Oral squamous cell carcinoma
oral cancer symptoms
oral cancer stages
For Bradley A. Schiff, MD, Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine
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patient education
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Tumors of the head and neck
Overview of head and neck tumors
Laryngeal tumors
Nasopharyngeal tumors
Oral squamous cell carcinoma
Oropharyngeal squamous cell carcinoma
Tumors of the maxillary bone and of the jaw
Ear tumors
Salivary gland tumors
Paranasal sinus cancer
Oral squamous cell carcinoma affects about 30,000 US denial people each year. Over 95% are tobacco smokers, consumers of alcoholic beverages, or both. Initial lesions, susceptible to healing, are rarely symptomatic; therefore, prevention of a poor prognosis pathology requires early detection through screening. Treatment is based on surgery, radiotherapy or both; however, surgery plays the main role in the treatment of oral cavity cancer. The overall 5-year survival rate (all sites and combined phases) is> 50%.
The cancer of the oral cavity is located in a region that goes from the inside edge of the lips to the junction of the hard and soft palate or the posterior third of the tongue.
In the United States, 3% of human cancers and 2% in women are oral squamous cell carcinomas, most of which occur after age 50. As with most head and neck cancers, the squamous cell variant is the most common histotype.
The main risk factors for oral squamous cell carcinoma are
Smoking (in particular> 2 packages / day)
Use of alcohol
The risk increases considerably when the consumption of alcohol exceeds 180 mL of distillate / day, 180 mL of wine / day or 360 mL of beer / day. It is estimated that the combination of excessive smoking and alcohol abuse increases the risk of 100 times in women and 38 times in men.
Squamous cell carcinoma of the tongue can also result from any chronic irritation, such as coronal fractures, excessive use of mouthwash, chewing tobacco, or the use of betel. Oral infections of human papillomavirus (HPV), usually acquired through oral-genital contact, may play a role in the etiology of some oral cancers. However, the role of human papillomavirus is not as well defined as in the case of oropharynx tumors.
Approximately 40% of oral squamous cell carcinomas occur on the floor of the mouth or on the ventral or lateral surface of the tongue. About 38% of all squamous cell carcinomas of the oral cavity occurs on the lower lip; these are usually tumors related to solar exposure of the external surface.
symptomatology
Oral lesions are initially asymptomatic, which underscores the need for oral screening. Most dental professionals accurately evaluate the oral cavity and oropharynx during routine care and can perform biopsy by brushing abnormal areas. Lesions may appear to be erythroplasic or leukoplasic and may be esophitic or ulcerated. The tumors are often of hard and compact consistency with a cercine. The increase in size of the lesions can cause pain, alteration of the joint and dysphagia.
Erithrophage and oral squamous cell carcinoma Erithrophage and oral squamous cell carcinoma Erithrophage and oral squamous cell carcinoma
Image provided by Jonathan A. Ship, DMD.
Leucophagy and oral squamous cell carcinoma Leukopakhia and oral squamous cell carcinoma Leukopakhia and oral squamous cell carcinoma
Image provided by Jonathan A. Ship, DMD.
Diagnosis
Biopsy?
Endoscopy to detect second primary tumor
RX thorax and CT of the brain and neck
Suspicious areas must be biopsied. Incisional biopsy or exfoliative cytology can be performed according to the surgeon's preference. To rule out other synchronous neoplasms, patients with oral cavity should be referred to direct laryngoscopy and anophagoscopy. The staging is usually completed by performing a CT scan of the cervico-cephalic district from a chest X-ray; however, as with other neoplasms, PET / CT is assuming an increasingly important role in the evaluation of patients with oral cavity cancer.
Prognosis
If the carcinoma of the tongue is localized (without lymph node involvement) the 5-year survival is> 75%. For localized oral floor carcinoma, 5-year survival is 75%. The presence of lymph node metastases reduces the survival rate by about half. The metastases first reach the regional lymph nodes and later the lungs.
For lesions of the lower lip the 5-year survival is 90% and the metastases are rare. The carcinoma of the upper lip tends to be more aggressive and metastatic.
Treatment
Surgery, post-operative radiation or chemoradiotherapy if necessary
For most oral cancers, surgery is the initial treatment of choice. Radiation or chemoradiotherapy is added after surgery if the disease is more advanced or has high-risk characteristics. (See also the report of the National Cancer Institute Lip and Oral Cavity Cancer Treatment.)
Selective laterocervical depletion is indicated if the risk of lymph node disease exceeds 15-20%. Although there is no consensus, neck dissections are usually performed for T2 tumors (staging of head and neck tumors) (maximum size 2 to 4 cm) and for most T1 lesions with a depth of invasion ≥ 4 mm.
Routine surgical reconstruction is the key to reducing postoperative oral disability; procedures vary from local fabric flaps to free tissue transfers. Phonatory and swallowing rehabilitation may be necessary after extensive resections.
Radiation therapy is an alternative treatment. Chemotherapy is not routinely used as primary therapy, but is recommended as adjuvant therapy in combination with radiation therapy for patients with extensive lymph node disease.
The treatment of squamous cell carcinoma of the lip is the surgical excision with reconstruction to restore post-operation functionality as much as possible. When large areas of the lip show precancerous transformation, the lesion site can be surgically removed or removed by laser. Mohs surgery can be used. Subsequently, the application of suitable sunscreens is recommended.
Key points
The main risk factors for oral squamous cell carcinoma are intense smoking and alcohol.
Oral cancer is sometimes asymptomatic in the initial stages; examination of the oral cavity (typically performed by specialists in the field) is useful for early diagnosis.
To exclude a primary synchronous cancer, perform a direct laryngoscopy and an esophagoscopy.
Once the diagnosis of cancer is confirmed, it is advisable to perform a CT scan of the neck and a chest X-ray, or a PET / CT scan.
Initial therapy is usually surgical
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