Oral Squamous Cell Carcinoma

Aka: Oral Squamous Cell Carcinoma, Squamous Cell Carcinoma of the Oral Cavity, Oral Cancer, Oral Malignancy, Oropharyngeal Carcinoma

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II. Epidemiology

  1. Squamous Cell Carcinoma represents 90% of oral cavity tumors
    1. Of new head and neck cancers, 70% are HPV-related oropharyngeal Squamous Cell Carcinoma
    2. HPV-related oropharyngeal SCC is the most common HPV-related cancer (34,000 cases/year in U.S.)
  2. Incidence increases with age
  3. Oral Cancer is 9th most common cancer
    1. Represents 3% of cancers in men
    2. Represents 2% of cancers in women

III. Risk Factors: Human Papilloma virus (70% of head and neck cancers)

  1. See Human Papilloma virus
  2. White race
  3. Male gender
  4. Multiple sexual partners
  5. Orogenital sex
  6. Age 35-55 years old

IV. Risk Factors: Non-HPV Related Head and Neck Cancers

  1. Tobacco Abuse confers 6 fold risk
    1. Smokers represent 90% of Oral Cancer patients
  2. Alcohol Abuse or heavy use
  3. Combined risk of heavy Alcohol and Tobacco use
    1. Women: 100 fold risk of Oral Cancer
    2. Men: 38 fold risk of Oral Cancer
    3. Blot (1988) Cancer Res 48:3282-7 [PubMed]
  4. Other risks
    1. Other Viral Infections (HSV)
    2. Sunlight exposure
    3. Poor Dentition

V. Symptoms

  1. Halitosis
  2. Painless non-healing Oral Ulcer
  3. Trismus may be present with deep invasion
  4. Head or Neck Mass
  5. Dysarthria or Hoarseness
  6. Dysphagia
  7. Globus Sensation
  8. Oropharyngeal Paresthesias

VI. Signs

  1. Early changes
    1. Erythroplakia
    2. Leukoplakia
    3. Spotted Leukoplakia
  2. Distribution (perform complete Oral Examination)
    1. Lateral Tongue
    2. Floor of mouth
    3. Lower vermilion lip border
    4. Alveolar ridge
  3. Later Changes
    1. Oral Ulcer with raised borders
  4. Spread to submandibular and cervical Lymph Nodes
    1. See Lymphadenopathy of the Head and Neck
    2. Firm, fixed or matted Lymph Nodes
    3. HPV related SCC results in cystic Neck Masses with rapidly expanding Lymph Nodes
      1. May present with Dysphagia, Dysarthria, Hemoptysis

VII. Differential Diagnosis

  1. See Neck Masses in Adults
  2. See Causes of Neck Mass in Adults
  3. See Lymphadenopathy of the Head and Neck
  4. Cystic Neck Masses in age >40 years old are malignant in 80%

VIII. Associated Conditions

  1. Adjacent cancer in Larynx, Esophagus, lungs in 15% cases

IX. Management

  1. Surgical excision
  2. Radiation Therapy

X. Prognosis

  1. Oral Cancers are advanced by diagnosis in 60% of cases
  2. Five year survival: 50-55%

XI. Prevention

  1. Tobacco Cessation
  2. Alcohol cessation

XII. References

  1. Diaz in Noble (2001) Primary Care Medicine, p. 1757
  2. Alvi (1996) Postgrad Med 99(4):149-56 [PubMed]
  3. Weinberg (2002) Am Fam Physician 65(7):1379-86 [PubMed]

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