Oral cavity
Squamous cell carcinoma
General

Author: Nat Pernick, M.D. (see Authors page)

Revised: 24 April 2018, last major update November 2013

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Oral cavity squamous cell carcinoma[TI]

Cite this page: Pernick, N. Squamous cell carcinoma - general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/oralcavityscc.html. Accessed July 19th, 2018.
Definition / general
  • 95% of oral cavity cancers are squamous cell carcinoma
  • Usually ages 50 - 70 years, 90% men
  • Represent 4% of malignant tumors in men and 2% in women; 30,000 new cases annually in U.S. with 8,000 subsequent deaths
  • Recent trends show reduction overall in oral cancer deaths but increase in black men, black women and women overall
Risk factors
  • Alcohol, tobacco (RR: tobacco 2 - 4x, alcohol 2 - 6x, tobacco and alcohol 15x), chewing tobacco, marijuana, betel nuts and pan (India)
  • Also syphilis, oral sepsis, iron deficiency, oral candidiasis and Fanconi anemia
  • HPV 6, 16 or 18 detected in 50% of Waldeyer tonsillar ring carcinomas versus 10% of other oral carcinomas
  • EBV detected in most tumor cells in all oral cancers (Hum Pathol 2002;33:608)
  • Fruit and vegetable consumption significantly reduces risk
Clinical features
  • Sites: floor of mouth, tongue, hard palate, base of tongue (areas constantly bathed in saliva and with thin nonkeratinized squamous epithelium)
  • Spreads locally, metastases to lung; also liver, bone, mediastinum
  • Tumors of hard palate and alveolar ridge: low metastatic risk, metastasizes to buccinator, submandibular, jugular and occasionally retropharyngeal nodes
  • Tumors of other sites: metastasize to submandibular and jugular nodes, rarely to posterior triangle / supraclavicular nodes; metastases may have melanocyte colonization (Hum Pathol 1983;14:373)
  • Bilateral cervical metastases more likely if primary is closer to midline
  • Site of nodal involvement is usually predictable (unless surgery or radiation was given), spreading to upper, then middle, then lower cervical nodes, although anterior oral cavity may spread directly to middle cervical nodes
  • 50% are fatal
  • Multiple primaries: present in 27% (probably due to field effect of local acting carcinogens); to be considered multiple must be intervening nonneoplastic mucosa or there must be proof that the second tumor has an in situ mucosal origin
Karnofsky scale
Measures performance status:
  • 100: normal, no complaints, no evidence of disease
  • 90: able to carry on normal activity, minor signs or symptoms of disease
  • 80: able to carry on normal activity with effort, some signs or symptoms of disease
  • 70: cares for self; unable to carry on normal activity or do active work
  • 60: requires occasional assistance but is able to care for most of own needs
  • 50: requires considerable assistance and frequent medical care
  • 40: disabled; requires special care and assistance
  • 0: patient dead
Poor prognostic factors
  • Low Karnofsky scale, either noncohesive, irregular, jagged small cords or infiltrative pattern of invasion or widespread single cells
Treatment
  • Surgery, radiation therapy
  • 5 year disease free survival: in patients 40 years or less, survival rate is 76%
Gross description
  • Leukoplakia, then masses with necrosis, ulcers and rolled borders
  • Induration is relatively specific for invasion
Microscopic (histologic) description
  • May have verrucoid growth pattern but moderate / marked atypia at base, irregular and infiltrative stromal invasion
Positive stains
Negative stains