Malignant neoplasmsarising from mucosalsurface epitheliumexhibiting squamousdifferentiation ascharacterized by theformation of keratin
A 65 year old male reported to Ear, Nose and Throat (ENT)outpatient with painful ulcerative lesion of left lower twothird of the face. It started as a tiny lesion at leftnasomaxillary groove one year back. This graduallyincrease in size.On clinical examination,it was an ulceratedlesion of 5cm by 3 cm involving whole upper lip and rightangle of mouth.The lesion extended to involve lower half ofcollumella and adjacent zygomaxillary lesion.The marginswere irregular and the base was covered with purulentsecretion.After cleaning, debridement the whole lesion wasexcised.On histopathological examination it was diagnosedas SQUAMOUS CELL CARCINOMA. ( Journal of Pakistan Medical Association)
• EARLY DIAGNOSIS• TUMOUR SIZE• USUALLY ONLY ONE CHANCE TO CURE• RECURRENCE• COMPLEX• DEPENDS ON AGE, MEDICAL CONDITION,EXACT SIZE,DEGREE OF SPREAD AND HISTOLOGICAL TYPE.• CO-ORDINATED BY MULTIDISCIPLINARY TEAM
Identify the Type Spread Stage of carcinoma Evaluate co morbidity
• Clinical examination and imagingCLINICAL EXAMINATION: Palpation Clinical signs, such as nerve palsies, also indicate extent of spread.IMAGING:CT ScanMRIPET(includes neck and chest to identify and exclude lymphnode and blood borne metastasis.
• Biopsy of the carcinoma provide information on the degree of differentiation and the pattern of spread.
• Patients are heavy smokers or alcoholic• CVS , respiratory ,neurological or liver disease poses an anesthetic risk or compromise recovery from surgery.• Nutritional status should be assesed.• Patient’s psychological fitness.
• Preferred for small carcinoma’s of tongue• Those involving bones b/c of the risk of later radionecrosis and for verrucous carcinoma. AIM??????
• Neck ressection to remove the cervical lymph nodes along with the juglar chain from the base of skull to clavicle + submental +submandibular lymph nodes for prevention of relapse.
• Acceptable and functional result.• Discomfort and unwanted long term effects• External beam radiotherapy• Telotherapy• Brachytherapy
• Act by radiosensitisation as well their direct effect on cancer cells.• Carried out with radiotherapy for best effect.• Alkylating agent cisplastin + 5 fluorouracil• Neoadjuvant therapy = b /f surgery or radiotherapy• Adjuvant chemotherapy after, both reducing side effects.
• Advanced tumours and treatment failure• Radiotherapy• Surgery when large tumours comprises the airway or become grossly necrotic.