This document discusses oral squamous cell carcinoma, including its definition, risk factors, signs and symptoms, diagnosis, treatment, and prevention. Key points: - It is a malignant neoplasm of the oral cavity epithelium capable of local growth and metastasis. Major risk factors include tobacco use, alcohol consumption, and HPV infection. - Common symptoms are non-healing sores, lumps, pain or difficulty swallowing. Diagnosis involves biopsy and imaging tests. Treatment options are surgery, radiation, chemotherapy and rehabilitation. - Prevention focuses on reducing risk factors through health education and discouraging behaviors like smoking, as well as early detection through screening to find cancer at earlier, more treatable stages.

1. Preethi Agnes.R
B.D.S 2012 Batch

2.  It
is a Malignant neoplasm of stratified
squamous epithelium in the oral cavity
 capable of local destructive growth and
distant metastasis

5.  Possible
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




sites
lower lip
tongue
floor of the mouth
soft palate
gingival / alveolar ridge
buccal mucosa

6. Incidence
lower lip
tonguefloor of
mouth
soft palate
gingiva
buccal mucosa

7. The etiology is unknown. But a
number of etiological factors have been
implicated.
Strong Association:
•
Tobacco smoking and chewing
•
Chronic alcohol consumption
•
Human papilloma virus infection

9.  Major
source of intra-oral carcinogen.
 All forms of tobacco consumption have been
linked.
 South east Asia: bethel quid– North Africa
and Middle East: a mixture of Tobacco and
lime water or oil called naswar or nash
 It could be held in the mouth
 Smoked in crude cigars or factory made
cigarettes
 Carcinogens in tobacco: Nitrosamine
(nicotine), the polycyclic aromatic
hydrocarbons (3,4-benzopyrene)

10. 2nd major risk factor
 Associated with cancer of the floor of the mouth
and tongue.
 Excess consumption of EVERY TYPE of
alcohol(including “hard” liquor, wine, and Beer)
raises the risk status of oral cancer
 Potentiates the effects of tobacco
 Mechanism(s)

Dehydrating effects of alcohol on the mucosa
 increasing mucosal permeability,
 Irritation of mucosa
 and it also acts as a solvent for
carcinogens(especially those in tobacco)


12. Weak association:

Chronic irritation from ill-fitting denture

Sub mucosal fibrosis

Poor orodental hygiene

Nutritional deficiencies

Exposure to sunlight(lip cancer)

Plummer –Vinson syndrome

13.  NEOPLASIA:The
process of transformation
from a normal cell to a cancerous one.
 An
abnormality of cell growth and
multiplication characterised by:

At cellular level




Excessive cellular proliferation
Uncoordinated growth
Tissue infiltration
At molecular level

Disorder of growth regulatory genes

14. NEOPLASTIC (malignant) CELLS
Increase
in growth
factors
Increase
in growth
factor
receptors
Increase in
signal
transduction
- Disturbed processes of mitosis and protein synthesis
Increase in
activation of
transcription

15. 
Continuous reproduction

Formation of abnormal proteins

ANAPLASIA:





loss of normal cell function (abnormal DNA transcription)
proliferation
movement of cells
Caused by altered DNA and altered
invasion of nearby tissue
cellular programs which make new
metastasis
signals

16.  two

Monoclonal


general types
initial neoplastic change affects a single cell
Field origin

carcinogen acts on large number of cells producing
field of potentially neoplastic cells

17. growth factors
 receptors
 signal-relay or
transduction factors
ras - colon cancer
myc - lymphoma
bcr-abl - chronic
myelogenous leukemia
(Philladelphia chromosome)


18. - code for factors that down-
regulate the cell cycle, promote
differentiation and supress
oncogenes from causing cancer
Rb-1 – retinoblastoma gene
p53

19. NEOPLASIA  proto-oncogene is activated or
tumor suppressor gene is inactivated
normal growth  oncogenesis
Activation of proto-oncogene:
point mutation
translocation
gene amplification
Also - Failure of Immune Surveillance theory :
immune system responds to neoantigens as to foreign
antigens, but neoplastic cells escape recognition and
destruction --> become clinical cancers

20. 


Transmission of some forms of cancer from parents to
offspring through defects in the DNA of the egg or sperm cells
E.g.  Retinoblastoma – tumor of the retina of the eye
Polyposis coli syndrome – polyps that grow in the
colon and
rectum
Other colon, breast and kidney cancers
Cause: loss of a segment of DNA or a change in the coding
sequence of DNA


Detection – DNA sequencing, DNA probes
In many cases – abnormalities in tumor suppressor genes

22. A sore in the mouth that does not heal (most
common symptom)
 Pain in the mouth
 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


23. 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


24. 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.

25.  Increased
mitotic activity
 Well differentiated
 Keratin pearls (abnormal keratinization)
 Hyperchromatic nuclei
 Pleomorphism
 Epithelium islands
 Connective tissue stroma with chronic
inflammation (histiocytes, lymphocytes, etc.)

26. Keratinized
cells
Mitotic
figures
Inflamed
connective
tissue
stroma

27. 
Primary:
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
Photographs
Incisional biopsy
Fine needle aspiration biopsy
Orthopantogram
Mucosal staining
CXR
chemiluminescent light
Routine blood investigations
For staging

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MRI
CT face + neck ± CT chest
USG of neck or primary ± USG guided FNAC of suspicious
lymphadenopathy
PET
Endoscopy

29. 
Surgery
 Removal
 Removal
of part or all of the jaw
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

30. 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.


31. 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 (reduction in blood vessels
and blood supply.
 Affect other forms of dental disease (caries, or
soft tissue complications),
 Cause bone death (osteonecrosis).


32.  Rehabilitation
of patient after surgery could
be either surgical reconstruction, prosthetic
reconstruction or both
 This is aimed at restoring esthetics, function
and speech.
 All patients must be placed on life-long
review of about 6monthly intervals during
which risk factors should be continually
assessed.

35. 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
 Use of hat in sunlight for farmers
 Wearing of facemasks for factory workers involved
with chemicals and metals
 Health education

36.  SECONDARY:
aimed at detection of cancer
atan early stage.
 Early detection, especially at the
precancerous stage, offers a better prognosis
with a better chance of cure.
 Public
education on early signs and selfexamination
 Screening
 TERTIARY:
Treat late stage of disease and
complications