncommon  Adenocarcinoma are relatively common  Seen in countries like India where reverse smoking is the custom  Present as asymptomatic, red or white plaques in older men  Metastasis to cervical nodes or large lesions SQUAMOUS CELL CARCINOMA HISTOPATHOLOGY  Most are moderately or well-differentiated lesions  Keratin pearls & cell keratinization are usually evident  Invasion into subjacent structures in the form of hyperchromatic cells  In poorly differentiated lesions, keratin is absent

SQUAMOUS CELL CARCINOMA PROGNOSIS  As clinical stage advances from I to IV, prognosis worsens  Another factor influencing the prognosis is the increased risk for the development of a second primary lesion CARCINOMA OF THE MAXILLARY SINUS  Unknown cause  Squamous metaplasia of sinus epithelium with chronic sinusitis & oral antral fistulas may be a predisposing factor  Disease of older age, patients over age 40  Men are generally affected  Past history frequently include symptoms of sinusitis  As the neoplasm progresses, a dull ache in the area occurs, with eventual development of overt pain  As neoplasm extents toward the apices of the maxillary posterior teeth, referred pain may occur as Toothache  Tumor may displace teeth and cause vertical mobility of teeth  Failure of a socket to heal following extraction may indicate a tumor involvement  A recently acquired malocclusion may also indicate a growth  Squamous cell carcinoma is the most common histologic type  Lesions are generally less differentiated that those occurring in the oral mucosa  Dental origin must be ruled out before making the diagnosis  Vitality test of teeth  Palatal involvement should also cause the clinician to consider adenocarcinoma of minor salivary gland origin, lymphoma and SCC.  Generally treated with surgery or radiation or both  A combination of the 2 treatments are more effective  Radiation completed first, with surgical resection following  Chemotherapy used in conjunction with radiation is somewhat successful  Cure is dependent upon the clinical stage of the disease at the time of initial treatment  Sinus lesions are discovered in a more advanced stage because of delay in seeking treatment  Difficult to remove surgically because it is richly vascularized  5 year survival rate- 25%

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