Squamous cell carcinoma

          Squamous cell carcinoma

         Definition

                A malignant neoplasm of squamous epithelium.

                It constitutes 95% of oral cancers.

         Etiology

             1.  Tobacco  and  alcohol  are  the  most  common associations  (Tobacco   chewing   or

                 smoking).

             2.   Leukoplakia and Erythroplakia.

             3.  Oncogenic viruses as, Human papilloma virus, Herpes simplex virus, Epstein –Barr  virus.

             4.  Candidal infection.

             5.  Syphilis.

             6.  Genetic factors.

             7.  Exposure to ultra-violet light (cancer of the lip), or exposure to x-ray.

             8.  Iron deficiency and vitamin deficiency ( A and B).

          Clinical Features

              Site:

                    a)  Lip

                    b)  Tongue

                    c)  Floor of the mouth

                    d)  Gingiva

                    e)  Buccal mucosa

                    f)  Palate

                 Ages & sex : old Men (50-60 years).

              Symptoms: usually asymptomatic, but pain may occur with deep invasion.

              Shape: oral squamous cell carcinoma  of  any site has a varied clinical presentation and can arise                   as:

                        1.  Exophytic mass:

                            -Papillary or virrocous, indurated mass (feel hard on palpation),

                            -The   color   vary   from   normal   to   red   to   white   (depending on amount of

                            keratinization or vascularity).

                        2.  Endophytic growth:

                             - Non-healing ulcer.

                             - Has raised rolled, everted margin,indurated base and  necrotic floor.

                       3.   Leukoplakic (white patch).

                        4.  Erythroplakic (red patch).

                        5.  Erythro-Leukoplakic.

                         a.   Squamous cell carcinoma of lip

           Mostly on the lower lip (exposed to ultraviolet radiation).

           Common at the site where the patient hold pipe,cigar or cigarette, due to

               combustion end products of tobacco.

           Metastasis is late to submental lymph node.

           Has a favorable prognosis (as it is visible).

                         b.   Squamous cell carcinoma of the tongue

             Account for more than 50% of oral cancer (most common intraoral site).

             Mostly found on the posterior lateral border of the tongue.

             In advanced lesions with invasion of the surrounding tissue,there is:

                 -   Immobility of the tongue.

                 -   Altered speech.

                 -   Difficulty in swallowing (dysphagia).

             Metastasis is early to the submandibular and deep cervical lymph nodes.

             Has poor prognosis as it is difficult to visualize and tongue is rich in lymphatic

               vessels.