Bdent 3 Pathology: Oral Cancer 3

Front 1

What does a typical Oral SCC look like?

Back 1

Irregular shape, mix of red and white, often ulcerated, exophytic or endophytic (growing our or in) growth pattern, firmer than surrounding tissues.

Front 2

Is any pain associated with Oral SCC?

Back 2

Early lesions are asymptomatic. Pain is a late feature.

Front 3

Does an Oral SCC show anything on a radiograph?

Back 3

Ragged radiolucency if bone involvement

Front 4

Describe Oral SCC of the lip

Back 4

One of the more common site of involvement, secondary to UV exposure.

Slow growing, well differentiated usually.

Relatively good prognosis

Front 5

Describe Oral SCC of the tongue

Back 5

Lateral tongue is most common site.

Majority of patients have hx of smoking and alcohol abuse.

Most common site in younger (<40) people

Front 6

Describe Oral SCC in the FOM

Back 6

Almost equal to lateral tongue as common site

Most patients have hx of cigarette smoking and alcohol abuse

Front 7

Describe Oral SCC on the Gingiva/Alveolar mucosa

Back 7

Unusual site for oral SCC

More common in women (2:1)

More common in patients with no identifiable risk factors for oral SCC

Front 8

Describe Oral SCC on the Buccal Mucosa

Back 8

Not a very common site

Front 9

Describe Oral SCC on the Palate

Back 9

Most SCC affecting the palate are on the lateral soft palate. Rare on the hard palate.

May be difficult to determine whether the lesion originated in the Maxillary sinus and invaded through the floor.

Front 10

What are the Differential Dx for SCC?

Back 10

- Non specific ulcer
- specific infection eg TB or syphilis
- immune mediated conditions eg Wegener's granulomatosis, Crohn's disease

Front 11

Describe a radiograph showing SCC

Back 11

Usually a late phenomenon as requires direct invasion of the bone.

Ragged, moth eaten radiolucency with ill defined borders.

Front 12

Describe the histology of SCC

Back 12

Invasive cords and nest of malignant squamous epithelial cells arise from dysplastic surface epthelium.

Tumour cells show increased nuclear/cytoplasmic raion, cellular and nuclear pleomorphism, and mitotic activity.

Varying degrees of keratin (high or low)

Front 13

Describe the Oral SCC Histological Malignancy Grading system by Anneroth and modified by Bryne

Back 13

Score of 1 to 4 in four categories:
1. Keratinisation
2. Nuclear polymorphism
3. Pattern of invasion
4. Infiltration by lymphocytes and plasma cells

Scores:
4-8 = low grade
9-12 = intermediate grade
13-16 = high grade

Front 14

What is the significance of metastatic lymph nodes in oral SCC and where are they most common?

Back 14

Presence of a metastatic lymph node decreases chance of cure by 50%.

61% are submandibular
57% below angle of mandible
44% mid SCM
20% lower SCM
4% posterior triangle

Front 15

What is the TNM classification?

Back 15

It grades and combines the extent of the primary tumour, involvement of lymph nodes and distant metastasis to provide prognosis to assess severity.

Front 16

What is the tx of Oral SCC?

Back 16

Depends on stage of disease:
-Wide radical surgical excision +/- neck dissection
-Radiation therapy
-Combination of both
-Chemotherapy

Front 17

What are the prognostic factors of intra-oral cancer?

Back 17

Site
Stage - TNM Clinical Classification
Histological Grade

Front 18

Prognosis of SCC?

Back 18

Generally poor because most patients present in Stage III or IV

50% 5 year survival - worst prognosis of any major cancer

Front 19

Recurrence of SCC?

Back 19

Periodic follow up is necessary post tx.

10-25% develop new upper aerodigestive tract malignancies, esp if carcinogenic habits continued.

Front 20

What is Verrucous SCC?

Back 20

Less agressive, relatively uncommon form of SCC that usually develops in elderly male patients.

Smokeless tobacco is often mentioned as a contributing factor.

Front 21

How does Verrucous Carcinoma present?

Back 21

Diffuse white or mixed red and white plaque.

Alveolar mucosa, hard palate and buccal mucosa most frequent sites.

Tends to grow laterally

Front 22

What is the histology of Verrucous Carcinoma?

Back 22

Often misdiagnosed by pathologists not familiar with it due to bland features. Dx usually based on architecture of tumour, not appearance of individual cells

Front 23

Tx for Verrucous Carincoma?

Back 23

Surgical excision.

Radiotherapy discouraged due to sporadic reports of Verrucous Carcinoma tranforming to more aggressive SCC

Front 24

Do Verrucous Carcinoma become SCC?

Back 24

20-25% of completed excised VC show foci of transformation to routine SCC