Squamous Cell

Carcinoma
 Introduction
• Oral cancers are one of the most frequent malignancies encountered in our
country.
• Different studies indicate that about 5 to 12 % of all malignancies in India
arise in relation to oral cavity.
• Amongst oral cancers, more than 90% are squamous cell carcinoma.
• Oral SCC is encountered more frequently in males.
• Leukoplakia often precedes development of oral SCC.
• Depending on the site of origin, etiology of oral SCC varies.
• For carcinoma of the lip, in fair skinned persons, excessive exposure to UV
rays is implicated. To a lesser extent, smoking and repeated trauma is
believed to play a role.
• For cancers of the oropharynx, tobacco and alcohol abuse are the major
culprits. Some other associated factors are: poor oral hygiene, iron
deficiency, syphilis, and candidiasis
• In carcinoma of tonsil and base of tongue, presence of oncogenic variants of
HPV has been demonstrated in ~ 50% of cases.
 Role of tobacco as an etiological factor
• Role of tobacco as an etiological factor in oral SCC is now well
established.
• Epidemiological studies in India have thrown up the following data:
– With daily consumption of 40 cigarettes, the risk increases five folds.
– With daily consumption of 80 cigarettes, the risk increases seventeen
folds.
– Use of smokeless tobacco increases the risk four folds.
– Tobacco + Paan + SMF, increases the risk nineteen times.
– Tobacco + Alcohol, increases the risk fifteen times.
– A study done in 1993 in our country showed that about 40% individuals
over the age of 15 years, indulge in some form of tobacco consumption.
Annual incidence of new patients with SCC was found to be 1.5 to 2.0
lacs.
• Epidemiological studies in western countries, show that heavy
smoking in conjunction with alcohol abuse raises the risk to about 100
folds in females, and 38 times in males.
 Clinical Features
• Oral SCC can present as a solitary ulcer, a lump, leukoplakia,
erythroplakia, numbness of lips in absence of trauma or
infection, trismus or cervical lymphadenopathy.

• Tumor is found most commonly on ventral surface of the

tongue, floor of mouth, lower lip, soft palate and gingiva.

• Lesions on hard palate are found more frequently in reverse

smokers.

• Irrespective of the initial appearance of the lesion, all tumors

progress to produce either a protruding mass (exophytic lesion)
or an ulcer with rolled out edges (endophytic mass).

• Oral cancers are notorious for exhibiting the phenomenon of

field cancerization.
Squamous Epithelium – Normal Maturation
Squamous Cell Carcinoma – Well Differentiated
SCC – Moderately Differentiated
SCC – Moderately Differentiated
SCC – Poorly Differentiated
 Site specific peculiarities of oral SCC
• Tumors of lip vermillion are slow growing. They also
metastasize late.
• Lesions of floor of the mouth are the ones most likely to
arise from pre-existing leukoplakia. They are also more
likely to give rise to a second primary lesion.
• Tumors of gingiva and alveolus can mimic benign lesions
like pyogenic granuloma.
• As oropharyngeal cancers are located posteriorly, they
are more likely to present, initially as cervical
lymphadenopathy, or in an advanced stage of the disease.
• Oral SCC can be seen in different stages and it may be of variable grade.
Stage of the tumor is more important for determining the prognosis.
• Metastasis from oral SCC occurs initially in ipsilateral lymph nodes followed
by contalateral or distant lymph node involvement. Lung, liver and bones are
the most frequently involved sites for blood borne metastasis.
• Stage of the disease and the site of the primary tumor, are the best indicators
of prognosis
– Cancer of tongue
• If localized: five year survival is 50%
• Stage 4 tumor: five year survival is 10%
– Cancer of palate and tonsillar area
• If localized: five year survival is 65%
• Stage 4 tumor: five year survival is 17%
– Overall survival
• For stage 1: five year survival is 85%
• For stage 4: five year survival is 10%
• Tumors of lip has the best ,and palate the worst prognosis.
• Presence of desmoplasia indicates more aggressive behavior.
• Tissue eosinophilia is a favorable prognostic sign.
• Over expression of P21 and amplification of 3q26.3 locus indicates poor
prognosis
Deaths from Oral Cancer
Squamous Cell Carcinoma
Squamous Cell Carcinoma
Squamous Cell Carcinoma
Squamous Cell Carcinoma
Squamous
Cell
Carcinoma
Squamous Cell Carcinoma
 SCC
Post
Surgery