Oral Squamous Cell Carcinoma (OSCC)

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

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Oral squamous

It is a malignant neoplasm of stratified squamous

lower lip 30-40%

The etiology is unknown. But a number of etiological

Human papilloma virus infection

Major source of intraoral carcinogen.

Second major risk factor

Dehydrating effects of alcohol on the mucosa

The first group, called proto-oncogenes, produces protein

Proto-oncogene is activated or tumor suppressor gene is

Cytogenetic analysis of these carcinomas has

Carcinoma in situ (CIS), also known as

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

Difficulty chewing or swallowing

Increased mitotic activity

Grossly, squamous cell carcinoma of oral cavity

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

TNM Clinical Staging

TNM Clinical Staging

Mucositis: an inflammation of the mucous membranes in the

A diffused, largely exophytic, superficial spreading,

Most common sites involved

Surface is usually papillary and is covered by thick layer

Prevention involves interventions aimed at eliminating,

SECONDARY: Aimed at detection of cancer atan early stage.

TERTIARY: Treat late stage of disease and complications

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