Oral squamous cell carcinoma
Overview
A type of cancer that develops in the mucosal lining (epithelium) of the mouth and can affect lips, tongue, palate and tonsillar area, floor of the mouth. This cancer type tends to progress further into pharynx and invade tissues nearby.
Source: National Cancer Institute, Merck Manuals
Symptoms
Initial onset of oral lesions are asymptomatic. Further disease progression may result in:
- Persistent sore in mouth
- Pale oral lesion
- Ulcerated oral lesion
- Sore throat
- Swollen throat
Most dental professionals carefully examine the oral cavity and oropharynx during routine care and may do a brush biopsy of abnormal areas. The lesions may appear as areas of erythroplakia or leukoplakia and may be exophytic or ulcerated. Cancers are often indurated and firm with a rolled border.
Abnormal swelling and persistant sore throat, accompanied with pain radiating into ears, might be indications for tonsillar carcinoma. A metastatic mass in the neck may be the first symptom, particularly in tonsillar cancer.
Source: Merck Manuals
Causes
Risk factors that can increase your predisposition to this cancer include:
- Smoking and other use of tobacco
- Alcohol abuse
- Drinking mate
- Infection with human papillomavirus (HPV).
Source: National Cancer Institute, Merck Manuals
Prevention
Avoid risk factors, including heavy smoking and alcohol consumption. The combination of heavy smoking and alcohol abuse is estimated to raise the risk 100-fold in women and 38-fold in men.
Source: Merck Manuals
Diagnosis
- Biopsy
- Endoscopy: direct laryngoscopy, bronchoscopy, and esophagoscopy are done to exclude a simultaneous second primary cancer
- Chest x-ray is done if an advanced stage is suspected or confirmed
- CT of head and neck
Prognosis
If carcinoma of the tongue is localized (no lymph node involvement), 5-yr survival is > 50%. For localized carcinoma of the floor of the mouth, 5-yr survival is 65%. Lymph node metastasis decreases survival rate by about 50%. Metastases reach the regional lymph nodes first and later the lungs.
For lower lip lesions, 5-yr survival is 90%, and metastases are rare. Carcinoma of the upper lip tends to be more aggressive and metastatic. For carcinoma of the palate and tonsillar area, 5-yr survival is 68% if patients are treated before lymph node involvement but only 17% after involvement. The prognosis for tonsillar carcinoma is often better stage for stage than that for oral cancers. Oropharyngeal cancer associated with HPV infection may have a better prognosis.
Source: Merck Manuals
Treatment
Surgery and radiation therapy are the most common treatments.
At early-stage of tongue leasions, surgery is usually recommended. Routine surgical reconstruction is the key to reducing postoperative oral disabilities; procedures range from local tissue flaps to free tissue transfers. Speech and swallowing therapy may be required after significant resections.
Chemotherapy can be recommended on an individual basis.
In some cases, like tonsillar carcinoma, treatment usually includes a combination of concomitant chemotherapy and radiation therapy. Another option includes radical resection of the tonsillar fossa, sometimes with partial mandibulectomy and neck dissection.
Source: Merck Manuals