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24 Cards in this Set

  • Front
  • Back
What does a typical Oral SCC look like?
Irregular shape, mix of red and white, often ulcerated, exophytic or endophytic (growing our or in) growth pattern, firmer than surrounding tissues.
Is any pain associated with Oral SCC?
Early lesions are asymptomatic. Pain is a late feature.
Does an Oral SCC show anything on a radiograph?
Ragged radiolucency if bone involvement
Describe Oral SCC of the lip
One of the more common site of involvement, secondary to UV exposure.

Slow growing, well differentiated usually.

Relatively good prognosis
Describe Oral SCC of the tongue
Lateral tongue is most common site.

Majority of patients have hx of smoking and alcohol abuse.

Most common site in younger (<40) people
Describe Oral SCC in the FOM
Almost equal to lateral tongue as common site

Most patients have hx of cigarette smoking and alcohol abuse
Describe Oral SCC on the Gingiva/Alveolar mucosa
Unusual site for oral SCC

More common in women (2:1)

More common in patients with no identifiable risk factors for oral SCC
Describe Oral SCC on the Buccal Mucosa
Not a very common site
Describe Oral SCC on the Palate
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.
What are the Differential Dx for SCC?
- Non specific ulcer
- specific infection eg TB or syphilis
- immune mediated conditions eg Wegener's granulomatosis, Crohn's disease
Describe a radiograph showing SCC
Usually a late phenomenon as requires direct invasion of the bone.

Ragged, moth eaten radiolucency with ill defined borders.
Describe the histology of SCC
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)
Describe the Oral SCC Histological Malignancy Grading system by Anneroth and modified by Bryne
Score of 1 to 4 in four categories:
1. Keratinisation
2. Nuclear polymorphism
3. Pattern of invasion
4. Infiltration by lymphocytes and plasma cells

4-8 = low grade
9-12 = intermediate grade
13-16 = high grade
What is the significance of metastatic lymph nodes in oral SCC and where are they most common?
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
What is the TNM classification?
It grades and combines the extent of the primary tumour, involvement of lymph nodes and distant metastasis to provide prognosis to assess severity.
What is the tx of Oral SCC?
Depends on stage of disease:
-Wide radical surgical excision +/- neck dissection
-Radiation therapy
-Combination of both
What are the prognostic factors of intra-oral cancer?
Stage - TNM Clinical Classification
Histological Grade
Prognosis of SCC?
Generally poor because most patients present in Stage III or IV

50% 5 year survival - worst prognosis of any major cancer
Recurrence of SCC?
Periodic follow up is necessary post tx.

10-25% develop new upper aerodigestive tract malignancies, esp if carcinogenic habits continued.
What is Verrucous SCC?
Less agressive, relatively uncommon form of SCC that usually develops in elderly male patients.

Smokeless tobacco is often mentioned as a contributing factor.
How does Verrucous Carcinoma present?
Diffuse white or mixed red and white plaque.

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

Tends to grow laterally
What is the histology of Verrucous Carcinoma?
Often misdiagnosed by pathologists not familiar with it due to bland features. Dx usually based on architecture of tumour, not appearance of individual cells
Tx for Verrucous Carincoma?
Surgical excision.

Radiotherapy discouraged due to sporadic reports of Verrucous Carcinoma tranforming to more aggressive SCC
Do Verrucous Carcinoma become SCC?
20-25% of completed excised VC show foci of transformation to routine SCC